When Breastfeeding Gets Hard, Lactation Consultants Can Help

Photographed by Krystal Neuvill.
Four out of five babies born in 2015 started out being breastfed. But by the time they were six months old, that number had dropped to under 58%, reports the Centers for Disease Control and Prevention.
While there are benefits to breastfeeding, there's nothing wrong with making a choice to stop if you find that it doesn't work for you or your family at any point. That said, it's likely that at least some of the parents who gave it up between their child's first days on Earth and their sixth month wanted to keep going — but hit a roadblock along the way. And that's something a lactation consultant possibly could have helped with.
"Even though breastfeeding is natural, that doesn't mean it's automatic," says Linda Dahl, MD, founder of the Dahl Otolaryngology Center in New York City and author of the Clinical Guide to Breastfeeding. "It's not something that you'll just know how to do. You might, but getting help and getting guidance for it, for some moms, is absolutely essential."
Dr. Dahl knows what she's talking about. Seventeen years ago, she had trouble breastfeeding her own newborn. "I experienced first-hand what mothers go through. Sadly it's really not that different 17 years later," she tells Refinery29. "There's literally nothing in Western medicine about breastfeeding," she explains. "No matter which residency you go through, you maybe get a lecture on breastfeeding. And it's not even about breastfeeding, it's about breast milk and how it's made."
Today, Dr. Dahl helps infants with breastfeeding issues — in part by working closely with lactation consultants, whose job it is to offer guidance to parents who need it. This guide offers up everything you need to know about the practice, and how to figure out whether it's the right fit for you.

What is a lactation consultant, exactly?

A lactation consultant helps you with breastfeeding. You can call one for just about any related issue: if you're having persistent pain while breastfeeding, if you're experiencing latching issues, if you feel your baby isn't getting enough milk, or if you worry they're nursing for too long.
Tip: Look for a consultant who has an IBCLC, or International Board Certified Lactation Consultant, certification, suggests Sarah Eichler, IBCLC, LCCE, a lactation consultant based in Brooklyn, NY. "To become an IBCLC, you need to get clinical hands-on practice," she says. "You can do it with a mentor, which is what I did. Then you have to have a minimum of 500 clinical hours." You can also get a bachelor's degree in human lactation, she says, but in the U.S., there aren't many programs available. There's another route available for nurses and doctors who wish to become certified lactation consultants, Eichler adds.
There are other certifications a lactation consultant could have, such as Certified Breastfeeding Counselor or Certified Lactation Counselor — but IBCLC is the gold standard.
To find a consultant, start with your pediatrician; they might have one working in their office. If not, ask your healthcare provider for recommendations.

What can I expect at a lactation consultant appointment?

Here's what Eichler's appointments look like: After reviewing your medical history, she will ask you to nurse your baby on each breast. She'll assess the baby to make sure they're latching properly and nursing comfortably, and weigh the baby before and after feeding to determine how much they're eating. Eichler might show you different nursing positions, and you'll have a chance to bring up any concerns you have. You can ask about how to pump or store breastmilk, for instance, or if a certain sensation is normal, or about supplementing with formula. Expect an appointment to last one or two hours.
Follow-up appointments are often not necessary, but they're available if more help is needed. You might have a second appointment if your baby isn't gaining weight, if you're trying to switch from the bottle back to the breast, or if you're having issues with milk supply, Eichler says.

Can I see a lactation consultant during the pandemic?

Yes. Some are still offering in-person appointments. But these days, there are plenty of lactation consultants who offer virtual options too. Andrea Syms-Brown, IBCLC, RLC, a lactation consultant who owns her own private practice called Baby In The Family, has operated on a virtual-only basis since January — something that has come in handy since COVID-19 hit.
Syms-Brown's virtual appointments look kind of like Eichler's: She'll review your medical history, then assesses your breast and, if necessary, the baby's mouth. She'll answer any questions, and she always follows up. It just all happens via Zoom.

How much do lactation consultants cost?

"A lactation consultant can charge over $300 for a visit," Dr. Dahl says, acknowledging that the price — often not covered by insurance — makes the service a privileged option: "It's a very rich white woman thing." She encourages people who could use help breastfeeding to seek out a consultant who does accept insurance (like she does). It might take a little legwork, but it can be worth it for a parent who really wants to breastfeed, but is having trouble getting started.
"It does [often] come down to finances," Eichler agrees. "A lot of people don't get their session covered by insurance; that plays a huge part in getting support and how much support they will get. It's not so cheap, it's an investment. But it's worthwhile."
That said, there are plenty of free lactation groups and videos out there for reference if you're seeking help, and many new parents get the hang of breastfeeding without needing the extra support at all. There are options; it's just a matter of trusting your intuition and finding the one that's the best fit for you.

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