Question 1

Where do you make home visits?

Accepted Answer

My service area is listed here.

However, please do not hesitate to reach out if you don't see your city/town/neighborhood listed! I will try to visit you anyway if I can or recommend a trusted colleague who may be able to.

Question 2

Will insurance cover your home visit?

Accepted Answer

In most cases, yes!

Lactation care is mandated under the ACA. This means that insurance companies have to cover lactation support. For Aetna and MGB, I am in network to bill them directly, meaning I visit you at home, and send them the bill, and they pay for your visit.

For other plans, I am not in network so coverage has more steps and I cannot bill your insurance directly. Instead, you pay me for my services, and then I provide a receipt and a superbill which you then submit to the insurance so they can pay you back in full for the visit. This usually happens pretty quickly (within a week or two of you submitting the request to them).

Because insurance is complex, the best way to verify for sure they will cover my visit is to just call or message them and ask! If needed, my NPI number is 1073932059

Question 3

What do you do in a home visit?

Accepted Answer

We'll chat for a bit about your health, life, baby's health, birth story, your feeding goals, and what you would like help with. I'll weigh your baby in his/her diaper on a super accurate scale (it can measure to 2g which is about the weight of a dime!).

With your permission, I'll do an oral exam on your baby with gloves on to feel how they are using their tongue, lips, and facial muscles and the strength and pattern of their suck.

Then, I'll observe a feed at the breast and we'll weigh the baby again after the feed so we can see exactly how much milk was transferred.

After collecting all of that information, we'll then make a clear plan that works for you as an individual for addressing your struggles and concerns.

Later that day, I'll also fax a copy of my note to your pediatrician so they stay in the loop, as well as any other care provider you would like me to keep updated.

Question 4

How long does a home visit last?

Accepted Answer

Generally, we get through what we need to in about 1 to 1.5 hours but if we need a little longer, that's OK too.

Question 5

Do things need to be really wrong to be able to have a home visit?

Accepted Answer

No!

Nothing needs to be wrong for you to access lactation care or to have me come to you. Even in perfectly normal situations where all is going well, breastfeeding can still feel hard and confusing. Lactation care is considered a preventive care service meaning you have a right to it, and can benefit from it, to keep you healthy and set you up for success, even if you are not experiencing a specific or complex problem. Some of my favorite visits are when I can reassure patients that nothing is wrong!

Similarly, you do not need to wait until things get "bad enough" to ask for help. It's almost always easier to solve problems when they are still small instead of waiting for them to get bigger.

Question 6

How should I get ready for your visit?

Accepted Answer

Since for most concerns, I will be observing a feeding, it's best if your baby is a little hungry when I get there. This usually means feeding him/her about 2 hours before our scheduled visit time so that your baby is hungry but not hangry when I arrive! 
I'll weigh your baby in his/her diaper before you feed, so it's best to be able to undress him/her fairly quickly (just in case he/she is hungry, not because I'm in a rush!).

However, babies don't know the plan! So often they get hungry when we don't expect, need a diaper changed right after the last one, etc., and I go with the flow of the baby, always.

Most importantly, things you should NOT do are: clean the house, change out of your pajamas or brush your hair unless you want to, or do anything else special to get ready for me. I have two little kids and there are frequently cheerios on the kitchen floor and alwasy a basket of laundry waiting to be folded, so please know I am not judging the state your home!

Question 7

Do you do virtual visits?

Accepted Answer

I do! They are covered by most insurance plans. I do my virtual visits on a secure, HIPAA complaint platform that does not require you to install anything on your end.

Usually, I prefer to have the initial visit be a home visit so I can get a full assessment of the situation at hand, including your baby's weight, a weighted feed, and an oral exam, which are things that are not possible to do via video. However, if you are a new patient and you would prefer to be seen virtually to start or prefer all virtual care for any reason, I'm happy to accommodate!

Question 8

Can I just ask you a question about my baby real quick without a visit?

Accepted Answer

If I have seen you recently (in the last 6-12 months), sure! Since I will have gathered lots of information on you in your initial visit(s), likely I can answer simple follow up questions by email or text.

For patients I have not yet met, no! This is not to be unhelpful, but because what sometimes seems simple can be complex and I do not want to cause harm by giving you an answer to your question without the complete information that would come from a visit.

However, if you truly have a simple question, please take a look at my resources and FAQ as I may have answered that or link to information that does!

Question 9

Can I drink alcohol when I am breastfeeding?

Accepted Answer

While no alcohol at all is the safest practice, the short answer is that one standard drink has not been shown to be harmful to babies. The amount of alcohol in milk mirrors the alcohol levels circulating in the lactating person. Safest practice is to nurse or pump, then have an alcoholic drink immediately after, and then wait 2-3 hours to nurse or pump again. In this scenario, there is no need to pump and dump!

More info from the CDC is here.

There are a number of companies that make alcohol test strips for breastmilk to test if the milk is safe to consume for your baby. Following the above guidelines, you do not need to test, but if for peace of mind, or you have had more alcohol than you planned and want to test, these can be helpful tools.

Question 10

Can I drink coffee while I am breastfeeding?

Accepted Answer

The short answer is this is usually OK! Caffeine usually passes through to breastmilk in low levels, and the CDC considers 300mg of caffeine to be OK for breastfed babies (generally 300mg of caffeine = 2-3 cups of coffee).

Very occasionally, some babies are quite sensitive to caffeine. This is usually not dangerous, but these babies may act jittery, irritable, or sleep poorly after their breastfeeding parent has caffeine. In these cases, it's best to avoid caffeine. 
https://www.cdc.gov/breastfeeding-special-circumstances/hcp/diet-micronutrients/maternal-diet.html

Question 11

Do I need to take herbs/lactation tea/lactation cookies/drink Body Armor every day to make enough milk?

Accepted Answer

The short answer is probably not, but if you want to, it's likely OK in moderation (but check interactions with other medications or health conditions first!)

We have very little high quality evidence on galactogogues (things that can increase your milk supply). This does not mean that they are not helpful but just that we can't say with scientific certainty that they are. Many cultures traditionally serve foods to post partum women to support their milk supply, and they may be helpful and certainly are not harmful.

However, the most important driver of milk supply is milk removal/transfer from the breast, and while galactogogues may boost supply, they will not help much if milk removal / transfer are not also going well. If you have low milk supply, it really is best to have an IBCLC evaluate for the root cause of the issue and make a comprehensive plan to address it.

If your milk supply seems to be fine and your baby is gaining weight normally, then likely a galactogogue is not needed. Save your money and buy something else nice for yourself!

Question 12

Do I need to eat a special diet or eliminate foods when breastfeeding?

Accepted Answer

Usually no!  There is no need to proactively eliminate any food groups to prevent allergies or reactions in your baby. For most breastfeeding parents, eating a normal, balanced, healthy (or healthy most of the time!) diet is just fine.

If your baby seems to be having an allergic reaction to something in your diet, you may need to identify it and eliminate it. This can be a very tricky thing to pin down, however!

Before you eliminate multiple major food groups or foods you love, I highly recommend working with a dietician who understands breastfeeding so that you can be on the least restrictive diet that supports your and your baby's nutrition.
The Free to Feed free course for parents is also a good place to start understanding allergies and elimination diets.

Question 13

How do I know if my baby has a tongue tie?

Accepted Answer

There is no one, simple way to identify an oral restriction in a baby (which is frustrating for all of us!)

A tongue tie is both an anatomical and functional problem, so it's difficult to tell from exam alone if your baby is tongue tied. I have seen what anatomically looks like very tight, restricted tissue in babies that feed remarkably well, and what look like very minor ties in babies that do not transfer milk well and cause severe pain to their breastfeeding parent.

If you baby is feeding well with no breast pain on your part and baby is happy and gaining weight normally, there is usually no reason to worry.
If you are experiencing nipple pain, damage, poor weight gain, low milk supply, prolonged feedings, sleepy feedings, or other problems, a tongue tie can sometimes be the cause, or one of many the causes of these things. The best way to determine if a tongue tie is present and affecting feeding is to have a comprehensive visit including a thorough oral exam from an IBCLC who is educated about ties.

Question 14

Is the medication I was prescribed safe for breastfeeding?

Accepted Answer

My favorite resource for medication compatibility with breastfeeding is e-lactancia.

It's easy to use with clear, color coded answers. For medicines in the "likely safe"/yellow category, it's important to have a thorough conversation about the risks and benefits of the medication with your care providers so you can make the best decision for you and your family. Lactmed and InfantRisk are also helpful resources for the more detailed information that you and your team may find helpful in making nuanced risk/benefit decisions. I'm also happy to weigh in on these decisions anytime!