Heather Henson had trouble breast-feeding her son, Daniel, almost from the moment he was born. "The nurses kept shoving my breast into his mouth, saying he'd eventually get the hang of it," recalls the Brooklyn mother. "But Daniel would gag every time." Just hours after being discharged from the hospital, he became yellowed with jaundice, made worse by lack of fluids; the next day, he was readmitted with dehydration. Henson's doctor wasn't much help: He referred her back to the nurses, who merely suggested an instructional video she'd already seen.
Henson was at a loss until she hired a lactation consultant, a professional trained to help mothers with breast-feeding questions and difficulties. The consultant spotted two problems at once: Henson's nipples were flat, and Daniel wasn't sticking his tongue out far enough to latch onto her breast. The consultant gave Henson a nipple shield, which allowed Daniel's sucking to lengthen her nipple, and demonstrated how to massage the baby's jaw and gums to help extend his tongue. Within a month, Daniel was breast-feeding unaided; by 2 months of age, he'd doubled his birth weight.
The few studies available suggest that anywhere from a quarter to two thirds of breast-feeding women face significant difficulties within the baby's first week. Top complaints include sore nipples, infant sucking problems, excessive infant weight loss (more than 10 percent of birth weight), and delayed onset of the mother's milk supply. Yet when researchers in a 1999 study at the University of California at Davis provided lactation consultants to every study subject who needed one, the overwhelming majority of participants' breast-feeding problems were resolved successfully.
"Lactation consultants are a breast-feeding mother's best hope for detailed troubleshooting and advice,'' says Kathleen Huggins, R.N., IBCLC, a certified lactation consultant in San Luis Obispo, California, and author of The Nursing Mother's Companion (Harvard Common Press, 4th rev. ed., 1999). Because breast-feeding was out of vogue in America from the 1940s through the 1970s, Huggins points out, today's new moms seldom have older, experienced relatives they can ask for help. Furthermore, obstetricians, nurses, and pediatricians receive little or no training in breast-feeding. Certified lactation consultants can help fill that void.
Professional consultants offer a broad range of services, which include everything from teaching a new mom how to position her baby on the breast to giving her tips on how to increase her milk supply or handle a breast infection. They can also devise special feeding strategies for preemies, multiples, or infants with serious medical conditions such as heart disorder or cleft palate. (These babies especially need the extra nutrition and nurturing that breast-feeding provides.) And even months into breast-feeding, moms who want help finding a good pump or figuring out the nursing implications of starting their babies on solid foods can benefit from hiring a pro.
Sometimes the most valuable commodity a lactation consultant offers is simple reassurance—either affirmation that you're not a failure as a mother if you're struggling or concrete proof that breast-feeding is indeed working well. At each visit, for example, Henson's consultant weighed Daniel before and after he completed a feeding to make sure he was getting enough milk.
Typically, a consultant's fees range from $50 to $100 per hour, depending on location. Some hospitals offer free lactation services. Often one visit is sufficient, with follow-up by phone. Some insurance companies will reimburse new moms for these services, but there are no guarantees. Nor will all flexible-spending health-care accounts accept the charge.
To ensure a high standard of training and expertise, look for lactation consultants who have been certified by the International Board of Certified Lactation Consultants. (The letters IBCLC will appear after their name.) The IBCLC requires thousands of hours of experience and training in anatomy, physiology, sociology, psychology or counseling, child development, nutrition, and medical terminology. There are more than 8,000 certified lactation consultants in the U.S., some employed by hospitals, birthing centers, and pediatric offices, others in private practice.
Even after their breast-feeding crises are over, many mothers find it reassuring to underscore the lessons of a lactation consultant by attending a breast-feeding support group, such as those held nationally by La Leche League. "Nursing goes much more smoothly if women get the support they need," says New York City-based certified consultant Laura Best-Macia, IBCLC. "When that happens," she adds, "breast-feeding can be easily integrated into even the most complex lives."