When to Seek out Lactation Support Prenatally (or Immediately Postpartum!)
Wednesday, August 2, 2023
_By Lena Edelstein, MD, FAAP, IBCLC and Ashley Brichter, Founder Birthsmarter _
If you’re expecting and hoping to provide breastmilk to your baby it’s so important to learn about lactation ahead of time.
Even though it’s “natural,” nursing does not come “naturally” and education and preparation can make a world of difference.
For most people, a high quality prenatal lactation class\* will get you set up for success but some people should strongly consider a 1:1 visit with a lactation specialist prenatally.
Who should schedule a 1:1 prenatal lactation visit?
While prenatal breastfeeding classes can be an excellent resource to prepare for typical situations, a 1:1 prenatal visit can be useful for anyone with:
- concerns regarding their breasts or nipples (i.e. shape or size of breasts, flat nipples, inverted nipples)
- a history of breast procedures (i.e. breast biopsies, reductions, implants)
- pre-existing medical conditions (i.e. diabetes, PCOS, thyroid conditions, etc)
- complications with pregnancy (i.e. gestational diabetes, hypertension, pre-eclampsia)
A prenatal visit can also be extremely useful for anyone expecting who wants to reflect on a prior breastfeeding journey.
A prenatal appointment would include taking a maternal medical history and creating an anticipatory plan based on your unique history and pregnancy to make you feel best prepared for breastfeeding after delivery.
Prenatal appointments can be done virtually, however, a breast exam can only be performed in person. If you have concerns regarding the shape of your breasts or nipples, an in-person exam may be more useful although much can be evaluated virtually as well.
Who should seek early support after delivery?
If you’ve already given birth, the first “big milestone” you’re looking for is moving through Lactogenesis Stage II (also known as “milk coming in”). This stage of lactation typically occurs on the third or fourth day postpartum. However, there are certain maternal medical conditions that can delay or impair lactogenesis stage II. This isn’t to say that breastfeeding cannot happen, but that these families should plan on having _support_ readily available especially in the early days-weeks postpartum.
Some maternal conditions that _may_ delay or impair lactogenesis include
- being a first time mother
- maternal age >30
- cesarean section delivery
- a long stage II of labor
- excessive maternal fluid load in labor (hooked up to an IV for many hours)
- Diabetes
- Obesity
- PCOS
- prior breast surgery (especially breast reduction)
Again, I want to emphasize that these conditions do not mean that you will not be able to breastfeed, just that these babies may need closer monitoring of their weight gain, and you may want to know what resources are readily available to you if you need breastfeeding support.
If there is any concern about how your baby is feeding, or if your baby is getting enough, do not feel like you need to troubleshoot on your own!
Who should you turn to for support?
Certified Lactation Counselors or Breastfeeding Educators have received 40+ hours of introductory training to assess and support clients through the basics of an infant’s latch and milk production.
An International Board Certified Lactation Consultant (IBCLC) has thousands of hours of clinical training and can provide comprehensive support, perform thorough assessments, and help you to create a feeding plan but it is out of their scope of practice to diagnose and manage problems.
A Breastfeeding and Lactation Medicine Physician is a doctor who has done further medical education to be able to evaluate, _diagnose_, and manage breastfeeding and lactation problems for both the lactating parent and the child.
Most Breastfeeding Medicine Physicians are also IBCLCs, although if they are not they would gladly collaborate with an IBCLC you may be working with separately.
Want to learn more? Check Out:
\*If you’re considering a prenatal lactation class look for a class where:
There’s no dogma about “breast is best.” You’ll get up-to-date information without the guilt trip so if and when you incorporate formula you don’t feel bad!
There’s a heavy emphasis on milk production and how to build your milk supply so you can improvise based on your lifestyle.
There’s a discussion around the interconnectedness of breastfeeding, biomechanics, mental health, work-life balance, and relationship dynamics and practical strategies that will help you make the best of your nursing relationship!
Find live, virtual & on-demand classes and support groups near you: