What to expect during an in-home lactation consult with Rachel
These days it’s pretty rare for a health care professional to come to your house, and you may be a bit nervous at the thought of breastfeeding home visits- but I know that the majority of your hours nursing your baby in the early days will be spent at your home. You probably have your favorite spot to sit or lay in to breastfeed, along with your favorite pillows and blankets that you use each day.
It makes perfect sense for me to come to you instead of having you pack everything up and come to me! Here’s some tips on what to do (and not to do) before I arrive on our appointment day, and what to expect while I’m with you.
- Fill out my health history and consent forms, if you can. I’ll email them to you.
- Try not to feed baby within an hour of my visit so they’ll eat while I’m there (but if baby is scream and hangry go ahead and feed them and we’ll make it work!)
- Put your dogs up in another room or outside. I love pets, but they can become very territorial over “their” baby when strangers arrive; even sweet, loving dogs have bit lactation consultants!
- Make a list of all of your questions for me (but remember that you can text, email, or call me for free for 2 weeks after my visit if you forget anything).
- Expect me to be with you in the room where you spend the most time nursing, whether that be your living room, bedroom, nursery… bathroom… whatever!
- If you have questions about the breast pump you’re using, or the bottles you’ve chosen, or any other gear you’re using, try to have them available in case we need to look at them together.
- Older siblings are always welcome to be playing nearby during a consult. You will want to plan an activity or distraction for them during our time together so that you and I can chat freely.
- don’t clean your house. Really. I don’t care. 95% of the time one of my tips will be to let go of household chores and spend more time skin-to-skin with your baby anyway.
- don’t change what you’ve been doing unless I told you to before the visit. I need to be able to see the whole picture so I can get a better idea of what little tweaks may make a difference in your breastfeeding or chestfeeding relationship.
- don’t kick everyone else out of the house. If you have a spouse, a close friend, or a loved one who is a support to you, I’d love to have them in the room during my visit. Spouses, grandparents, and sometimes even postpartum doulas have sat in on my consults and told me that they learned a lot about how to support the nursing parent.
- don’t hesitate to tell me if something doesn’t feel right. I will ask you repeatedly during the consult how things are feeling- both physically (pain and comfort wise) and emotionally. A lot of us have it ingrained to not admit we are hurting or that something sounds like it won’t work for us. I really DO need to know what’s working for you so that we can come up the plan that best allows you to meet YOUR nursing goals!
- I will wash my hands more or less as soon as I walk in the door, and before I touch you or your baby.
- We will sit and talk first, unless baby is hungry and ready to nurse as soon as I walk in the door! I’ll go over your health history, you baby’s history, and your challenges and concerns. Then I will ask to observe you breastfeeding, in whatever position and manner you use most.
- I try to be as physically hands-off as possible. I will ALWAYS ask before I touch you, your breasts, or your baby.
- Usually before your baby has eaten, I will put on latex-free gloves and do a manual exam of your baby’s mouth. I will not do this unless I see a need to assess baby’s oral anatomy and function closely.
- If there are any concerns about how much milk your baby is getting when nursing, I will weigh your baby before and after the feeding to assess intake.
- I may lay your baby on a flat surface in order to complete a full-body assessment of their structure and function, as these may affect baby’s ability to nurse successfully.
- I may look at your nipples before and after your baby nurses. This helps me not only to assess whether you are experiencing nipple damage, but it also gives me a lot of insight into exactly how your nipples is placed in baby’s mouth while she or he is breastfeeding.
- Within 24 hours I will email you a superbill (itemized receipt) to submit to your insurance company for reimbursement (though I can’t promise that they will reimburse you) and will email you the detailed report that I also send to your baby’s health care provider.
what happens when I leave your house?
Before I leave, I will hand you a written care plan and we will discuss your next steps.
Within 24 hours I will fax a written report to your child’s pediatrician (and any other relevant medical providers) and I will send a copy to you for your files.
You will have unlimited phone, email and text support from me for the next 14 days as you work through your care plan. If a follow-up visit is needed, they are available at a reduced rate, and this extends your phone, email and text support for the following 14 days.
Let’s be honest- nobody calls me for a consult because breastfeeding is going perfectly and everything is just fine. Nursing problems tend to be complicated with a lot of moving parts and variables- and fixing them takes time and effort. You don’t walk into your doctor’s office expecting to walk out cured, right? I probably won’t be able to make everything about breastfeeding work perfectly for you before I leave your house (though I certainly will try!). This is why we will work together over the next two weeks to make improvements in your problem areas.
I expect to hear from you to tweak the care plan- if I don’t hear from you, I will assume everything is going well.
Fixing breastfeeding problems is a process. Some say it takes as long to fix a breastfeeding problem as it took for that problem to develop. Others say that fixing nursing problems tends to be two steps forward, one step back. But you will have me with you through it all, cheering you on, reassuring you, providing you with evidence-based support- and helping you to meet YOUR nursing goals, whatever they may be.