Ali Wong's new Netflix special is full of so-true-they're-hilarious analogies about breastfeeding and motherhood. She calls her breasts the Bellagio Fountains, says a clogged duct is like "a kidney stone in your titty," and compares learning how to breastfeed to parallel-parking a car. At one point, she talks about how "breastfeeding is not free," and tells a story about having to hire a lactation consultant to help her unclog a duct.
"A lactation consultant is a white NPR-listener with dreadlocks named Indigo, that you have to pay $200 to rush over to your house and Roto-Rooter your titty," Wong says. Obviously, this description is part of a joke, but it conjures a very specific image of a middle-aged hippie woman with overpriced services based on pseudo-science and Goop. People on Twitter loved it, and one person said the description "spoke directly to my soul." But of course, not all lactation consultants are like this.
A lactation consultant is a healthcare professional who specializes in the practical and medical aspects of breastfeeding, according to the International Lactation Consultant Association. While an OB/Gyn helps a new parent start breastfeeding in the hospital and at postpartum visits, a lactation consultant's role is to navigate issues that they may face at any stage in the breastfeeding process, according to the American College of Obstetrics and Gynecology. Like milk production, latching, painful breasts, and as Wong says, helping someone with a clogged duct.
Not just anyone can slap on the title of "lactation consultant." Lactation consultants have a unique skillset that's specific to breastfeeding, so they can help coach the breastfeeding person and educate families about breastfeeding, and this requires specialized training that's kind of intense. In order to become a professional board-certified lactation consultant, you need to already be a recognized health professional (like a registered nurse, physician, or nurse midwife), or have completed college-level health science courses, according to the United States Lactation Consultant Association (USLCA). Then, you take 90 hours of lactation-specific courses, complete between 300-1000 clinical practice hours, and take an exam.
There are a few different "tiers" of lactation consultant certifications, and their scope of practice varies. The most advanced one is an international board certified lactation consultant (IBCLC), who provides professional, evidence-based services in a clinical setting. Then, a certified lactation counselor (CLC) can educate and guide families on basic breastfeeding issues (like latching). And then a peer counselor is someone who speaks from personal breastfeeding experience and provides encouragement.
For lots of parents, breastfeeding is an incredibly difficult process, that can come with lots of emotional and logistical road bumps. So, as you can imagine, lactation consultants can offer valuable resources for a new parent trying to troubleshoot breastfeeding complications. The question is, how much do they cost? Under the Affordable Care Act, hospitals in the United States are required to offer breastfeeding support to new parents during their hospital stay, and that includes a lactation consultant's services. And most insurance companies also have lactation consultants you can see under your health insurance plan. But there are plenty of lactation consultants who operate privately and are cash-only. Those are probably the ones who charge $200 for their services and also make house calls, like Wong says.
The important thing to keep in mind is that not everyone has access to a lactation consultant, because there just aren't enough resources in every state. Every two years, the Centers for Disease Control puts out a "report card" that evaluates the number of people who are breastfeeding, and the progress we've made as a country in terms of access to breastfeeding support. From 2006 to 2013, the number of IBCLCs increased from 2.1 to 3.5 per 1,000 live births, which is great. But in 11 states, there are fewer than three IBCLCs and fewer than 3 CLCs per 1,000 live births.
Maternal healthcare is no joke, but it's great that people like Wong can find ways to talk about these less-glamorous aspects of motherhood in a funny way. While Wong's bit doesn't paint the full picture of what lactation consultants do, like all comedy, it has a hint of truth in it about how damn hard breastfeeding can really be.