Twin Cities breastfeeding help: Know your options

The Twin Cities is positively engorged (I do apologize for the pun) with options for help for breastfeeding/lactating people. We have a thriving community of doulas and other birth professionals, free-standing birth centers, and many hospitals that are getting on board with the Baby-Friendly Hospital Initiative. As a result, lactation help is thriving, too. Your options range from one of the many La Leche League meetings to IBCLCs who will lug a scale to your home, and everything in between. Be prepared for breastfeeding; know your options for getting help.

It bears mentioning that terminology, and the letters after a care provider’s name, do matter. Whenever possible, seek help from an IBCLC (International Board Certified Lactation Consultant). Someone who is described as a “lactation consultant” is not necessarily an IBCLC; most IBCLCs clearly advertise the fact that they achieved this designation. Beware of anyone who calls themselves a lactation consultant but not an IBCLC (or is a CLC, CLEC, CLE). This is, at best, an accident, and, at worst, deliberately misleading. There is room for non-IBCLC support for breastfeeding, but, as someone who has provided such support as a CLC for years, it was rare to provide a home visit for a situation that 100% fell within my scope as a CLC and I often needed to make referrals.

Notes: These are listed in no particular order—i.e., this is not an hierarchy. Where possible, I am including resources for outside of the Twin Cities area. The general commentary applies to any locale.

Peer-to-peer support

Peer-to-peer support (sometimes called mother-to-mother support) is provided by people who have breastfed their infants for a certain amount of time (often one year, but qualifications vary), show a passion for helping others breastfeed, and who have received some training in breastfeeding and counseling. While some peer supporters may have advanced qualifications, such as being IBCLCs, their scope of practice is fairly narrow while in the peer support role. They should be willing and able to refer you to a health care provider if your situation warrants it.

The major players on the peer-to-peer support scene are La Leche League, Breastfeeding USA, and WIC (Women, Infants, and Children). La Leche League of Minnesota and the Dakotas covers Minnesota and North and South Dakota, and their website lists support groups by region. There is a robust LLL presence in the Twin Cities metro area, with meetings available almost every day of the week. La Leche League leaders are available through phone, email, text, and in person.

Breastfeeding USA is a small but growing organization of peer-to-peer breastfeeding counselors. Counselors help via phone, email, text, and somtimes meetings. Contact information is listed on the Breastfeeding USA website.

WIC provides supplementary food packages and nutrition counseling, including support with breastfeeding in some Minnesota counties, to those families who meet the income requirements. Something like 50% of families in Minnesota qualify for WIC, so even if you think you may make too much to receive help, it may be worth applying if you have a need. Not all counties have a peer breastfeeding program, but those that do match experienced, trained breastfeeding mothers with WIC participants. Much of the counseling is done over the phone, but some counselors use text or in-person meetings. One big benefit of the WIC program is that if you qualify and they have one on staff, you may be able to see an IBCLC for free. For information about WIC in Minnesota, click here. For contact information for WIC in other states, check out this directory.

I prefer these groups over hospital/clinic/boutique support groups because the facilitators are trained and help maintain quality control of the information shared, and the association with a larger organization leads to greater accountability.

Attending facilitated peer support meetings can be an incredible way to meet other parents who share your values, see breastfeeding babies of various ages in action before and after you have your own baby, and receive help for common breastfeeding and pumping issues. These meetings can encourage friendships that last a lifetime.

Hospital/clinic/boutique support groups

Partly due to the increase in hospitals becoming part of the Baby-Friendly Hospital Initiative (BFHI), partly as a marketing tool, and partly as a desire to increase access to breastfeeding support, support groups that are affiliated with hospitals, clinics, and boutiques/studios are popping up everywhere. BFHI requires hospitals to provide information about breastfeeding support for after the hospital stay, and it makes sense for them to encourage you to stay within their system.

Not everyone who runs or facilitates these groups is a lactation professional, and, at least in the Twin Cities, facilitators tend not to be IBCLCs. Often, facilitators are childbirth educators or those with some basic lactation training—Certified Lactation Counselors (CLCs), Certified Lactation Educator Counselors (CLECs), Certified Lactation Educators (CLEs), and so on. These individuals can provide great support for basic breastfeeding issues and can help connect you to other parents and community resources.

These support groups sometimes offer “baby weigh-ins.” Weigh-ins within the context of a group support situation, and not an individual lactation consult, can be problematic. CLCs, CLECs, CLEs, and other non-IBCLC lactation professionals also do not have a scope of practice that would encompass situations where an infant’s weight gain is an issue. If you do go to support groups with weigh-ins, take this additional data with a  grain of salt. I, and at least some other lactation professionals, feel that weigh-ins are not a best practice.

These support groups are often free or donation-based, and sometimes require a small fee.

Lactation clinics

The number of Twin-Cities-area birth centers, yoga studios, childbirth education studios, baby boutiques, and other baby-related businesses continues to rise. Many are making the smart and supportive move to include lactation-support hours, either through drop-in hours or appointments, as part of their offerings. In some cases, lactation counselors or educators are providing these services; in others, IBCLCs are on hand to help.

These business are often connected with other care providers, too. Common offerings include massage, chiropractic, and acupuncture. Some have midwives, therapists, or herbalists on hand.

Lactation clinic visits are often less expensive with non-IBCLCs and often less expensive than a home visit by an IBCLC. Some care providers offer a choice between a clinic or home visit; you might have a home visit when your baby is very new, and come into the clinic for later follow up. It may be difficult to find such a clinic that will bill insurance directly, and may be difficult to obtain reimbursement from your insurance company, so be prepared to pay up front for services.

Hospital-based and physician-owned clinics

Many Twin Cities hospitals are increasing the number of options they offer for outpatient lactation help. Some of these outpatient clinics are staffed by employees who provide inpatient lactation support, and others only providing outpatient support. Many, but not all, hospitals require their IBCLCs to be RNs. Some clinic “lactation consultants” are not IBCLCs, and it can be difficult to determine if the professional you are seeing is someone who has the right experience, education, and credentials.

Breastfeeding/lactation clinics are not always widely advertised. You may need to call/email your hospital/clinic and ask if they have this service available (or, in this age of Google, search for “[your hospital name] + breastfeeding”).

It is important to note that nurses and doctors do not receive a lot of training on breastfeeding as part of their normal professional education, and being able to provide services as a nurse or physician does not necessarily translate into being able to provide the best-quality lactation support. A care provider who is able to diagnose and treat conditions as well as prescribed medications and is an IBCLC can be very helpful for more complicated cases, such as when there is insufficient glandular tissue, tongue tie, prematurity, etc.

One large benefit of visiting a hospital-based or physician-owned clinic for lactation support is that they will be able to bill your insurance company directly. Under the Affordable Care Act, some lactation services should be covered by your insurance company, but this process may not always be simple. Clinics have dedicated billers and other experts, and lactation professionals in this setting are more readily reimbursed because of their association with licensed providers such as MDs. Another advantage is the ease of sharing medical records between clinics, especially in this era of electronic medical records. This means the lactation professional can have a fuller picture of your medical history, and can share the results of your and your baby’s visit more easily with your other care providers.

One potential limitation of hospital-based and physician-owned clinics is that the appointments may be limited to a specific time slot. You may wish to ask how long your visit will be and if there is a set end time to the appointment. There are clinics that do not limit the time spent.

There are times when the lactation support provided in a hospital-based or physician-owned clinic is offered by an independent contractor, such as a private-practice IBCLC, and not an employee of the health system or clinic.

Private-practice lactation support

Private-practice lactation professionals usually provide visits in your home, and some offer clinic hours (see “Lactation clinics” above). These visits tend to last about 1.5 to 3 hours. Depending upon the individual practitioner’s experience, qualifications, guidelines for practicing, and reason for the visit, the visit may include taking a full history, weighing your baby (including doing a test-weight feeding in some cases), a breast examination, an oral examination of your baby’s mouth, observation and assessment of breastfeeding or pumping, and creating a feeding plan. IBCLCs are the most qualified to provide all of the above.

In-home visits are especially beneficial in the early days of breastfeeding, when rest is a priority. In-home visits offer the IBCLC or other lactation professional to observe your home environment and offer suggestions that may help ease breastfeeding. For example, you could learn how to do side-lying nursing in your own bed and how to make your sleep surface safe for your baby, or you may have overlooked the perfect pillows for body support while breastfeeding.

Hospitals sometimes send home-visiting nurses, sometimes with scales, to visit families with newborns. You may need or want lactation-specific help on top of these visits, depending upon your circumstances.

Payment for private-practice visits are usually made up front. (Some IBCLCs are able to bill insurance directly.) Superbills and receipts can be provided, which you submit to your insurance company in hopes of reimbursement. It is theorized that IBCLC licensure will make it easier for IBCLCs to directly bill insurance companies and obtain reimbursement. For more information on licensure in Minnesota, visit the Minnesota Breastfeeding Coalition website.