Women and health professionals often assume
that breastfeeding is such a natural process that anyone should be able to do it without
difficulty. The fact is that many women are not confident about their ability and often
stop nursing their babies, before they had planned, due to problems that are avoidable or
easily managed.
Lactation support services, both before and
after the baby is born offer information, support, and technical assistance. The following
information is meant as a guide to those services.
Breastfeeding Classes
Prenatal breastfeeding classes can provide general information on
breastfeeding basics, teach techniques to make it easier, and suggest problem solving
strategies. Knowing the normal course of breastfeeding and how to avoid the most common
pitfalls before the baby is born contributes to a longer, more satisfying breastfeeding
experience. The increased knowledge and confidence is worth the few hours invested in a
prenatal class.
Classes may be offered as part of a childbirth preparation series, as a
separate class at a hospital, or be taught privately by a lactation professional.
Sometimes a class taught by an employee of a hospital or medical group has its class
content (particularly consumer issues) influenced by the employer. A good way to tell if
the teacher is an employee is by whom you pay for the class. Independent practitioners
usually get paid directly.
Classes are usually more effective when taught in small groups. It is desirable to have
your support person attend with you. Additional features may include live demonstration of
techniques and postpartum follow-up by phone or personal consult. You can use the
directory within or ask your childbirth educator, hospital or health care provider for a
referral.
In the event no breastfeeding classes are available, helpful support and information
can be gotten from a
good breastfeeding book, other
nursing mothers, and by visiting breastfeeding resources of this
site.
Mother-to-mother support groups like La Leche
League are also good resources.
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Breast Pump
Rentals
Breast pumps and other breastfeeding accessories may be rented
and/or sold by rental stations. They may be individuals with or without special knowledge
about breastfeeding. Types of equipment and fees vary so shop around. Some insurance
policies will cover rental costs if there is a medical indication.
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Lactation Professionals
Finding and choosing a lactation professional can be a confusing matter. There is a
wide array of individuals who offer lactation services with different levels of training
and skills. Some are licensed health practitioners while others have no medical
background.
Since the field is not a licensed profession, individual practitioners may call
themselves Lactation Educator, Lactation Consultant, Lactation Specialist, Lactation
Counselor and so on. To find a competent practitioner you can work with, consider the
following criteria:
Academic Credentials - What are their academic credentials
related to breastfeeding? Where did they get their training? A practitioner may have no
formal training, may have taken a university certification course, may have passed a
written certification exam, or taken a correspondence course. They may be a doctor (MD),
nurse (RN, LVN), occupational or physical therapist (OT, PT), a registered dietitian (RD)
or speech therapist. They may call themselves a certified lactation educator (CLE),
certified lactation consultant (CLC or IBCLC), a certified lactation specialist (CLS) or a
certified lactation counselor(**CLC). This can be very confusing. You can ask to see their
official credentials if you wish.
Experience - What did their lactation training consist of?
Was there a clinical component? How many years of experience do they have? Training
and experience vary widely among practitioners, so ask about it.
Services - What kind of services do they offer? Classes, phone
counseling, in person consults, rental and/or sale of breast pumps or other breastfeeding
accessories are possible.
Location - Where are services provided? Are home or hospital
visits made?
Fees - What are the fees for the various levels of service?
Costs may be eligible for insurance reimbursement. Fee schedules vary so shop around. Some
practitioners offer a sliding scale. Ask for an official bill to submit to your insurance
carrier. See pages 20 - 22 for free and MediCal reimbursable services.
Business Hours - When are services available? Is there coverage
for evenings and weekends?
Affiliations - Is the practitioner affiliated with a hospital
or particular medical group?
Continuing Education - How does the practitioner keep up with
the current research and issues in breastfeeding?
Professional Organization - Is the practitioner currently a
member of a professional lactation organization?
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Keys to Credentials Listed Within
BA/ BS/ BSN - Bachelor of Arts/Science/Nursing
CCE - Certified Childbirth Educator
CD - Certified Doula
CHES - Certified Health Education Specialist
CLE - Certified Lactation Educator
CLC - Certified Lactation Consultant
**CLC - Certified Lactation Counselor
CNM - Certified Nurse Midwife
CNS - Certified Nutrition Specialist
FACCE - Fellow of American College of Childbirth Educators
IBCLC (RLC) - International Board Certified Lactation Consultant
ICCE - ICEA Certified Childbirth Educator
LCCE - Lamaze Certified Childbirth Educator (formerly ACCE)
LE - Lactation Educator
LD - Labor Doula
LLLL - La Leche League Leader
LM - Licensed Midwife
LVN - Licensed Vocational Nurse
MA /MS /MN - Master of Arts /Science /Nursing
MD - Medical Doctor
MPH - Master of Public Health
(CP) NP - (Certified Pediatric) Nurse Practitioner
OT - Occupational Therapist
PT - Physical Therapist
RD - Registered Dietitian
RN(C) - Registered Nurse (Certified)
Certified Lactation Educator (CLE) - has successfully completed a one week
course in lactation and its management, and required post seminar homework
which may include a clinical component.
Certified Lactation Consultant (CLC) - has had extensive formal lactation
education and supervised clinical training .
International Board Certified Lactation Consultant (IBCLC) - most have had
extensive formal lactation education and clinical training, has passed an
international certification exam and has continuing education requirements
in lactation. May also use term “Registered” (RLC).
Certified Lactation Counselor(**CLC) - has taken a one week course in
lactation counseling and passed a post test.
All licensed health practitioners have additional continuing education
requirements to remain current in their respective
fields.
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Tips for Successful Pumping
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Pump at approximately the same time each day.
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If separated from your baby, pump at the times your baby usually feeds.
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Promoting the milk ejection reflex (letdown) with a relaxed environment,
warm compresses and gentle breast massage will improve milk flow.
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When single pumping, move the breast cup back and forth between breasts
several times throughout the pumping session to improve milk yield.
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Don't be discouraged if your first attempts result in very little milk
yield. Regular pumping usually results in ample yield in one to two weeks.
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Store milk in amounts baby is expected to consume in a single feeding to
avoid waste.
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Milk may be stored in glass or rigid plastic baby bottles. Label bottle
with date, time of collection & any unusual food or medicine consumed. Milk may be
refrigerated for use within 48 - 72 hours. Freezing is recommended for later use.
Acceptable times for frozen storage vary with the temperature of the freezer.
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Raw human milk separates on standing with fat rising to the top. Just
shake gently to redistribute fat particles evenly.
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Human milk should be gently warmed to body temperature by standing the
bottle in a bowl of warm water. Heating in boiling water or a microwave may destroy some
components in human milk and scald your baby during a feeding.
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Your baby may resist initial attempts to take milk in a bottle. Using a
newborn size, slow flow nipple, and having someone else offer the feeding may make it
easier. Depending on the age of the baby, cup or spoon feeding may be more acceptable. BE
PATIENT!
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If you require assistance, please call one of the listings in the
Provider section of the Directory.
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Getting Insurance
Reimbursement
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In most instances, you will be asked to pay the provider of breastfeeding
services directly at the time the service is given. It is the patient's responsibility to
file for insurance benefits.
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Not all insurance providers reimburse for breastfeeding services. They
are more likely to do so if there is a medical need on the part of the mother or infant. A
doctor's prescription for the service is advisable.
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MediCal and CPSP (Comprehensive Perinatal Services Program) provide
lactation support through their certified providers where there is medical need. This is
usually done through, or supervised by a licensed health practitioner.
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If the medical need is for the infant (hospitalized, allergic or
premature), apply for payment on the baby's insurance claim. If the medical need is for
the mother (hospitalized, breast infection), apply for payment on the mother's insurance
claim.
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A mother returning to work and pumping her milk is not usually considered
medical need.
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Ask the breastfeeding service provider to give you a detailed bill
complete with the corresponding insurance code numbers. Attach the doctor's prescription
to the insurance form. This is more likely to make it through the system.
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If your claim is denied, call the case manager and explain why the
service or equipment was necessary. You may need to educate the insurance company as to
the health benefits of breastfeeding and how it will save them health care costs for both
the infant and mother.
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Make the insurance provider aware that the American Academy of Pediatrics
passed a resolution recommending that 3rd party payers provide or reimburse for lactation
services as a cost effective measure.
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Submitting your claim several times, each time with fuller explanations,
has been known to work so keep on trying.
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Explore your insurance provider's policy towards breastfeeding services
before the need arises.
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