How to interview a lactation professional.

I’ve thought about this some, but then it came up in the comments for another post. A few of my posts reflect ideas I’ve had on this topic, so I’m going to expand on those as well as adding some new thoughts.

This should probably be broken into two groups: Prospective mothers (expecting), and/or those requiring generalist help and current mothers who have experienced a problem.

Let’s cover expectant mothers first.

If you are expecting your first baby, or your first baby you wish to breastfeed, you want to make sure you have an adequate amount of support. You should be focusing first on what resources are available to you.  This means checking with your hospital, your birth care provider, your pediatrician (if you are in the US for example), your local LLL chapter as well as seeing what private lactation professionals there are in your area. You should focus on how to access the services and what the cost will be to you. Having knowledge of where to find these resources is just as important as a birth plan, and for much the same reasons. The goal is to educate yourself to make informed choices. In addition, trying to find a lactation professional when you are desperate for help does not allow you to make informed choices. Try not to wait until you are desperate.

General questions to ask:

  • What are your qualifications? Here is a lovely guide I found on what all the titles mean.
  • How long in practice?
  • Is there any particular area you have additional expertise or interest in? (If you’ve got low supply and you are talking to a IBCLC specializing in oversupply she might not have the resources to give you the best help. If you are surveying what is available in your area then this is information worthy of noting down.)
  • What are your working hours? Do you work out of any hospitals or clinics?
  • What are your fees? What are your followup policies?
  • What breastfeeding challenges have you seen, treated, or overcome yourself?
  • Do many of your clients meet their breastfeeding goals?
  • If I experience a problem outside your area of expertise do you feel you have relevant resources to refer me elsewhere? What would you consider outside your area of expertise?
  • If I experience problems it will likely be a very emotionally turbulent time for me. Have you had experience supporting decision making and coming to a consensus about ways to resolve the problem (your provider should be willing to have a back and forth with you and if you decide that enough is enough support you in that as I refer to in this post).
  • What kinds of issues have been most difficult for you to help mothers and babies with and why? (as in, do they find the mother’s determination lacking, are surgical referrals difficult to get, etc. This is should act as a sounding board for their typical experience, if they have professional peeves as well as how understanding they may be to your situation)
  • How do you generally balance a mother’s well being with her initial desire to breastfeed? How do you manage situations that do not meet expectations and goals?

I also think that pursuant to this list, some of the general things you should ask a lactation professional if they have experience in are:

  • Do you have experience identifying lip and tongue ties, including posterior ties as well as other oral abnormalities like bubble palate? Are you confident identifying these types of abnormalities?
  • Do you have experience identifying a breast with  insufficient glandular tissue?
  • If you are a first time mother at risk for breastfeeding difficulties (PCOS, diabetes gestational or otherwise, history of thyroid disorders, lack of breast changes) you should certainly mention that. An appropriate response to my view would be a physical examination of the breasts as well as a wait and see with potential aggressive treatment if desired. Go the other way if you are told that any of those things will not matter.

Now for mothers who have previously experienced issues or are currently experiencing issues.

You’ll want any of the above that seem relevant as well as the following.

Specific questions:

Most of these are fairly situational so choose or adapt any that seem appropriate to you.

  • My issue last time was X. Will you help me explore solutions for that? How will you do that?

I’ve found some sounding board questions quite helpful to see how much recent research has been kept up with. You might ask if they know about the link between PCOS and breastfeeding issues, thyroid problems and breastfeeding difficulties, or even a more general tricksy question-what medical factors are you aware of that influence milk production in the mother and milk extraction or digestion in the baby?

  • What are your guidelines for supplementation in the infant.?

This is a personal preference one. The answers may range from over 7-10% weight loss, to watch the baby. I’d be wary if they say that supplementation is almost never necessary. If they say that I’d follow up with askance for some clarification i.e. in general or among your clients? What techniques do you use then for managing babies with milk extraction issues or mothers with milk production or ejection issues?

  • If supplementation becomes necessary which methods will you support me with? Are there any you will not support?

If you used donor milk last time and plan to should it become necessary again you’ll want a professional that supports you in that. If you used formula and prefer that, again, support. If you want to use bottles, you’ll want support in managing that, if you don’t you’ll want tips on other feeding methods.

  • As my issue was X last time can you give me some realistic expectations on what management of this issue will look like on a daily basis and what difficulties I am likely to face?

If they tell you you’ll need to pump 15 times a day as well as do some other things and this does not seem sustainable to you because of other children then bring that up. Discussion about an action plan is key.

  • Make sure to mention things you did or tried previously and whether or not you feel they worked as well as whether you’d be willing to do them again.

For instance, I tried domperidone and it inhibited my letdown reflex, and I am open to supplementing via SNS if it can be demonstrated to me that an oral abnormality is not the issue etc. You don’t need the frustration of reinventing the wheel and to avoid that the LC will need as much information as you can give her.

Warning signs:
  • Being told to wait and see or being told that every baby is different when you’ve experienced issues previously. Wait and see is a reasonable approach for some things but not if you want to be proactive. With some things it’s important to act quickly.
  • Your LC should never touch your breasts without permission.
provide support and encouragement to enable mothers
to successfully meet their breastfeeding goals

So if your goal is to breastfeed for 2 months then move to combination feeding for the next year she should be able to give you strategies on how to do that. She should also be supportive of your goals and willing to have an open and non-judgmental conversation with you. If your goal is to exclusively breastfeed with contraindicating issues she may (unpopularly) explain that that may not be possible, but give you long term management tips.

Note: there are a range of breastfeeding topics I do not have much experience with. Issues like oversupply, feeding multiples, flat or inverted nipples, breast size issues, prematurity in the infant, allergies in the infant, and reflux as well as others so I can’t give examples of more specific questions relating to those issues. However I can say that if any of your concerns are brushed off without explanation that is cause for alarm.
Overall you want to be having a conversation. Figuring out if this is the right person to help you if and when you need help.
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4 Comments

  1. So awesome! As I was reading I’d come up with questions and then the next line you’d have that question, but you had worded it way better. Bookmarked and ready to fire off at people asking about LCs. Who knows, maybe in a couple years I’ll get to use it!

    Reply
  2. Glad you like it. I’d thought of a few scenarios like elimination diets and such where I hadn’t had much experience (our elimination diet wasn’t nutritionally threatening to me, just annoying), but the best way I was able to sum it up was in the How do you balance a mother’s well being question (since that one can also cover a lot of other medical issues I hope).
    I’m open to suggestions for other questions as well!

    Reply
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