Rachel O'Brien, IBCLC

FAQ

My most asked questions on home visits for breastfeeding help, insurance coverage for visits, what I can and cannot help with, what my personality is like, and more!

My home base is Sudbury, MA and my service area includes Acton, Ashland, Bedford, Bolton, Concord, Framingham, Hudson, Lincoln, Lexington, Maynard, Marlborough, Natick, Northborough, Southborough, Sudbury, Stow, Wayland, Waltham, Wellesley, Weston and Westborough.  I will travel to other towns and cities in Eastern and Central Massachusetts as well, but I may charge a travel fee for visits outside my service area.

I will do visits in Boston and the suburbs of Arlington, Belmont, Brookline, Cambridge, Newton, Somerville, and WatertownI will do visits in Boston and the suburbs of Arlington, Belmont, Brookline, Cambridge, Newton, Somerville, and Watertownfor an additional $50 fee that is NOT reimbursed by insurance.

Because I do home visits I spend a lot of time driving every day- and if you live here, you know traffic can be BRUTAL!  When I have to drive more than 30 minutes to see you that leaves me less time in the day to see other clients. Charging a travel fee for clients that require more driving time allows me to see families in towns that I normally wouldn’t be able to get to in time.

I am an International Board Certified Lactation Consultant (IBCLC) with a master’s degree in human lactation.  I have been doing home lactation visits for 5 years and I also work on the maternity floor of a large local hospital as a lactation consultant.

I have extensive additional training in the areas of oral function, tongue tie, oral habilitation of the breastfeeding dyad,  cranial nerve dysfunction in the precrawling infant, infant massage, and am a certified TummyTime! Method instructor. 

I accept cash, check, credit cards (VISA, MasterCard, American Express, Discover), HSA& FSA cards, Apple Pay, Google Pay, and PayPal.

I offer a 50% discount to transgender parents and co-nursing families.  Transgender nursing parents and co-nursing parents with low family income may receive FREE lactation services from me.  Please contact me before booking to discuss!

No, sorry!  I can’t give you individualized breastfeeding advice or care without a signed consent form and your health history- it would be irresponsible of me… and my malpractice insurance provider wouldn’t be thrilled with me either! 

You sure can!  I can take your HSA/FSA debit card or I can provide you with an itemized receipt to submit to the HAS/FSA company. 

I am in network with Aetna and Unicare for all lactation services.  For all other health insurance companies, I am an out-of-network provider.  You pay me directly and I provide you with an itemized receipt to submit to your insurance company.

IBCLCs aren’t licensed in Massachusetts, and because of this loophole, most health insurance companies won’t allow us to be in-network providers.  Trust me, I hate this as much as you do.

The best way to know is to call the member services number on the back of your insurance ID card and ask whether they will reimburse you for lactation support by an out-of-network provider.  The Affordable Care Act says that insurers are required to cover “breastfeeding support, supplies and counseling” for every birth with no co-pay or deductible. Many insurers (like BCBS of MA, Harvard Pilgrim, Neighborhood Health, Tufts and Fallon) are good at reimbursing for lactation visits.  Some other insurers are… not so good. 

I’ll provide you with an itemized receipt (“superbill”) that has all the information your insurance company needs.  Call member services and ask about the process for submitting for out-of-network reimbursement; every insurer does it a little differently.

Contact me and let me know why they denied the claim.  I will see if a different superbill or diagnosis code might work better; unfortunately I can’t guarantee that any claim will be reimbursed and I’m not responsible for any claims that are denied.  This toolkit from the National Women Law Center will help you to get reimbursed.

As an out of network provider I cannot speak to your insurance company directly.

Clients tell me I am funny, kind, supportive, realistic, and non-judgmental.  I pride myself on being non-militant, friendly, upbeat and guilt free.  I know that most Americans grow up without ever seeing a baby breast-feeding– and then we tell you it’s natural and shove your baby in your arms and leave you to fend for yourself.  How are you supposed to know how to do all of this?  

I spend a lot of time at visits talking to the babies.  They’re just as confused and overwhelmed as you are! Babies tell us a LOT with their behavior and body language.  

I won’t make you feel like you’re doing something wrong or like you’ve made bad choices.  I know that every parent does the best they can, and that newborns are totally overwhelming.  We’ll work together to see what we can improve and if there are ways I can help to simplify your routine.

Please don’t clean for me. I’d much rather you spend that time snuggling your baby.  Messy houses don’t even register on my radar!

Usually we start by talking about your birth, your baby and your health history.  I will take notes and ask questions to make sure we’re on the same page.  Next, I usually weigh baby on my super sensitive fancy schmancy scale.  I will do an oral exam on your baby and may do a breast exam on you.  We’ll work on whatever feeding issue you’re having; usually I ask to see what you’ve been doing first, then we work as a team on improving the situation.  I often weigh baby again after feeding to get a snapshot of how well baby transferred milk.  I may have you pump during the visit as well.  Then we sit and make a plan based on your baby, your life, and your goals.  Initial visits are usually 2 hours long and include 2 weeks of unlimited phone/e-mail/text follow up.

  • I’ll send you a consent form and health history you can fill out before our visit; this helps us get right down to business when I arrive! 
  • Make a list of any questions you have for me. 
  • If you’re taking any supplements or herbs for milk supply it’s helpful to have them available so I can take a peek at the ingredients. 
  • If you have a pump and think we may be using it, it would be helpful to have nearby. 
  • If you have pets, especially dogs, please have them put away in another room as they can get very territorial of their new family members.  
  • Please have the baby with you if we’re going to be working on latching or positioning at all! 

More information about preparing for my visit can be found here.

If you have mastitis or a plugged duct there is no reason to cancel.  We can work on it together.  If someone has a cold or mild illness I am still happy to visit.  If you, baby or someone in your household has a more serious communicable illness please inform me as soon as possible before our visit and we can discuss it.  Remember, I work with newborns who may be fragile or immunocompromised and I would never want to spread any illnesses.

If I’m sick, I’ll contact you as soon as possible to discuss rescheduling.  Your family’s health is very important to me.

As I work on a maternity floor in a hospital I am required to be fully immunized and up to date on all vaccinations at all times.

Well, I hope so!  But realistically, breastfeeding problems are often complicated and involve lots of moving parts.  We’ll work together on a plan that should help to improve your situation within 48 hours; it may take a lot of time and work on your part but I’m here every step of the way to guide you and cheer you on!

I have received over 60 hours of additional training on tongue and lip ties.  I have attended a dental laser frenotomy course as an observer (I do NOT perform frenotomies).  I have extensive experience with identifying ties, optimizing latch and feeding techniques with or without frenotomy, suck training, and other full-body exercises that can affect tongue function.  I’ve also completed intensive training on cranial nerve dysfunction and the TummyTime! Method.

No.  Lactation Consultants get a bad rep when it comes to tongue ties, but think about it- we only see babies and parents who are having problems.  Nobody pays me hundreds of dollars to come to their house and see what an amazing job their baby is doing with painless, easy breastfeeding!  So it stands to reason that as specialists, we see a fair number of babies with tongue ties and lip ties.  I have what I consider to be a moderate approach to ties.  I don’t care how a tongue looks; I care how it works.

Yep, I really enjoy bottle refusal consults.  Usually there’s a reason the baby won’t take the bottle and I love playing detective.

Absolutely.  I have had clients who are partially or fully formula feeding who have called me for help.  I don’t play the guilt game and I don’t think formula is evil. 

Absolutely!  Exclusive pumping is SO HARD and I can help!  I work with exclusively pumping parents all the time.

I’ve done home visits with twins and triplets, and I’d love to help you too.

Whether you want to continue tandem nursing or stop tandem nursing, I can help.

I’ll be totally honest, this is not an area I’ve done work in.  I suggest you look for a kink-knowledgeable provider here.

It’s part of our ethical code as IBCLCs that we cannot broker (or appear to broker) relationships for milk sharing, so even if I know someone with lots of milk, I can’t tell you!  I suggest checking the Facebook group Eats on Feets or Human Milk 4 Human Babies– or attend some breastfeeding support groups and ask the other attendees.  Some great info on informal  human milk sharing can be found here. There is also pasteurized processed human donor milk available through Mothers’ Milk Bank Northeast (located in Newton). 

Maybe!  I am happy to do virtual consults for inducing lactation, milk supply issues (low supply or oversupply), weaning plans, pump and back to work planning, and prenatal consults.  However if you are having difficulty with latching or positioning I do not do these as virtual consults; I need to see the situation in person!  Contact me to see if a virtual consult may be helpful in your situation.

If it’s not working for both parent and baby, it’s not working.  Yes, if you want to wean your baby (partially or fully) I will absolutely help you.  I won’t argue with you or shame you.  

I happily do prenatal and/or preadoption consults (including induced lactation) to help you get off on the right foot, whether this is your first baby or not.  Many times there are things in your health history that affect lactation and we can make sure there is a game plan to address these issues head on.  

After baby is born,  families contact me in the first couple of days of baby’s life (before you leave the hospital or birth center) and we schedule the first home visit around day 4-6.  If things aren’t going well then we can meet sooner.  In the meantime if you have any questions at all, feel free to text or call me.