35: What to Expect With a Home Lactation Visit
I recently spoke with a friend living in a different state who just had her first baby. She reached out because she was having some nipple discomfort with breastfeeding. She was still at home, nursing her 2 week old baby and although she wasn’t expecting breastfeeding to feel like rainbows she also had this nagging sense that it shouldn’t be uncomfortable either. After a week of over analyzing whether what she felt actually counted as discomfort (a common mind trap for new mothers) she called me. After a long chat I encouraged her to get an in-home lactation evaluation and in the meantime use cooling soothies (such as these and no I am not an affililate) between nursing for comfort. Then she asked me something so obvious but unexpected. What happens during an in-home lactation appointment?
If you don’t work in a clinical setting or with new mothers regularly the idea of lactation assessment may feel as foreign as the first prenatal appointment. Knowing what to expect may mean the difference between getting support or not, so today I’m going to describe a typical in-home visit from a lactation consultant so that you know what to expect should you call upon one.
A typical home visit should include a thorough conversation about medical and birth history for both you and your baby. Usually a thorough history form is sent ahead of time. When they ask if you have had any surgeries, please include everything since sometimes unexpected things can impact lactation.
The consultant will likely want to take a look inside your baby’s mouth and perform a simple oral mechanism exam. This may include feeling inside the baby’s mouth with a gloved finger to feel the structures, looking at their oral reflexes and seeing how the tongue is moving and responding to input, and feeling how your baby sucks. Remember that although this can be an important part of information gathering, this alone is not enough to diagnose things like tongue tie. It’s just information gathering. Technically lactation consultants without other credentials are not meant to diagnose oral motor issues or provide structural diagnoses.
Once some baseline information is gathered, the consultant will want to weigh your baby. They’ll need to do this before your baby nurses and again afterward to get an idea of how much milk your baby drank that feeding. Professional lactation consultants should have a special scale, sensitive enough to estimate how much milk your baby took while breastfeeding with accuracy. This means the scale must be sensitive within 2g. Other common baby scales meant to track growth over time are often not sensitive enough to get an accurate read per feed, which means it may appear as if your baby took a lot less or a lot more than they actually did. Even doctors office’s frequently do not have the type of scale that can accurately tell you how much your baby ate during a specific feeding. Trust me when I say you do not want to use the wrong type of scale and drive yourself nuts with inaccurate, wildly swinging numbers.
A lactation consultant will of course observe your baby breastfeeding and take note of their state before and after they eat. They may also help adjust the position of your baby, help you to get more comfortable, and support better alignment for both you and your baby. Remember that good alignment is hugely important for an optimal latch.
The consultant can teach you how to put a finger at the corner of your baby’s mouth to gently break the suction and unlatch them so your baby doesn't take your nipple with them if you’re feeling any discomfort and need to start over or relatch.
Your breasts will also be evaluated and palpated with your permission, or at least viewed during an assessment. It’s helpful to see your baseline prior to a feed such as any engorgement or the state of your nipples and then again after the feed. This provides a lot of clues to the whole breastfeeding picture. Checking for signs that your nipples are not being misshapen or damaged is very important for your comfort and your baby’s success. Remember that supporting your breast health is part of their scope of practice.
A good lactation consultant will provide you with a summary sheet of the findings and a written report with a plan. They should also follow up in a way that is appropriate for your situation so they can make changes as progress permits or if any issues start to snowball.
Remember that whoever you work with should respect your feeding goals. You should be comfortable with this person as they are supporting your body and your baby. And at any time it is your right to say no thank you or find a new consultant. I highly encourage at least a phone call to get to know someone and see if they are the right fit for you. Here are a few helpful questions you can ask:
What is your experience working with babies the age of my child?
Do you have a network of mentors or other professionals you can ask questions to?
Do you work with mothers who also bottle feed?
These types of questions give you some insight to someone’s experience with your specific concerns, if they are open minded enough to have a large network of resources, and if they are supportive to your feeding plan. The last thing you need is to be working with someone who feels judgy or inflexible. Remember that we professionals all have different backgrounds. I started as a speech language pathologist, so I have a clinical background grounded in infant oral skills and feeding difficulties and do diagnose in this area. Whereas, another lactation consultant may have a much stronger background assessing pumping and flange fit for example.
My point here is that, each professional you encounter has a scope of practice, but also an experience and a personality. I believe finding the right fit for you is really important and a key to success.
Last but not least, most insurances cover multiple lactation consultation visits. You may have to find the right consultant that also happens to be in your network, and ask if they charge a travel fee for your location, but with websites like TheLactationNetwork.com getting pre approved visits that are covered is extremely easy. I’ll include that resource in the show description.
Well mama, now that you know generally what to expect, you are one step closer to finding your support team. And as for my friend, she did get her in-home consult and after a minor change to the way she held her baby while breastfeeding her discomfort went away completely.
Links mentioned in the show: