Q&A With International Board Certified Lactation Consultant, Julie Matheney
Tell us a little bit about who you are and your credentials.
My name is Julie and I have a masters degree in speech pathology and am board certified as a lactation consultant. I work in a hospital doing both types of work. My job as a speech therapist there is primarily feeding preemies in the NICU and feeding adults who have swallowing problems from stroke, car accidents, cancer or other medical issues. I also work on the postpartum floors helping moms feed their new babies. My main passion is my private practice as a lactation consultant. I love helping moms feed their babies and use my medical background to help them achieve their breastfeeding goals.
What made you decide to become an LC?
I told my mom when I was ten years old that I wanted a career where I could feed babies. But I didn’t want to be a nurse and deal with the shots and blood. So I found speech pathology and learned I could feed babies doing that. In my work in the NICU with preemies as a therapist, I realized my true passion was helping moms and their babies and not just bottle feeding. So I pursued lactation consultation and it’s my dream job.
What is your favorite aspect of your job?
I love empowering moms in feeling confident to feed their babies. There’s no greater feeling than seeing a mom go from struggling to feed her baby to giving her the tools to do it herself and see her succeed.
What does a lactation consultant do?
Lactation consultants specialize in all things related to feeding babies at or near the breast/chest. We work with pregnant and lactating people to reach their goals of feeding the babies. Breastfeeding changes as baby ages. In the early days after birth we work on position, latch and establishing milk supply. We help problem solve issues like plugged ducts and increasing milk supply. If baby needed to take a bottle we also help transition baby back to breast. We can also help people who have never been pregnant to lactate, including adoptive moms or people in same sex relationships. We also help manage all kind of issues with the breast such as low supply, breast infections, pumping and connecting moms to local resources for their babies.
What is IBCLC and why is this important?
International Board Certified Lactation Consultant. This is the gold standard for lactation care. It means the lactation consultant has taken substantial coursework related specifically to breastfeeding, has completed hundreds of clinical hours with a mentor in the field, and sat for a 4 hour board exam. It’s a lot of work and makes us qualified to provide the best quality care to our families. Not everyone who calls themselves a lactation consultant is board certified.
Why should a breastfeeding mom see an LC?
Breastfeeding is natural but can still be a struggle and need nurtured. We no longer live in a tribal community where we are other people breastfeeding, so it can be hard to know what to do. Lactation consultants provide the support to successfully breastfeed and help when challenges arise. If you have any doubts, feel like something isn’t right, have pain or nipple damage, have had breast surgeries or are struggling to breastfeed, there’s help.
How do I know if I’m receiving good breastfeeding support from the hospital staff or clinic?
You should feel heard and the information you receive should be clear and concise. If you can’t repeat back what you are being told, it has not been explained well. You should also be hearing consistent information across staff members. You should feel like you have a plan that fits with your lifestyle and that you can follow. Having information written out for you is also so helpful. It’s hard to retain information when you’ve just given birth.
Can an LC help moms who are exclusively pumping? If so, how?
Absolutely! We can help get your pump fitted specifically to your breast to maximize supply. We can also help with strategies such as pump settings to maximize output. If you are exclusively pumping not by choice and eventually want to go back to having baby at the breast we can also help with that transition.
How can a mom find an IBCLC?
The simplest way is to do a google search for an IBCLC in private practice in your area. Yelp can also be a helpful tool. There are also many local moms groups on Facebook which can be helpful to ask who is recommended in your area. Your pediatrician, midwife, or OB may also have a list that they refer to.
What is an “average” charge for a session with an LC?
This really depends on the city and state you live in. Country towns are always cheaper than large urban areas. In Los Angeles it seems most consultations are between $180-250 for an initial consultation with possible travel fees depending on where you live.
Does health insurance cover LC services?
Legally lactation services should be covered as preventative services at 100% according to the laws of the Affordable Health Care Act. Insurance companies try to get around this in various ways, but legally it’s your right to have them covered. Some lactation consultants are in network with different insurance companies and you can get a list directly from your insurance company. Some will provide you with a superbill which you can submit to your insurance company for reimbursement. If your claim gets denied, you’ll often have to resubmit the claim or speak with a representative as legally services should be covered.
Do you know of any access to free or income based LC services?
WIC has free breastfeeding services for all women enrolled in their services. Some hospitals have free outpatient lactation services if you gave birth there. The La Leche League also often has free community resources.
What is the best way to prepare for “successful” breastfeeding?
Take a prenatal breastfeeding class in the community or at your Birthing hospital or birth center. Know what to expect and set up realistic expectations through educating yourself.
What can I expect in the first few days of breastfeeding after birth?
It can vary greatly depending on your birth. Most babies will be quietly awake in the first hour and want to breastfeed in that period of time. Babies coming through a long labor and delivery will be sleepy. Most babies will sleep on and off the first day and want to be up at night. The second night is the hardest. Most babies will go through a period of cluster feeding and fussiness. Mom will still have colostrum, milk won’t have transitioned to mature milk yet, and baby will want to feed all the time, making mom question herself and her milk. This is when many, many moms reach for the formula. But this is normal. Baby is cluster feeding to stimulate your milk production and swallowing to help themselves poop. Around the third day, milk will start to transition to mature milk if it has been stimulated well in those first three days.
Is breastfeeding supposed to hurt?
Nipple tenderness in the first five days after birth is normal. Nipple tenderness that lasts for the first few sucks while baby is adjusting into the latch is normal. Your baby practiced sucking and swallowing in the womb by sucking on their fingers and the umbilical cord. They need a few days to stretch out from the cramped quarters of the womb and figure out how to use their mouth since they’ve never done it before. Toe curling pain, pinching, clamping on the nipple and nipple damage are never normal and there is always a cause: either baby is in a poor position at the breast, baby is not latched deeply enough, baby has a tongue tie or there is tension in their body from Intrauterine or labor positioning. Damage. Is. Not. Normal. It may now be culturally acceptable because it happens to a lot of women, but it is not normal and can/should be fixed.
How do I know if my milk has come in?
Colostrum is milk. It is in the breast starting between 10 to 14 weeks gestation. This is so that no matter how early the baby is born, mama is ready to feed the baby. Some women may see colostrum dripping from their breasts between 34 to 38 weeks. The birth of the placenta triggers hormones to release colostrum from the breast and start a chain reaction to transition colostrum to mature milk. Colostrum will transition to mature milk sometime between 3-5 days after birth. Your breasts will go through a process of natural engorgement where they will get full, maybe lumpy, hit or heavy. You may see blue blood vessels on the breasts. This is a sign your milk is transitioning. The fullness softens when you feed. Heat, massage, and frequently emptying the breast make the transition smoother and the actual engorgement and transition usually takes around 24 hours.
How do I know if I’m producing enough milk?
The best signs are a pain free latch, seeing baby actively suck and hearing baby frequently swallow while at the breast, baby making lots of wet and dirty diapers and baby gaining weight over time.
Is the amount of milk I produce when I pump a sign of how much my baby is getting when they feed?
An electric pump is never as efficient as a baby. Pumping is not a true indicator of milk supply as it cannot empty as well as a baby. Some moms do respond well to pumps and can pump large volumes of milk. Some moms don’t respond well at all to pumps and while they can successfully breastfeed their babies may not be able to pump hardly any milk.
What increases lactation or would you suggest to boost production for moms who struggle with milk supply?
The best way to make milk is to empty milk. The more frequently a mom pumps or feeds the more milk she will make. The longer she goes between pumping or feeding the less milk she will make. Find a lactation consultant to help you figure out why your supply is low and get to the root of the issue. .
Do lactation cookies and teas really work?
Honestly the best way to make milk is to empty milk. The more frequently the breast is emptied the faster it will make milk. Teas and cookies are supportive of lactation, but so is eating a well balanced diet with quality protein and healthy fats. There are some cases where using herbs can be beneficial, like separation from your baby at birth, not having sufficient glandular tissue in the breast, having a large blood loss at birth or being and exclusive pumper.
Why does lactation decrease?
When a baby is first born, the uterus doesn’t tell the breasts how many babies there are, so the breasts go into overdrive to feed whatever came out. Once birth hormones regulate, the body becomes efficient and supply drops to just what the baby demands from it.
Are there lactation problems after a cesarean birth?
A c-section may delay when you actually start breastfeeding. Early, frequent breastfeeding is important to get Lactation off to a good start, so asking to hold baby in skin to skin as soon as possible helps. Some women may have a delay in their milk transitioning (up to 7-10 days) put baby to breast often and depending on circumstances initiating pumping right away can help. Some women experience pain at the surgical site and may have difficulties getting into a comfortable position when trying to breastfeed. Football hold tends to work well as it minimizes pressure on the stitches. The emotional impact of a surgical birth, especially if it was unplanned, can also take a toll. Finding someone to talk to about your birth experience and processing through your experience can be helpful. Get help from a lactation consultant right away if you have any concerns.
How do I prevent clogged milk ducts?
There are several causes of clogs: right fitting clothes or bras that prevent milk from freely flowing in the breast, sleeping in a position that stops the flow of milk in the breast, and not emptying the breast routinely. The best way to prevent clogs is to be frequently emptying the breast every 1-3 hours when baby is under 2 weeks and every 1-4 hours for the first three or more months. If someone else is feeding your baby, your breasts still need to feed something. Feed yourself baby or feed your pump. That helps milk from sitting in the breast which causes the fat in the milk to clog the ducts.
How do you know if you have an “oversupply” and what can you do to manage it?
You’ll often know. Your breasts will feel very uncomfortable and full even after feeding and it makes you more prone to plugged ducts. An average milk supply is making somewhere around 20-30 ounces a day. The average baby takes 24 ounces in 24 hours. I’ve seen moms pumping 40-60 ounces a day. That’s enough for twins. Pumping and trying to empty the breast actually makes it worse. You want to gradually pump less milk (shorten pump sessions and slowly space them out) while letting your body adjust. Hand express or pump just to comfort and not to empty the breast. Using a cold, green cabbage leaf in the bra for 20 minutes once or twice a day for 2-3 days can also quickly drop supply.
What is a tongue or lip tie and why is diagnosing it important?
Our tongues need to go side to side, up and down, and in and out. A tongue tie is when the connective tissue that connects the tongue to the floor of the mouth is too short or tight and doesn’t allow the tongue to move in these directions.
You usually can’t tell if a tongue is tied just by looking at it unless it’s a very tight tie to the tip of the tongue. Some people have that little connective tissue under the tongue and it moves just fine. In others you can’t see it because it’s all the way at the back of the underside of the tongue and you can only find the tie by lifting up on the tongue. Obvious tongue ties are when the tissue comes all the way to the tip of the tongue and makes the end of the tongue look like a heart.
Symptoms of tongue tie:
Difficulty latching or staying latched
Popping on and off the breast
Painful latch that doesn’t go away with better positioning
Pinched or damaged nipples
Low milk supply
Baby feeding a really long time and still not satisfied
Gassy, fussy, colicky baby
Baby not making enough wet and dirty diapers
Making a clicking sound while feeding
Reflux
Recurrent mastitis
Mouth breathing as an infant is NEVER normal unless baby has a stuffy nose
Infant snoring
If someone tells you there’s no tongue tie because baby can stick out their tongue, that person does not understand the tongue and all its planes of movement. People with severely tight ties can still stick the tongue out. It’s the middle of the tongue and its ability to lift that tells us whether or not it’s tied. Be wary of people telling you from a picture alone if a tongue is tied. We don’t want to put your baby through a surgical procedure if it’s not necessary. However when it is a tie and necessary, it can make a world of difference.
What is “comfort nursing” and is it something I should be worried about?
Babies in the first few months rely on instinct and reflex. Their instinct is to be with or on a caregiver, especially mom, to survive. Comfort nursing is when a baby isn’t really hungry, they just want to be on the breast to comfort. This is normal and biological. The breast means safety, security, pain relief, comfort, happiness, and growth.Stimulation of the breast, even when only for comfort, also helps maintain your milk supply. If you’re not sure if a baby is still hungry or just wants to comfort, it’s totally fine to put them to the breast. When in doubt, boob out. If you’re feeling touched out, it’s also ok to soothe the baby in other ways.
For more breastfeeding tips and tricks, follow me on Instagram @lalactation. Feel free to email me at Lalactation@gmail.com I am available for phone, home and office consultations!
