Doc Talk: Telehealth Lactation Support

The benefits and advantages of breastfeeding have been widely advertised, but for many mothers, breastfeeding can present significant challenges. In the early weeks, it can be especially difficult. A woman might experience milk that won't come in, babies who won't latch on, breasts that are painful, and other obstacles. Whether it’s your first child, or your third, it’s important to have the support you need to navigate your breastfeeding journey. To better support and help expecting mothers and mothers of newborns, Women’s Comprehensive Health Care and Manchester OB-GYN Associates have partnered with the Nest Collaborative, a collection of International Board-Certified Lactation Consultants (IBCLC) who conduct online, video appointments to help guide moms through the breastfeeding process. We spoke with Briana Huguenel, MD, of Women’s Comprehensive Health Care to learn more about the Nest Collaborative and how moms and moms-to-be can use this new telehealth service to help navigate breastfeeding.

First off, can you explain to people, who might not know, what a lactation consultant is and why someone might need lactation support?

A lactation consultant provides breastfeeding education and clinical support to new and expecting mothers. Anyone can really benefit from a lactation consultant. Prenatal appointments are appropriate to help a mother prepare for breastfeeding and to set them up for success. Any postpartum mother can benefit from a lactation consultant because every baby is different, and your breastfeeding journey with your second, or third baby may be different than with your first child.

Some people may choose to meet with a lactation consultant after their baby is born to confirm they are off to a good start and confirm that what they are already doing is correct. Positive reinforcement and emotional support are always helpful. Not everyone has a family member or friend who has breastfed, so it is nice to feel a connection in the breastfeeding community. Some women have issues that might require more guidance. For example, if you are a mom who had breast surgery, are having issues with low milk supply, or think the baby may have a bad latch due to breast pain or poor infant weight gain, a lactation consultant can be very helpful.

What is the Nest Collaborative and how did your practice get involved?

The Nest Collaborative is a great program led by a group of International Board-Certified Lactation Consultants (IBCLC) who use video appointments to provide lactation support for prenatal and postpartum moms to address lactation concerns including pain, milk supply, latch, positioning, pumping/storage concerns, and return-to-work planning.

WCHC got involved because we are always looking for new ways to provide patient-centered care. We want to be able to bring our services to patients in innovative ways and having telehealth appointments for lactation consultations seemed like a great option. Especially now in the COVID-19 era, it’s important to find new ways for patients to have the resources they need, while staying safe and social distancing.

Why might having a lactation consultation over video be more appealing to expecting mothers and mothers of newborns?

There are a variety of reasons new moms and moms-to-be might prefer to have a consultation over video. It’s important to note, a virtual appointment is when your healthcare is delivered via live telecommunication technology, so you can have these appointments from your home without the need to travel. So I think this is an appealing option for women who have just delivered a baby and are unable to independently travel to office appointments, especially since some lactation issues can require multiple follow up visits. This service also helps women who may have driving restrictions after C-section, who may not have easy access to transportation, or have other children at home who need childcare. And some people may have issues, especially now with COVID, with new people coming into their homes, so they may not want a consultant coming for a home appointment. The Nest Collaborative gives patients another way to access resources to help them.

Another benefit is the lactation consultants work closely with your ObGyn team to provide you with the best breastfeeding support you need. The lactation consultant can send notes from your virtual appointment back to us, your primary care team. This is important because the Nest Collaborative consultants do not prescribe any medications, so your consultant would send over any recommendations that they think you might need to us. Then we can set up an appointment and discuss the recommendation and be able to prescribe the medicine you need.

How can a patient sign up/ schedule an appointment for this service?

You can schedule an appointment online, directly through their website by selecting your preferred lactation consultant, date, and time. You provide your insurance information and they will verify your insurance for you. The Nest Collaborative will then send an email confirmation and an invitation to complete your registration.

One of the best things about this service is, not only are you able to choose a date and time that work for you, but they have profiles of all of their IBCLC on their website so you can read about them and really choose the provider that you thinks fit best. For example, one of their consultants is a mother of twins, so if you are a new mother of twins that might be a good option for you.

Can you walk me through the process of a typical telemed lactation support appointment, how long is the appointment, and what can be discussed during these appointments?

Because you will likely be hands-on with your baby during the visit, they recommend finding a comfortable location with good lighting and Wi-Fi. I would also recommend using a tablet or a computer rather than a phone so it can be sitting on a table and you don’t have to hold it. This way, the lactation consultant can better visualize what you are doing with the baby.

The appointment usually lasts 45 minutes, and you can really talk about whatever you want. Whether it's preparing for transitioning back to work and how you are going pump for the baby, or general breastfeeding practices. Some of the basics that women struggle within the beginning and can make a big difference are latch and positioning. The ergonomics of breastfeeding make a big difference in mom's comfort and the baby's ability to latch on and transfer milk effectively, efficiently, and without causing mom pain. Later on, mothers may have questions about how to balance returning to work and pumping for baby, or adjusting the feeding schedule to optimize mom's and baby's sleep as time goes on. The appointments are very patient-driven because it’s about what the patient needs or wants to discuss.

How can women get the most out of their appointment?

I would make sure you have thought about your needs ahead of time, and that you are in a set up at home where the lactation consultant can visualize what you are doing. Also, if you are looking for help for feeding, it is important that you select an appointment time where the baby would normally be feeding. That way the baby is awake and hungry and you can get the most out of the appointment.

What do you think is important for women to know about this service?

The great thing about this service is all the lactation consultants are mothers, so they have first-hand experience with breastfeeding, and then most of them have 10 years of experience as an IBCLC. An IBCLC certification requires thousands of hours of experience and training and having a unique body of knowledge and skill to provide breastfeeding and lactation care in routine and high-risk situations.

Is this service covered by insurance?

Yes, most commercial health plans cover lactation visits with no co-pay and no deductible. This is provided under state and federal (ACA) mandates.

They are in-network with:

• Blue Cross Blue Shield
• Aetna
• United Healthcare
• Oxford Healthcare
• Husky (CT)
• Cigna
• Johns Hopkins Healthcare (EHP)
• Tricare (Prime and Standard)
• Multiplan

Is there anything else you would like to add/ have patients know?

The Nest Collaborative seems very invested in physical, emotional, and logistical support of the breastfeeding experience to really help mothers make breastfeeding what they want it to be. And especially early on, some mothers can have some big challenges in their breastfeeding journey, and these lactation consultants want to help and provide ongoing support. I hope this service allows women to breastfeed with more ease, so they can enjoy the experience and do it for as long as they want.

If you are in need of breastfeeding support, there are many practices at Women’s Health Connecticut’s who have lactation consultants on-staff and all our divisions are affiliated with hospitals that have access to lactation support. You can also learn more about Nest Collaborative here.