The few studies available suggest that anywhere from a quarter to two thirds of breastfeeding 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' breastfeeding problems were resolved successfully. "Lactation consultants are a breastfeeding 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. Because breastfeeding 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 breastfeeding. 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 breastfeeding provides.) And even months into breastfeeding, 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. But 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 breastfeeding is indeed working well.
There are a couple of ways to find a lactation consultant. One is to ask if there's one at the hospital where you deliver; many hospitals have one on staff. "We recommend that all mothers ask for a consult in the hospital," says Cathy Carothers, president of the board of directors of the International Lactation Consultant Association, chair-elect of the United States Breastfeeding Committee, and an International Board Certified Lactation Consultant (IBCLC). Another option is to go to the International Lactation Consultant Association's website, www.ilca.org, which has a search function that allows you to find a professional in your area.
Many lactation consultants are nurses or other health professionals. To ensure a high standard of training and expertise, look for 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.
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.
Distractions abound for new mothers, whether it's a flurry of visitors or sleep deprivation. To truly make the most of a visit from a lactation consultant, try turning off the TV and your cell phone, taking the dog outside, or asking your in-laws to run some errands so you can focus on what your consultant is saying and better soak up the information.
Not understanding a specific latching technique—or why your nipples are suddenly so itchy? Say something. Always ask questions during your consultation, no matter how awkward or embarrassing. "We always welcome questions," says Pat Gilliatt, RN, BSN, IBCLC, certified lactation consultant at Mercy Hospital in Des Moines, Iowa. "I don't think there is ever such a thing as a stupid question." In fact, if you feel uncomfortable talking to your lactation consultant, that might be a sign that you should start looking for a different one.
When it comes to seeking breastfeeding support, the more, the merrier. In addition to getting specialized help from a board-certified lactation consultant, look to an experienced friend, your baby's physician, the WIC (Women, Infants, and Children) program, or the La Leche League for advice, Gilliatt recommends.