Second baby, he's five weeks, and I have a 2yo who is currently eating dry cereal off the floor while I type this, so forgive the typos!
Around week two my nipples were creased flat coming out, like a lipstick, that shape everyone describes, and the pain was making me dread the letdown. With my first I never had this. I assumed second baby, easier, I know what I'm doing. I did not!
So I booked with a "lactation consultant" who does appointments out of a boutique baby store here in Sacramento. Her website said lactation consultant. Her sign said lactation consultant. She said lactation consultant on the phone. $225, cash, no superbill, and I paid it happily because I was in pain and I wanted help.
She watched maybe four minutes of a feed. Did not weigh him before or after. Did not put a gloved finger in his mouth. She looked under his tongue for a couple of seconds with her phone flashlight and said "posterior tongue tie, that's your problem," and handed me a card for a pediatric dentist who does laser releases. $700, cash, and he had an opening that Thursday.
I almost booked it. I was one tap from booking it. My husband, who is not a nervous person and does not usually push back on medical stuff, said something like, is she a doctor? And I said no, she's a lactation consultant, and he said okay, but what IS that. And I couldn't answer! i had paid this woman $225 and I could not tell you what her training was.
Here's what I found out. "Lactation consultant" is not a protected title in the US. Anyone can print it on a sign. The credential is IBCLC. Board certified, hundreds of supervised clinical hours, an exam, recertification. What she actually had was a weekend "lactation educator" certificate. Which is not nothing! It's a real thing that helps real people! It is also not the person who should be pointing at my son's mouth and sending me to a laser.
I found an actual IBCLC through the ILCA directory. $250. MORE than I paid the first woman! And it was ninety minutes. She weighed him before the feed and after (he transferred 2.7 oz in 18 minutes, which she said was great). She watched me latch him three different ways. And then she pointed out that I was doing the whole feed hunched sideways on the couch with one arm out, because my 2yo was climbing me, and my son was getting a shallow latch because I was physically not able to bring him to me.
She said, and I'm quoting: "I do see some restriction under his tongue. I'm not the person who diagnoses that. If we fix positioning and you still hurt in ten days, I'll send you for a functional assessment. A lot of what I see under tongues never needs releasing."
Six days of side-lying and a rolled towel and the pain is gone. Gone! My son still has whatever is under his tongue. He doesn't need a laser, he needed his mother to not be feeding him at a 45 degree angle while refereeing a toddler.
I'm not writing this to trash the first woman. I'm writing it because I have a graduate degree and I could not tell those two job titles apart, and I was four minutes and $700 from a surgical procedure on a five-week-old. How is anyone supposed to know this?
Priya, this is the post I've wanted someone to write for two years!! And I'm going to be linking it constantly, so thank you for putting a number and a Thursday appointment on it! Abstract warnings about credentials do nothing. "I was one tap from booking a laser" does everything.
Can I ask you something specific? What did her listing actually say? The words, verbatim, on the website or in the store. Because I run a directory and I need to know whether the failure was that she called herself something misleading, or whether she called herself something accurate that nobody...
Okay this thread has me spiraling a little because my baby is 5 months and I saw somebody at the hospital at day two who I could not describe to you now! She was in scrubs. That's all I've got.
Logistics questions, since I never got a straight answer anywhere: how do you actually find an IBCLC who isn't just whoever the hospital sends in? Priya said ILCA, is that the FALC directory? And separately, my friend used The Lactation Network and told me she never got a bill at all, which sounds fake to me?! Not a cheaper bill. NO...
Taking these in order.
Finding one: yes, ILCA's Find a Lactation Consultant directory (FALC). Everyone on it is an IBCLC by definition. That's exactly the filtering Priya didn't have. USLCA has a directory too. Local Facebook mom groups are honestly the highest-yield source, but ask for the letters, because the recommendation you'll get is "see Karen, she's amazing" and Karen may be anything.
The Lactation Network: real, not fake. They contract with certain insurers and bill them directly, so you may never see a bill. Usually a small number of visits, and it depends entirely on your plan and whether they have...
I'm the counterweight here I think. Mine was a real one and we did release it, and I still want people to hear this.
Three weeks pp, my LO couldn't sustain a latch for more than 90 seconds, clicked the whole time, and I had lost 40% of one nipple by week two. Real IBCLC, real functional assessment, then a pediatric ENT in Denver. Anterior tie, and he also had a lip tie the IBCLC had flagged. $850, not covered. It worked. Within four days I was not crying during feeds.
But nobody prepares you for the aftercare. Stretches four times a...
IBCLC here, and the "how is anyone supposed to know this" part has an answer. You aren't. That's the design, not your failure.
Roughly, the landscape:
IBCLC. International Board Certified Lactation Consultant. Around 95 hours of lactation education, a stack of health science prerequisites, and between 300 and 1,000 supervised clinical hours depending which pathway you come through. Then a board exam, and you recertify every five years. It's the only credential in this space with an independent board behind it. Mine took me two and a half years and it was the hardest thing I've done.
CLC. Certified Lactation Counselor. Roughly a...
"What's your L number." I'm putting that in my phone notes right now, next to "gap exception" from that other thread!
What's still sitting badly with me is that the first woman wasn't a con artist. She was nice. She held my baby. She was trying to help me and she believed what she told me. That's almost worse than if she'd been a fraud, because there's nobody to be angry at, it's just a hole in the middle of everything where the information should be.
Also, embarrassing, but the $250 one felt like a splurge and the $225 one felt like...