By Kathleen G. Auerbach
Are you pregnant or a new mother? If so, you’ll soon want to be in touch with professionals who can help you have the breastfeeding experience you desire. But because lactation consultants (LCs) are a recent addition to the health field, they tend to be one of a community’s better kept secrets. In other words, they can be difficult to find.
One of the easiest ways to locate an LC is to ask your doctor. Most LCs have connections within the medical community. An even better method, however – especially if you learn of more than one LC – is a referral from a friend, neighbor, or childbirth class member. Ask other new mothers if they have seen an LC and what they thought of her care. Compare their concerns with the questions you have. Another good resource is a local breast pump rental operation. Many dealers know the LCs in the community.
Once you’ve located an LC, you’ll need to decide whether she’s really the right consultant for you. Following are ten questions to ask when selecting an LC. Most consultants will be happy to answer any and all queries. If not, you might consider seeking care elsewhere.
1. Where did you do your training? Currently, only a few university-based programs exist, most at the undergraduate level. In cities and towns where no formal degree programs have been instituted, many LCs take a self-study course, often lasting several months. In other cases, an LC’s learning and training occur on the job or as part of many years of volunteer experience. Mentoring by skilled, practicing LCs also is possible. This last route is similar to that which existed in the early 20th century among physicians; most apprenticed with a doctor already in practice.
2. Are you certified? If so, by whom? The most comprehensive – and the most desirable – certification, and the one that many hospitals have begun to require, is offered by the International Board of Lactation Consultant Examiners, Inc. (IBLCE). This certification is considered proof of "minimal competency" – that is, the person holding it should be able to assist breastfeeding mothers in most situations. To receive certification, an applicant must pass a lengthy exam. They then receive a certificate that enables them to append IBCLC after their name for a period of five years. After that, they may recertify by retaking – and, of course, passing – the certifying examination or by submitting proof of having attended 75 hours of continuing education programs.
Some LCs call themselves certified, although they haven’t taken the IBLCE exam. In most cases, they’ve attended a conference or multiday seminar. You have to decide if you consider this sufficient qualification.
3. How long have you been practicing? Many aspiring lactation consultants have had several years of related experience before they seek formal certification. Generally, the more practice the better. Among the experience you should look for: employment at a hospital as a doctor, nurse, midwife, dietition, or pharmacist; a stint at a WIC office, working with pregnant and breastfeeding mothers; or service as a breastfeeding peer counselor, La Leche League leader, Nursing Mothers Association counselor, or other community-based volunteer.
The more experience, the better.
4. Where do you work and what age babies do you see most of the time? Many hospital-based LCs see only sick mothers and one age group of babies – usually newborns or sick or premature infants. So it’s important to ask about other experiences a hospital-based LC may have, especially if you are seeking her help outside the hospital. You want to know that she has worked with mothers of older children and with healthy babies.
5. What are your areas of specialty? If you are seeking help from the LC for a particular problem, you want to know that she has helped other mothers and babies with this same difficulty. If, for example, your baby is failing to gain weight, how many cases of failure to thrive has this LC helped?
6. Will you make referrals? A good lactation consultant, upon encountering a situation unknown to her, should refer you elsewhere or seek the guidance of a more experienced LC. This should give you confidence in her: It means that she wants to learn even as she assists you. Her best teachers happen to be the people seeking her help and the more skilled people whom she considers leaders in the field. Most LCs regularly network with their colleagues. Doing so enables less experienced LCs to continue to broaden their skills.
7. What do you charge? Unless you see an LC in the hospital, you will almost certainly be expected to pay for the consultation time. If the fee is based on an hourly rate, then ask about the usual total time required for a problem such as yours.
If the fee is per visit, ask how many visits are likely to be needed and why. Any lactation consultant who sets a value on her professional standing in the community should happily tell you what she charges and what you will receive for this fee.
8. Are you available for telephone assistance? Most LCs respond to telephone requests for help. Some charge for phone consults; others don’t. Some will include an hour or two of phone time as part of the first-visit fee; this allows you to ask those questions you didn’t think of when you were in the office.
9. What about insurance coverage? A professional LC should provide you with a billing form that can be submitted for insurance reimbursement. Before your first visit, though, check with your insurance carrier about its policies in terms of coverage for lactation assistance. Some require a referral from your primary care provider.
10. Will my doctor receive a report of our visit? The answer should be a definite "yes." A report detailing the visit should be called or faxed into the office immediately after your consultation. It will include information about your breastfeeding experience and your breastfeeding goals as well as any concerns the LC has.
In the end, you should leave your first consultation with your chosen LC with three essential things: a confidence in your ability to breastfeed; the answers to any questions you may have posed; and sufficient additional information to continue breastfeeding without needing another visit. If you have gotten all of this – and now find yourself happy and comfortable nursing – your experience will have been a resounding success. Congratulations to you, your child, and your LC.
Kathleen G. Auerbach, PhD, is a certified lactation consultant in private practice at The Parent Center, Ferndale, Washington. She is also the coauthor with Jan Riordan of Breastfeeding and Human Lactation (Jones and Bartlett, 1993) and three accompanying titles.