HOW TO CHOOSE A GOOD AND HELPFUL BREASTFEEDING-SUPPORT PERSON

When you seek help from a Lactation Consultant (LC), you should not feel that s/he is mainly trying to rent or sell you some product. The Lactation Consultant is there to help you with your breastfeeding problem, and very often help does not require any products. Even if you do need to rent a pump, for example, you should not feel that the lactation consultant is focusing on sales or rentals. Certainly, if she does sell you a pump or product, this sale time should not be included in her fee.

No matter what your problem, a good LC should not be telling you that you cannot breastfeed. We hear of some Lactation Consultants and doctors telling mothers they cannot breastfeed for various reasons. Do not believe them. If you have nipples you can breastfeed. Women are often told they must stop or interrupt breastfeeding due to illness or a medication they are taking or a test they must undergo–this is only very rarely true. See the following blogs: medication, sore nipples (taking the baby off the breast to allow the nipples to heal is a last resort only, not a first resort as many mothers are advised), sore breasts (not for a biopsy, not for mastitis, not for breast abscess),

No LC or breastfeeding-support person should ever bring formula with her to your home. LCs, in fact no health professionals) should distribute formula samples or recommend a formula by name. Ask her ahead of time if she intends to bring some formula samples with her. This may be an indication of her true support for breastfeeding.

Bottles are being used much too often to try to fix breastfeeding problems, even though sometimes there may be no choice. On the other hand, nipple shields should never be used. They are an apparent solution only, and in the long run, most mothers and babies will run into serious breastfeeding issues that are more difficult than ever to deal with because of the nipple shield. Once the milk ‘comes in’, many babies will latch on easily without a nipple shield. There are usually better ways of supplementing or feeding babies than using a bottle. Be sceptical if your LC is quick to use a nipple shield. Patience, perseverance, and good technic are almost always good enough to get any baby latched. See the blog “not latching”.

REMEMBER that the best way to avoid breastfeeding problems is to get the best latch possible, as soon as possible after the birth. Try to ensure and aim for the most natural labour possible. A good Midwife or Doula may be an invaluable way to achieve that goal.

BE WARY IF:

You are told to feed x number of minutes per side. A baby is not necessarily receiving milk from the breast just because he is latched on and sucking. It is important to know how to know the baby is drinking at the breast. Click these links Really good drinking with English text, Twelve day old nibbling, English Text, “Borderline” drinking with English text for video clips showing babies drinking well at the breast, or not.  Watch the videos, read the texts and then watch the videos again.

• Babies can feed well being on the breast for relatively short periods of time, and can feed poorly being on the breast all day. It depends if they are drinking, how much they are drinking (how long the pause in the chin is).

• Timing is meaningless and tells us nothing about what the baby is actually getting and whether or not it is enough

You are told to feed x number of times per day

• A baby who feeds well 6 times a day is better off than a baby who feeds poorly 12 times a day

• There are no studies to support the claim that a baby must feed 8-12 x/24 hour period. None whatsoever.

You are told to wake the baby every x number of hours

• A baby who feeds well will wake up when s/he needs to feed; if a baby feeds so poorly that he won’t wake up on his own, there is no point in waking him up so he feeds poorly more times a day; the point is to get the baby feeding well.

Your breastfeeding-support person weighs the baby before and after each feeding

What does this tell us? Even if the scales could be relied on as always accurate—so what? A 15 gm gain, for example, may mean baby consumed 15 mls of breastmilk—but what kind of breastmilk? 10 am breastmilk? 3 pm breastmilk? Tuesday’s breastmilk? The beginning of the feeding breastmilk? The end? What? Ensure baby is actually drinking and not just sucking, and follow our Protocol to Increase Intake of Breastmilk. See again Really good drinking with English text, Twelve day old nibbling, English Text, “Borderline” drinking with English text for video clips showing babies drinking well at the breast, or not.  Watch the videos, read the texts and then watch the videos again.

• That’s how you will know baby has had enough.

• Test weighs have been known to show many false negatives.

Your breastfeeding-support person tells you that it is normal to have sore nipples, and “everyone gets them” and you need to endure it. That by the time the baby is 3 weeks old the pain will be gone. That is a long time to wait to no longer have sore nipples. And it is not even true a lot of the time that the nipples get better without doing anything (like improve the way the baby latches on). Or that your nipples need to “toughen” up or that your skin is overly sensitive, or, if you are a red-head, that you are supposed to have overly-sensitive nipples.

• A good latch prevents and fixes sore nipples. See also the tongue tie and latch quiz

• Pain that endures for many weeks should not be allowed to happen. Get good hands on help as early as possible after the baby is born.

• Nipple shields are not usually an appropriate remedy for sore nipples. If you have been started on a nipple shield, your problem only seems to be resolved. Get good help, even if you have no pain with the nipple shields. Even if the baby now seems to be latching on (because a baby on a nipple shield is not latched on).

• Skin colour is irrelevant. Redheads are not more likely to get sore nipples and treatment is the same.

Your breastfeeding support person asks you to finger feed after you breastfeed your baby. This is really not a very good method of supplementing a baby who needs supplementation. See how to use a lactation aid at the breast if the baby needs supplementation.

If a baby needs supplementation then that baby should be supplemented at the breast as long as the baby is latching. Finger feeding is not an appropriate method of feeding a latching baby. It should be used to prepare a baby who is not latching on to latch on. The baby is this video is two months old born 8 weeks prematurely. He is exclusively breastmilk fed by bottle. This video shows. See Handout Finger and Cup Feeding

HOW MUCH SHOULD AN IBCLC CHARGE FOR A HOME VISIT?

There really is no set rate for IBCLCs and the fees for home visits may range dramatically. In Toronto, there are some support people doing home visits for $35/hr and some going as high as $180/hr. Please do not let price fool you—the most expensive IBCLC is not necessarily the best. Do a little home work and research and ask her over the phone about some of the points listed above. An average rate is probably around $100/150 for a visit lasting around 2 hours. This may seem excessive, but it is not—keep in mind that a good IBCLC will save you money in the long run by keeping you and baby breastfeeding and off expensive formula.

Our lactation consultants, working at the clinic, also do home visits. And they are the best.

Questions or concerns?  Email Dr. Jack Newman (read the page carefully, and answer the listed questions).

Make an appointment at the Newman Breastfeeding Clinic.