Question 1

How do I prepare for a virtual consultation?

Accepted Answer

As a clinician, I believe that nothing can replace an in-person lactation consultation. However in rural areas where there is no local IBCLC or under certain circumstances like the ones we are currently facing with COVID-19, virtual consultations are a great way to get the breastfeeding support you need at a crucial time.
 
Virtual consultations can provide assistance with common breastfeeding concerns, including prenatal education.
 
There are some limitations to virtual lactation consulting. Here are some helpful tips:
- Both users must have adequate internet connection
- Both users must have adequate lighting. Please keep a flashlight on hand for mouth assessments
- May need a second set of hands to help with positioning the device for best viewing

While virtual lactation consulting is beneficial, there will be times that Great Start Lactation must refer mom and/or baby to a local health care provider. These cases may include:
- Suspected tongue tie or other oral malformation
- Mastitis, thrush and other breastfeeding concerns requiring treatment
- Inadequate lighting/internet connection to perform a quality online assessment
- Concerns with weight gain, jaundice and/or general well-being of the infant

Question 2

What happens during an in-home consultation?

Accepted Answer

Upon my arrival you can expect me to ask where I could wash my hands. Actually, I may do so quite a few times throughout the consult.
 
We will start by chatting unless baby is ready to nurse as soon as I arrive!
We will review the health and medical history (yours and baby's) including birth and labor; as well as your breastfeeding concerns.
 
I will observe you and your baby in your environment (where you usually nurse, probably with your favorite pillow, blanket...) I need to see what you have been doing so far in order to assess the situation correctly and suggest improvement if needed.
 
I may need to take a close look at your breasts and nipples before and after a feed. Besides evaluation of potential nipple damage, this will give a great indication on baby's latch and where the nipple is placed in baby's mouth while he/she is breastfeeding.
 
I will put on latex-free gloves and do a manual assessment of your baby’s mouth ONLY if I see the need to assess baby’s oral anatomy and function more closely.
 
I will weigh your baby before and after the feeding and evaluate milk transfer. I use a pediatric scale with the highest resolution (0.1 oz or 2 grams).
 
We will go over all of your breastfeeding questions.
 
Your support system is welcome! Spouse, grandma, BFF, even post-partum doula can stay during the consultation. They may learn a few tips on how to support a lactating parent and be a great help to entertain older siblings if needed!
 
At the end of the visit, I will give you a written plan of care that you feel comfortable implementing and we will go over the next steps.
 
Within 24 hours, I will send a report to your baby's pediatrician (and any other relevant providers of your health care team) and provide you with a copy of that report.
Within 24 hours, I will also provide you with a superbill (an itemized form that describes the services rendered) for you to seek any reimbursement you are eligible for under the Affordable Care Act. (Check the FAQ regarding insurance for more info).

Question 3

What are the precautions for Covid-19?

Accepted Answer

I received the Covid-19 vaccine and I have resumed in-person lactation consultations with the proper personal protective equipment as per CDC guidelines.
Prior to the consultation patients are screened for Covid-19 symptoms and are rescheduled if needed.
Usually I allow the support system (partner, grandma, best friend, post-partum doula...) to attend the consultation; however until further notice I ask to limit the support system to one person only besides mom and baby. I require that all people present at the consultation wear a mask/face covering.
I maintain a 6 feet distance during the consultation except when performing a breast exam and/or oral assessment if needed.
 
As always, (even before Covid-19), the baby scale is sanitized before and after each use and a disposable pad is used to place the baby on, I wash my hands upon arriving at the client's home and put on (latex free) gloves and I use sterile tools (if needed).

Question 4

How do I prepare for an in-home consultation?

Accepted Answer

After booking online, you will receive a confirmation email. Please read through it carefully to make sure your requested appointment time has been accepted.
Be sure to click on the provided link to fill out the online intake and consent forms. It is important for this step to be done in advance so we can spend more time talking during the consult, and less on paperwork!
 
There is not much on your part that requires preparation, all you need to do is be there with a baby ready to eat! I will just need a sturdy surface (like a table) to place the baby scale on.
 
For baby to be interested in nursing while I am here, it is best to nurse him/her 1.5 to 2 hours prior to the consultation, but breastfed babies can’t tell time! If baby is hungry and frantic, go ahead and feed him/her! We’ll make it work!

If you are using a breast pump, please do not pump immediately before my arrival. Please record the milk yield in the last 24 hours prior to the consult. If you have been partially bottle feeding with expressed breastmilk or formula, please record how much baby has been taking in the last 24 hours prior to the consultation. These are very important pieces of the puzzle!

Please, DO NOT clean your house for this consultation! I expect the house to be messy – mine was for sure during the early post-partum period! In fact, I often recommend to let go of house chores to best take care of yourself and your new baby.

Question 5

Which cities do you cover?

Accepted Answer

My service area covers Greater Los Angeles (5 miles radius of 90048).

Question 6

What are your fees?

Accepted Answer

Visit the "Services" page to find out about consultations fees.
 
Cancellation fees:
There is a $75 cancellation fee for any reason when the appointment is cancelled within 24 hours of the scheduled visit. Cancelling within 1 hour of the scheduled visit or no show will result in a full charge for the consultation at the self pay rate. Please note that this fee is not covered by insurance.
 
Travel fee:
The Lactation Network verified coverage: for requesting in-home consultations with The Lactation Network, there is a $65 travel fee. Please note that travel fees are not covered by the insurance nor The Lactation Network.
 
Aetna members: there is a $65 travel fee for requesting an in-home consultation when the home location is outside of a 5 miles radius from Great Start Lactation office located in Los Angeles, 90048. This fee is not covered by Aetna.
 
There is a $50 additional fee for a consultation with twins.

Question 7

Do you take insurance?

Accepted Answer

Great Start Lactation is in-network with Aetna for all lactation services.
 
Great Start Lactation has partened with The Lactation Network. This means that Great Start Lactation provides the lactation consultations and Lactation Network handles the insurance part. Lactation Network covers most PPO plans and guarantees 6 lactation consultations at no cost to you once coverage is confirmed.
 
For all other insurance plans not covered by Aetna nor The Lactation Network, Great Start Lactation is an out-of-network provider. You pay me directly and I provide you with an itemized receipt (superbill) to submit to your insurance company for any reimbursement that you are eligible for under the Affordable Care Act (ACA).

Question 8

What methods of payment do you accept?

Accepted Answer

Great Start Lactation accepts major credit and debit cards and FSA/HSA cards at the time of booking or cash at time of service. Please note that I do not carry cash and that exact amount is required.
 
Click here for payment policy.

Question 9

Do I need a lactation consultation?

Accepted Answer

If you are wondering if you need a Lactation Consultation, chances are that you do! Breastfeeding concerns may arise at any time. Whether you are in the early days or a few months out in your breastfeeding journey; a first time mom, an experienced breastfeeder or anywhere in between, I can help!
 
My area of expertise includes:
Breastfeeding positions
Difficulty latching, shallow latch or painful latching
Sore, cracked or bleeding nipples
Engorgement, plugged ducts, mastitis, thrush
Signs of good milk transfer
Assessment of tongue-tie and lip-tie and referral to providers
Concerns about milk production and supply
Baby’s weight gain
Oversupply
Premature baby/NICU graduate
Supplementation and alternative feeding methods
Transitioning back to breastfeeding
Sleepy baby
Breastfeeding after breast reduction or augmentation
Twins and tandem nursing
Pumping/Returning to work or school
Weaning
And more

Question 10

What is the difference between an IBCLC and a lactation specialist (or any other title?)

Accepted Answer

When looking for breastfeeding support, you may come across different terms like breastfeeding peer counselor, certified breastfeeding specialist (CBS), certified lactation educator (CLE), certified lactation consultant (CLC), International Board Certified Lactation Consultant (IBCLC) and possibly more. How confusing!

Let me explain in a few words why those terms commonly used interchangeably ARE NOT equal and why it is important for you to know the difference.
 
IBCLC stands for International Board Certified Lactation Consultant.
The IBCLC credential is the gold standard in lactation care and is the only credential recognized by hospitals and most insurance companies for reimbursement.
 
Only IBCLCs are board certified. This means that not only IBCLCs have passed a rigorous exam, but they had to complete and document hundreds of hours in counseling nursing mothers as well as complete formal breastfeeding management education and college level health related coursework in order to be eligible to sit for this exam (including counseling, nutrition, pharmacology, clinical research, infant child growth and development and more).

Only IBCLCs are required to recertify every 5 years and maintain the credential current with continuing education.
 
This simply means that IBCLCs have the highest level of expertise in breastfeeding management and are trained to counsel and solve complex issues.

Chart credit: Allegra Gast

Question 11

What is the difference between a lactation consultation and a breastfeeding support group?

Accepted Answer

A breastfeeding support group is nursing mothers and babies getting together in order to help and support each other with breastfeeding. It is a great way for new moms to meet other new moms going through similar common experiences and feel that they are not alone!
Breastfeeding groups are facilitated by breastfeeding specialists, lactation educators, peer counsellors and even IBCLCs.
Some hospitals and non-for-profit organizations like La Leche League offer free support groups.

If you are experiencing breastfeeding issues (beyond the common challenges) that could impair breastfeeding success, a support group is not a substitute for a one-on-one lactation consultation, even if the group is facilitated by an IBCLC.
As much as an IBCLC would want to help you, a support group is not the proper setting to conduct an in-depth clinical assessment of the situation (for time constraints and liability purposes).