This article was written in collaboration with Lyla Wolfenstein, B.S., IBCLC. Lyla is a lactation consultant in Portland, OR.
A thorough lactation evaluation will probably be different than any other health-related visit you’ve experienced. It is time intensive, multi-dimensional, intuitive, experiential and often includes a bit of detective work. The International Board Certified Lactation Consultant (IBCLC) is the only health care professional that has the expertise and training required to perform such a specialized evaluation.
She (Lyla) is patient with new moms and has an ability to detect problems. She has creative solutions and never gives up on a client.
Since lactation involves 2 human beings working together, parent and baby are both “patients.” It may seem that your sore nipples (or milk supply, or latch, etc.) are the one and only problem to be fixed, but the IBCLC does not see it that way. The breastfeeding experience for both client and baby is what drives treatment for the IBCLC.
It is important for the lactation consultant to watch a baby at the breast, preferably taking a full feeding. For this reason, try to time the visit so that baby will be moderately hungry about midway through the appointment.
Health History of Client and Baby
The lactation visit usually begins with a conversation with the parent(s) about their concerns. Basic information will be needed regarding healthcare providers, weight history of the baby, etc. so it’s helpful to have all of that information nearby. The lactation consultant will likely ask about any previous breastfeeding experience. She may also ask some questions that seem completely irrelevant–but those questions do have a purpose.
That’s when the IBCLC will simply help you bring the baby to breast and fix all the problems, right? Wrong! There is still much more to do.
After learning about you and obtaining any health history that may affect breastfeeding, your lactation consultant (LC) will move to the baby.
We IBCLCs are interested in the baby’s body. For that reason, most of us find it very helpful to hold the baby, and interact a bit. We may move the baby to a flat surface to see how he holds his body. Did you know that baby’s shoulder alignment can affect his latch?
If you have low milk supply, sore nipples, repeated plugged ducts or your baby seems unsatisfied or is not gaining well, or you are experiencing other issues that could originate with the baby’s oral anatomy or mobility, a thorough oral evaluation of the baby is warranted.
A qualified IBCLC will know how to assess for ankyloglossia (tongue tie), lip tie, and other basic restrictions around the mouth and jaw. If done correctly and respectfully, most babies are not disturbed by this assessment.
Somewhere between 33% and 70% of the babies we saw last year (2012), combined, were referred by us for a release of lip tie and/or tongue tie! These statistics are, of course, higher than in the general population, since we are seeing babies and parents who are struggling with breastfeeding. Nonetheless, the incidence is significant, and since a tethered tongue or lip can impact breastfeeding, speech, swallowing, dental hygiene, orthodontic development, digestion, sleep (apnea) and more, a qualified IBCLC should examine every baby’s tongue mobility and oral anatomy.
This assessment requires that the IBCLC play with the inside of the baby’s mouth a bit, in order to learn how the tongue actually moves, to feel the shape of the palate, and examine the gums, inside of the lips, and under the tongue.
Renee assessed our baby’s mouth and noted a restrictive frenulum under the tongue. She referred us to a provider who could diagnose and treat a tongue tie. Neither hospital lactation nurses or her pediatrician were able to detect her tongue tie. She gave us very clear and direct guidance about breastfeeding positions, pumping, bottle feeding and a tongue tie procedure.
NO ONE has the ability to assess latch by simply watching the baby breastfeed. If anyone tells you, “The latch is fine” and your nipples are sore or damaged, we strongly urge you to search for another IBCLC as quickly as possible! “Good latch” and sore nipples cannot go together!
Weights and Feeding Assessment
After the oral assessment, a naked weight will usually be taken on the baby, and often a pre-feed weight as well, with clothes on. Not all IBCLCs do pre and post feed weights and it’s not essential in most situations.
After weights, the IBCLC will watch a feeding, adjusting positioning and latch as needed, and asking questions to assess your comfort. She may recommend trying devices to assist with breastfeeding if appropriate.
Plan of Action
The consultation should wrap up with a written care plan, follow up plans, and an opportunity for you to ask any questions you might have. It’s imperative that the care plan feel “doable” to you, the mother! It’s a waste of your time and money to accept a care plan that won’t work for you. This is your baby, your breastfeeding experience, and your consultation. Be clear and assertive about what will work for you and what will not. A good IBCLC will welcome calls/emails to change up a plan that isn’t working. They want to hear from you so that adjustments can be made in the plan as you make progress.
Working with Lyla enabled me to nurse my child for almost three years who was on a path to not being able to nurse at all. Lyla asked me if I wanted to nurse and if so to trust her, I did and it worked-against the odds.
We believe that everyone deserves an awesome breastfeeding experience! And often, that begins with your first consultation with an awesome lactation consultant!