Lactation Consultants at the Hospital and at Home: A Continuum of Care
If you’re an expectant parent, you might wonder if you should see a lactation consultant in the hospital, at home, or both. If you’re an aspiring IBCLC, you might wonder whether hospital practice or private practice is right for you. To learn more about both options, we spoke with Massachusetts Breastfeeding Coalition board member Tasha Gunnarsson, who works at Anna Jaques Hospital, and Massachusetts Lactation Consultant Association board member Melanie Venuti, who works in private practice in Greater Boston.
Give us your elevator speech: in brief, what does a lactation consultant in your position do?
Tasha: As a hospital lactation consultant, I assist with early feeds and the establishment of breastmilk supply, with special considerations for any challenges within a person’s own history, the experiences and interventions at and around delivery, and the baby’s current status, which may pose challenges to this very important start to one’s breast/chestfeeding journey. I also support parents throughout their journeys, assisting with continued education and hands-on help and tools through consultations beyond the first days within the hospital.
Melanie: As a private practice IBCLC, I work with families soon after they are discharged from the hospital up until they are planning their weaning journey. I visit with families in the comfort of their own homes and support them through feeding challenges based on their goals. It’s so fun!
Why did you choose to work in that setting?
Melanie: I started my career working as a nutritionist at WIC. I worked with low-income families with infants and children under five years old. During that time, I took several continuing education classes on breastfeeding and infant feeding and was intrigued by the complexity of breastfeeding and the challenges that parents often experience in the early weeks. I decided to pursue more continuing education on the subject and obtained multiple clinical hours, working with breastfeeding parents to sit for the IBCLC exam. While I didn’t yet have my own children, I knew my passion was supporting parents through this vulnerable time.
Tasha: I love helping parents during these vulnerable and tentative early days of parenthood, holding space for them, finding opportunities for engagement and education, and serving not only as an expert in a field that I find rewarding, but also as someone who supports and encourages during a time when this is so very important and needed. It is a true honor to be invited into this raw, personal, and important time in a family’s journey.
What are some reasons families see you?
Tasha: I see all birthing families who plan to feed human milk by any method. I also see any other patients who might have questions about their options and/or need assistance with anything having to do with lactation throughout their postpartum stay. I work with straightforward cases involving parents who are revisiting breast/chestfeeding all the way to very complex cases, which can involve parents with a history of lactation challenges, premature babies, babies with congenital anomalies, parents with personal trauma histories, and the list goes on.
Melanie: There are various reasons a family will reach out for support. The most common reason is slow weight gain in the newborn infant and breastfeeding parents complaining of pain and discomfort associated with latching.
We often will have families who want to meet to clarify that things are going well or to set themselves up with a support team for ongoing breastfeeding support.
We also have more complex cases that might include an infant with oral tethers, like a tongue or lip tie. It is not our job to diagnose; however, we are skilled in observing anatomical issues and suck insufficiencies and refer back to pediatricians as needed for referrals to specialists.
How do they find you?
Tasha: For outpatient lactation appointments, my contact information can be found on ZipMilk, at our local pediatrician and OB/CNM offices, and on our hospital’s website. A parent who plans to deliver at the hospital I work at does not need to organize anything with me directly; being seen by a lactation consultant is part of each patient’s postpartum stay.
Melanie: My practice thrives on referrals. I get many referrals from past clients, and referrals from pediatricians local to where I work. I also get many referrals from both the ZipMilk directory and the MLCA directory.
How often and over what period of time do you generally see families?
Tasha: I typically see patients once daily throughout their postpartum stay, sometimes more or less depending on their specific challenges or goals. As for outpatient visits, parents sometimes come for a one-time appointment, and some schedule repeat visits if there is a longer-term plan or goal they are working towards.
Melanie: This varies from family to family; some families need only one visit, while others may require multiple visits and remote support to reach their goals. I typically like to see families at least two times and then offer remote support via phone post appointments.
Do you have an overarching goal or philosophy in working with families?
Melanie: My philosophy is to support the family based on their goals. We have conversations in the early part of the appointment on what they envision their feeding journey to look like—whether that is exclusively breastfeeding, combination feeding, or eventually incorporating formula.
Tasha: Meet them where they are. My role is to support families in their own personal journeys. Their goals may sometimes shift and change throughout the process. My goal is to educate and empower the lactating parent to choose what is best for them and their family. It’s intriguing and informative to witness the many different paths and options people choose given rather similar lactation cases.
What is the most rewarding aspect of working as a lactation consultant in your setting?
Tasha: Being invited into such a special and sacred time in their journey as a family. Also, receiving feedback on what a pivotal role I played for them years later when passing a much more grown-up family on the sidewalk makes my day just a little bit brighter.
Melanie: It’s a pleasure to often be the first person to meet their precious babies in their home, and to see parents’ minds ease with a plan created specifically for them. I also really love when families send me pictures or follow-up messages about how lovely their feeding experience ends up being after a visit.
No one completely understands another person’s job. What’s one misconception about yours that you’d like to clear up once and for all? We’re interested especially in misconceptions other healthcare providers might have.
Melanie: I believe a common misconception for IBCLCs is that we are breastfeeding cheerleaders and are there to offer mom support on the surface of her feeding journey. On the contrary, we are skilled and knowledgeable healthcare providers who have completed multiple layers of education to allow us to do what we do. Lactation is a very scientific process and we are highly trained to investigate the “why.”
Tasha: “You get to play with babies all day and help them eat!” The role of a lactation consultant involves well-honed skills in the areas of counseling, resourcefulness, interpersonal skills, patience, cultural sensitivity and awareness, and a deep understanding and knowledge of lactation and the science behind it.
What’s one advantage your peers in the other setting have? If you could adapt it to your practice, would you?
Melanie: I believe hospital nurses and IBCLCs are meeting with moms during their most vulnerable time. They are so lucky to be there to offer families their very first bit of breastfeeding education to get families off to a great start.
Tasha: Private practice lactation consultants often have the benefit of working within the family’s home and feeding environment, which I feel is a true benefit to that family and their success. Unfortunately, the hospital just isn’t your home, but I do try to encourage recreating scenarios similar to at home and also using accessories and tools that you will have at the ready when you are at home.
How can hospital and private practice lactation consultants work together to support families?
Melanie: It would be so wonderful if every family who is offering breastmilk to their baby was set up with a postpartum lactation consultant.
Tasha: By holding the other profession up with families and working as a team, sharing notes and perspectives with each other. I am very careful approaching any parent-led discussions about the other profession. I always encourage understanding the special challenges that each profession can hold. It is also important to remember the very real challenge that is dealing with newly delivered parents who are often sleep-deprived; learning and recall are difficult tasks during this time.
What’s the number one change you’d like to see in our country’s healthcare system?
Tasha: A complete revamp of the rights and laws having to do with women’s health: longer maternity leaves based on science, and new protocols and benchmarks focusing on correcting racial and socioeconomic disparities within the fields of contraception, women’s health, birth, and baby feeding.
Also, one more: concrete laws and enforced repercussions for predatory infant feeding marketing.
Melanie: Access to quality lactation care for all families regardless of income status.
Thanks to both of you! Massachusetts families are fortunate to have caring and expert lactation consultants like you supporting them in the hospital and at home.