"BCB helped me become confident in my body's ability to nourish my child completely."
Mitzi S.
Frequently Asked Questions: Lactation Consultant Edition
You've got questions...We've got answers...
We know it can be confusing for new parents, since there are so many different people offering to help with breastfeeding. And even if parents are looking at credentials to figure out who has the skills needed to help their situation, there are just too many different certifications. (Breastfeeding Educators, Certified Lactation Counselors (CLC), WIC Peer Counselors, La Leche League Leaders, Breastfeeding USA Counselors, Breastfeeding Specialists, Registered Nurses, Newborn Care Specialists, Postpartum Doulas and on and on....)
Those of us in the lactation world call this the "alphabet soup" of lactation credentials.
What is an IBCLC®?
IBCLC's (International Board Certified Lactation Consultant®.) are healthcare workers who have extensive education and experience supporting breastfeeding families.
What does an IBCLC do?
An IBCLC provides skilled lactation management for everything from general lactation education and basic latch issues to more complicated lactation problems, such as tongue-tie or weight gain problems.
How are IBCLCs different from everyone else providing breastfeeding support?
A lot of these breastfeeding helpers have some lactation training, and may have even been required to take a exam showing basic breastfeeding knowledge. The difference is the level of education, training, and the hundreds of hours of hands on clinical experience required before you can even be be approved to take the IBCLC exam. Additionally, the International Board of Lactation Consultant Examiners (IBCLE)® ensures that the IBCLC exam is comprehensive. The IBCLC is considered to be the Gold Standard of lactation knowledge.
How do you become an IBCLC?
In order to become an IBCLC, you must complete a specific college curriculum of Health Science Education, you must complete at least 90 hours of lactation specific education, and complete between 300 - 1000 hours of hands on clinical hours. There are three pathways that candidates can use to achieve the IBCLC.
IBCLC’s are required to re-certify with continuing education and clinical hours or by exam every five years to demonstrate current knowledge.
The best time to see an IBCLC is before you have your baby. Seeing an IBCLC during your pregnancy will help you get things off to the best start:
- Lactation support is an intimate experience, getting to know your IBCLC before you have problems will make it easier
- Often there are things we can have new parents do during the pregnancy to have a better outcome. This is especially true if you had breastfeeding problems with a previous child.
- While there is some lactation support available in the hospital, the hospital IBCLCs are stretched thin and often can't spend much time with you to address your concerns. If we have already seen you, it is easy for us to be available even while you are still in the hospital to answer questions.
- Having an established relationship means it will be easier to get your initial appointment setup without delay.
Before their first visit, clients often ask how seeing a private practice IBCLC is different than seeing the LC in the hospital. But by the end of the first visit, everyone always says that they had no idea how different this experience really is. Here are some of the reasons why the support you get in the hospital just can’t compare to a private practice visit.
Time is limited.
In the hospital environment, the lactation specialist, nurse, or IBCLC has a set amount of patients to see during each shift and can’t spend a lot of time with anyone. They usually are expected to see at least 12-15 or more new mothers each shift, and patients will often see a different person for lactation support each day!
While the IBCLCs in the hospital work very hard, being a hospital-based IBCLC is very difficult – we know, because we’ve been there. They have a lot of information to teach in a short amount of time, and parents often get different and sometimes conflicting information from every IBCLC, nurse, or doctor they see.
Information Overload
Most patients are exhausted from their birth and often on medications that make it even more difficult to absorb what everyone is telling them. In our private practice, we spend time with you and your family to develop a relationship that spans your breastfeeding journey.
Our initial visit lasts 2-3 hours, and follow up appointments are generally 1-2 hours long. We know that this is a long time out of a new parent’s day, but it is vital to do a full assessment of both the parent and baby and understand each unique situation to create a care plan specific to that parent and their baby.
Assessment is difficult in the early days
Another problem is that many hospitals do not allow their IBCLCs to do a full assessment of the baby, so often, issues like lip and tongue ties are missed. Most patients are in the hospital for only one or two nights, well before their milk is in, and milk supply can be adequately assessed.
Most problems don't show up until you are home.
Most breastfeeding problems don’t show up until the mother’s milk comes in, usually on day 3-5 postpartum, and parents are left with limited resources to help with these breastfeeding problems.
So why choose our practice?
Our practice has multiple IBCLCs with advanced training in many complex issues. This allows us to not only cover a large geographical area but also to help match patients with the best IBCLC for their specific situation. In complex cases, we refer and cross-consult within our practice, so you always get the best information and guidance possible.
Our practice provides support for new parents throughout their breastfeeding journey, beginning in the prenatal period, in the hospital, continuing after returning home, and through weaning and we believe in walking beside you to support the full lifespan of your breastfeeding relationship.
Parents are often amazed at the wide range of things that we can help with. It is not just about breastfeeding! Hopefully this list will help give you a better idea.
Prenatally
- Preparing for a successful breastfeeding experience
- Basic breastfeeding education
- Choosing a breast pump
- Prenatal nutrition for optimal breastfeeding
- Induced lactation, co-nursing, adoptive nursing, breastfeeding without birthing
- Assessing breastfeeding difficulties from a prior breastfeeding experience
- Assessing for risk factors for breastfeeding problems (milk supply, infant issues, etc.)
Breastfeeding in the Early Days
- How to know if breastfeeding is going well
- What to do when your baby is cluster feeding
- Making latching or positioning more comfortable for the breastfeeding parent
- Making sure your baby is getting enough breast milk
- How to establish and increase your milk supply
- What to do if you make too much breast milk for your baby
- Breastfeeding a premature baby (preemie) or a baby in NICU
- Establishing a good milk supply when breastfeeding or exclusively pumping
- Understanding infant sleep and feeding patterns
Common Breastfeeding Concerns
- Correcting a painful breastfeeding latch
- Preventing and treating breast pain and sore nipples
- Preventing and treating mastitis and plugged ducts
- Thrush and other nipple or breast infections
- How to stop using a nipple shield
- How to nurse twins or other multiples
- Knowing how medications interact with breastfeeding
- Planning for returning to work
- What to do when your baby refuses to breastfeed (nursing strikes)
- What to do when your baby starts teething
- What to eat when breastfeeding (breastfeeding diet)
- Losing weight and exercising while breastfeeding)
- Questions about drinking alcohol and breastfeeding.
Bottle Feeding Breastmilk or Formula
- How to bottle feed
- What if baby is refusing the bottle
- Which bottle is best for your baby
- What do you do if your baby chokes or coughs while bottle feeding
- How much milk should your baby be drinking by bottle
- How to store breast milk safely
- How to properly prepare baby formula
- Bottle feeding at daycare or by another caregiver
Baby Concerns
- How to help a baby with a milk allergy or other allergies and sensitivities
- What to do if your baby has acid reflux or colic symptoms
- How and when to do tummy time
- How to prevent a flat head and what to do about it(plagiocephaly)
Pumping Concerns
- When and how to use your breast pump
- Exclusively pumping
- Selecting the correct breast pump flange size
- Power pumping and other strategies to increase milk supply
- What to do if pumping is painful
- Do you need a freezer stash, and if so, how to manage it
Tethered Oral Tissues (Tongue Tie) Concerns
- Assessing and managing ties
- Recovering from infant frenectomy, frenotomy, and frenulectomy procedures
- Rehabilitating oral function for the breastfeeding infant
Other Concerns
- How and when to introduce solids (baby-led weaning)
- What to do if you become pregnant while breastfeeding
- Tandem nursing (multiples, or nursing a baby and a toddler)
- Breastfeeding beyond the first year
- How to stop breastfeeding and wean
Our Focus
Our group practice is unlike any other. We focus on supporting our families throughout their entire feeding journey -- for the first 2 years of their baby's life. Our goal is to help you reach whatever your feeding goals are and to instill confidence in you parenting skills. We know that confident parents have thriving babies.
Our Experience
We have nearly 30 International Board Certified Lactation consultants with over 330 years of experience supporting new families and babies. With our breadth of experience, there isn't much that we haven't seen, and even if your specific IBCLC doesn't have experience with a particular problem, she can call on a deep bench of experienced IBCLCs to find answers. In addition to professional experience, we have personal breastfeeding experience as well. As a team, we have breastfed 89 of our own babies for a total of 148 years.
What do you do in a lactation visit?
The answer to this question is really a lot more than you probably think!
Most visits consist of the following:
- Birthing / Breastfeeding parent health history review
- Baby(s) health history review
- Breast exam/assessment
- Infant exam/assessment (including oral assessment)
- Feeding observation and assessment (weighted feed and/or observation of bottle feeding)
- Breast pump observation and assessment
- Education on relevant topics
- Creation of a personalized care plan
- Creation of report for physician(s)
How much time will my lactation specialist spend with me?
In a typical initial consultation with us, you will spend 2-3 hours with your IBCLC, and 1-2 hours in a typical follow up visit. And even before your first visit, we have you fill out detailed intake forms, so that we can review them before your visit.
Why is the visit so long?
A visit with us will be different than any other health-related visit you have ever experienced. Our visits are time intensive, multi-dimensional and comprehensive. Often feeding issues are multi-factorial -- in other words -- there are multiple things impacting the feeding. In lactation, we are the only medical providers who have two patients and we treat the parent and baby together.
What does a visit cover
If you want to know the nitty gritty of what we look at and might discuss during a visit, check out the lists below:
Health History for Birthing / Breastfeeding Parent
- Medical history prior to pregnancy
- Family medical history
- Previous breastfeeding experiences
- Previous pregnancy or birth experiences
- Preconception nutrition
- Preconception medications and supplements
- Preconception mental health
- Underlying health issues that may impact breastfeeding
- Prenatal medical history (current and any previous)
- Prenatal nutrition
- Prenatal medications and supplements
- Prenatal mental health and prenatal mood disorders
- Birth plan (in prenatal appointments)
- Postnatal nutrition
- Medications and breastfeeding
- Current Social support
- Maternity leave / returning to work plans
Health History for Baby(s)
- Birth History
- Medical History (diagnosed conditions, treatments, medications, surgeries
- Growth history (weight, height, head circumference)
- Feeding history
Exams/Assessment for Birthing / Breastfeeding parent
- Systems review (review of all symptoms)
- Mental health/mood disorder screening
- Assessment of current emotional and physical state
- Breast assessment and exam
- Bra fit assessment
- Milk supply assessment
Exams/Assessment for Baby
- Assessment of current emotional and physical state
- Oral assessment
- Current weight and weight gain
- Breastfeeding assessment (weighted feed)
- Bottle feeding assessment
Common visit topics
- Parent’s feeding goals and goals for visit
- Breast massage and hand expression
- Breast pumps (selection, instruction, and flange fitting)
- Proper storage of expressed milk
- Nipple and breast care (prevention of pain, infection, healing and treatments)
- Improving latch and positioning
- Infant feeding (frequency, patterns, length of feedings, what is normal)
- Infant issues that can impact feeding (oral anatomy, tongue tie, lip tie, torticollis, plagiocephaly, laryngomalacia, reflux, etc.)
- Infant gas, colic and reflux
- Infant sleep
- Infant growth
- Maternal issues that can impact feeding (breast anatomy, underlying health issues, nutrition, etc.)
- Milk supply (increasing, decreasing, maintaining)
- Bottle Feeding
- Inducing lactation
- Nipple shields
- Infant formula and donor milk
- At breast supplementers (SNS, Lact-Aid etc.)
- Nutrition and breastfeeding
- Alcohol and breastfeeding
- Medications and breastfeeding
Choosing what type of visit to have
We offer 3 ways you can have a lactation consultation. If you live in the greater Houston area, you can choose to have an IBCLC come to your home. We also have 5 convenient office locations throughout Houston (Greenway Plaza, Kingwood, Conroe, Cypress and Pearland). Or, you can even choose to visit with us virtually through our HIPAA compliant telehealth system, Spruce Health. So, what is the difference between each type of visit, and how do you choose which one is best for you?
In Home Visits
Having a lactation consultant visit you in your home is a wonderful choice. You get the benefit of having assistance in your normal environment and you don't have to brave Houston traffic. We can also work on positions that are difficult to do in an office environment, such as side-laying in bed while feeding. Home visits are an ideal choice for breastfeeding parents who may not yet have been cleared to drive, or parents with multiples (twins or triplets). Your IBCLC will bring a scale to weigh your baby at the visit and to do a weighted feed if appropriate.
Insurance coverage for home visits
Many of the insurance plans we take will cover the visit fee for a home visit; however, some Aetna plans do not cover this service. Additionally, some Aetna plans will apply a deductible, copay or coinsurance on home visits. If this happens, we are required to charge you these fees. Please check with your plan on coverage.
Travel charges for home visits
We charge a $60 trip/convenience fee for home visits to cover the travel time and cost and because we typically are not able to see as many clients in a day when doing in-home visits.
COVID-19 Screening for home visits
We require COVID-19 screening for all home visits, and will ask that you take your temperature prior to your IBCLC's arrival. Your IBCLC will remove their shoes and wear a mask prior to entering your home. The visit is limited to the breastfeeding parent, baby(s) and one additional caregiver.
Office Visits
Seeing your IBCLC in one of our conveniently located offices is a great choice. Because we are able to see more clients in a day when doing office visits, sometimes these visits are available sooner than a home visit. Even if you choose to have your initial visit in your home, we can often do follow up visits in one of our office locations. With office visits, there is no additional travel fee.
What to bring to an office visit
When being seen in one of our offices, we ask that you bring anything you are using when feeding your baby with you to your visit. We may also ask you to bring your breast pump to your visit. If you are using powered formula, please bring water with you to your visit.
COVID-19 screening for office visits
We require COVID-19 screening for in office visits, and will ask that you take your temperature prior to your arrival at our office. We do not use a waiting room at any of our office locations. If you are scheduled for an office visit, you will be asked to text us when you arrive, and your IBCLC will notify you when you can come directly into the office. We sanitize the office locations between scheduled clients. The visit is limited to the breastfeeding parent, baby(s) and one additional caregiver.
Virtual Visits
You might be surprised at what we can accomplish during a virtual visit! These visits are perfect for clients who are not located in Houston, for those who choose to not be seen in person, or for those clients who do not pass our COVID-19 screening. While the actual "visit" time is usually about an hour, we do ask you to provide a lot of information, pictures and videos prior to the visit for us to review ahead of time. This helps ensure we make the best use of our time together.
Insurance Coverage For Lactation Services
The good news is that for many clients, insurance will often pay for all or a portion of the visit fees. We are currently able to accept selected plans from the following insurance providers:
- Aetna
- We are in network with most Aetna plans, except for the Memorial Hermann ACO and a few other restricted access plans. Some Aetna plans charge a copay/coinsurance or deductible for services. For Memorial Hermann ACO, you will need to get a GAP exception approved PRIOR to your visit. For more information, view our Aenta Policies.
- KelseyCare
- We are in network with all KelseyCare Plan. KelseyCare will require a referral from your primary care physician for both the lactating parent and the baby PRIOR to your visit. For more information, view our KelseyCare Policies.
- Humana
- We were accepted in the Humana network in August 2022; however, we may not show up as an in network provider yet, as we are still onboarding.
- TRICARE EAST
- We currently have multiple IBCLCs who are TRICARE East certified. We are NOT an in-network provider, but we can bill for your visit and will charge a copay.
- Sana Benefits
- We are in network with Sana Benefits. For more informaiton, view our Sana Benefits Policies.
- BlueCross Blue Shield PPO and Anthem BCBS PPO
- We are in network with many BCBS plans. For more information view our BCBS Policies.
- Cigna PPO
- We can accept many Cigna PPO Plans through our partnerships. For more information, view our Cigna Policies.
- United Healthcare
- We are in network with many plans from United Healthcare, UMR, United HealthCare Shared Services, Allsavers, UHC Bind Benefits and United Healthplans INC. For more information, view our UHC Policies.
Click here to have your insurance coverage checked
What if you don't accept my insurance?
When we can't accept your insurance, we do require clients to pay for the services when rendered, but we provide a timely payment discount for these clients. Payment must be made within 1 business day. We can also provide a super-bill for you to file with your insurance company.
The Affordable Care Act requires that most health insurance plans, except self-funded and grandfathered plans, provide access to trained lactation support at no cost to the mother. So even if we don't accept your insurance, you may still be able to get your insurance company to reimburse you for your lactation visit.
What if I want to pay for a visit for someone else?
You can choose to purchase a gift card in any denomination for a lactation visit through Square.
What forms of payment do you take?
You will be required to give us a valid credit card number after scheduling your first visit with us. Our normal process is to charge the credit card you provided for your visit on the first business day after your visit. Delay in payment for a visit may result in forfeiture of the timely payment discount.
Using a FSA or HSA to pay for services
Clients who have an FSA (flexible spending account) or HSA (healthcare spending account) may use these funds to pay for their lactation visits.
Using an FSA or HSA does not prevent you from filing for reimbursement with your insurance company; however, if the insurer does reimburse you for the services, you may have to redeposit the funds in your account. We recommend that you discuss this with your accountant for specific advice.
Lactation support is about education, and good education will prevent problems. We love to see clients before they are having issues, as we can often give guidance that allows them to completely avoid problems.
And sometimes it is hard to know if things are going well or not. Breastfeeding changes as your baby grows, so the problems you encounter will change over time.
Just like the pediatrician who sees your baby regularly for well visits, we recommend that you come in between the pediatrician visits to see us. The pediatrician well check schedule is driven by the CDC's vaccination schedule. Babies are changing and growing every single day, and we find that having a nursing well check between the pediatrician visits can often head off problems. At these visits, we will observe a feeding, discuss what you should be seeing with your child for this age, check developmental milestones, check growth and development, discuss any concerns you have and give you anticipatory guidance of what to expect next.