A visit from an International Board Certified Lactation Consultant, or IBCLC, can and will look different for each breastfeeding mother-baby dyad. Depending on the current, or past, issues the focus may be on the baby or the mother, or we may be working with both.

Here is a list of things that happen at visits with me:

  • I will listen to your concerns
  • I will take a current medical history for both mother & baby
  • I will ask about your social history (diet, any drugs of abuse, alcohol, exercise, etc.)
  • I will ask about your birth story (interventions or medical concerns that occurred during birth)
  • I will ask about your current feeding history (including frequency, diaper counts, and any supplementation)
  • We will assess your baby’s weight, a weighted feed is often done, but not always
  • I will observe an entire feeding, specifically looking at:
    • latch
    • positioning
    • evaluation of transfer
    • evaluation of nipples after feeding
  • I will look at your baby from head to toe (structural assessment)
  • I will perform a functional oral assessment of your baby
  • If needed, I will palpate and assess your breasts
  • Next we will review, and I will ask any clarifying questions if needed
  • Finally, we will make a plan that works for you and your situation

Most of our time will be spent talking and I will work to educate you (and any present family member or support people) about whatever comes up. Typically while your baby is eating we can address any additional concerns about sleep (including sleep arrangements), dietary questions, pumping, returning to work, even partner intimacy and breastfeeding. I am not shy and will happily address any and all concerns I can in the time of our visit.
After we finish getting the big picture, I will explain what I see and what my recommended plan of action is to meet your feeding goals. I want you to succeed and will do my best to ensure that nothing I recommend feels like “too much” or is overwhelming. We will make the final plan together.

I also don’t want your baby to feel overwhelmed, so here is what it looks like when I do an oral exam on an older baby. This process is similar for a newborn.

How can you prepare for a visit?

  • Schedule a time when you baby is most likely going to be hungry. Observing a normal feed is important for me to make the best recommendations possible.
  • Have a change of clothes for your baby and diapers, as needed
    • And change of clothes for yourself if you think you might need it
  • If you are supplementing, have either pumped breastmilk or infant formula available
  • Have a log of diaper counts and feeding frequency available, I know you are sleep deprived, either a written log or an app is great for this.
  • If you have concerns about pumping, have your pump available for me to troubleshoot and assess
  • A list of questions that you want me to address
    • Don’t worry if you forget something, you can always email me!

Photos in the post were taken by the amazing Melissa Baker at Simple Still Photography.

If you think a visit with me would help you and your baby meet your breastfeeding goals, you can book online below!

Dear Labor & Delivery Nurse,

Thank you for supporting my birth doula client with me through transition, your words were supportive and kind. You honored my client and her innate ability to trust her body. You spoke softly and gently, you gave words of encouragement and affirmations. I could see how supported my client felt. It gave me a renewed faith in your hospital.

After about 20min of my client basking in the glow of her newborn, something changed in you. Your hospital was recently designated as Baby Friendly, which as both a doula and International Board Certified Lactation Consultant, I applaud the systematic change that took! You and your hospital see the value of ensuring breastfeeding starts within the golden hour after birth. What I didn’t expect for you to do was suddenly and forcefully decide it was time for my client’s baby to latch. You came over and said, “it has been about 20min, I think we should get her to latch.” You raised the bed nearly upright and then you took my clients fresh pink and healthy newborn and began forcibly shoving her face to my client’s breast. Her baby then started fussing and was not happy, and you said “don’t worry, we’ll get her on.” I stood there, next to my client watching you and wondering what on earth was going on. After a minute or so I calmly suggested we try repositioning.  I changed the angle of the bed to allow my client to lean back more, I then talked my client through moving her baby over a bit so when baby came to breast her airway would be nice and open. I guided my client, with my words, on how to move her opposite arm across her baby’s back to support her head and neck. I explained how to use her other hand to hold and support her breast. Then without a fuss, her baby latched on for the first time. I did not physically assist at all. It was beautiful and my client was glowing with pride. This only took a few minutes. I did not rush, I was not concerned.

Newborn baby breastfeeding

After a minute or so of a beautiful latch, on IBCLC Day no less, my client’s husband thanked me to being there and helping be sure breastfeeding got off to a great start. Maybe you didn’t know how hard breastfeeding was for their first baby? Maybe you didn’t know how medicalized and disempowered my client felt postpartum with her first child, as she was diagnosed with postpartum preeclampsia within minutes after birth? Maybe you didn’t know how important this postpartum time was to her? I did. I knew she could do it. I knew she wanted to do it. I continued to believe in my client and her ability to mother and latch her baby on her own, just as I had known she could birth without pain medication.

Our actions are powerful and a women who is still in the beautiful mind space of the golden hour does not need to be forced, she can be guided and, more importantly,  empowered. I encourage you to take all the wonderful knowledge you received in the course of your facility’s Baby Friendly designation, and find ways to continue to honor the journey of motherhood. Just because you know how to do something, doesn’t mean you should. Find those words of empowerment you gave in labor and apply them to the immediate postpartum. Take a moment to use your words to guide the mother through the first latch. It may take some practice, but that is okay. Empowering a mother to latch her baby for the first time on her own is hugely powerful! You will imprint on her that she can do it, and that she can do it without physical help! Observe and commentate on the latch. Explain what you see and let her know! If adjustments need to be made try to talk her through them first. I promise this does not take a lot of time. I know your time is rushed and you have so many things to do and other patients, but I am telling you, taking this extra moment will save you time and empower your patients. You want to be remembered for giving the gift of empowerment, not for being the one that did it for them.

Sincerely,

An empowering doula and IBCLC

The us versus them of IBCLCs and CLCs has been going on for years. I admit that I felt the same way many IBCLCs do about CLCs too. It is hard to see someone take a one week course and see themselves as equal, but I also don’t feel that is how most CLCs are. All lactation care providers have been continuously undervalued in healthcare and not given credit for their expertise. Not all breastfeeding dyads need the level of care an IBCLC can and does provide though. Many families simply need encouragement and education about the normal course of breastfeeding, including normal newborn behavior, which CLCs are well equipped to provide and should be providing. Even minor corrections in positioning and latch are well within the scope of a CLC. After careful consideration, and heated conversations (thank you to my friend and ally Lissa for challenging me to look at this issue through a health equity lens), I believe that the biggest issue in the minds of many IBCLCs is that there is no current place for CLCs in our healthcare system in regard to the currently used Current Procedural Terminology (CPT) codes and billing. I believe CLCs do have a place in our healthcare system, and I believe I have a solution.

CLCs are counselors, they are well equipped for counseling and should be reimbursed. CLCs know normal and know to refer when things are not normal. As IBCLCs we should embrace this and network with our community CLCs and support them.

The rest of this discussion gets in to some of the nitty gritty of billing and coding, which while not fun is part of this solution. So try to stay with me! I know when I starting looking at all of these codes and terms when I first started I felt like my head was going to explode!

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