Are you concerned about your breastfeeding? Do you think you might need to see an IBCLC?

Hi! I’m Marilyn Hogan, IBCLC and I am an International Board Certified Lactation Consultant.

If you are not certain that breastfeeding is going well, it might be an idea to consider having a consultation with me. I offer home visits in the Greater Vancouver, BC area. These consultations are open-ended, that is, not time-limited, and my services include a reduced-cost follow-up visit or free phone call. Most clients only need one visit to resolve their breastfeeding challenges.

Email me here to request a consultation or to discuss your situation first if you prefer, or leave a voice msg at 604-879-0730, preferably with the best times of day for me to call you back, including if possible, a range of times.

My current price is $175 for a no-time-limit home visit (and occasionally an extra $25 for very long travel). Most families need at least two or more hours to cover everything, including going over what happened and what led to the current breastfeeding challenge you are having. We also go over breastfeeding in different positions using YOUR furniture, and sometimes waiting for the baby to wake up! Without having to worry about time, we can relax and focus on you and your baby.

Usually one visit is enough. We can set up the visit for a time that works for YOU — and I often am available evenings and weekends. My price is the same regardless of the time I see you.

“One consultation is much cheaper than the cost of six months of formula!”

What are some of the reasons a mom would want to see an IBCLC?

There are a variety of reasons for having a consultation with a lactation consultant. These can even include simply reassuring you that breastfeeding and lactation are going well. But they can also provide information and assistance to help you prevent and trouble-shoot common concerns. Including:

— prenatal counseling about the factors that may affect breastfeeding and lactation, especially if you have a particular challenge

— basic position and latch

— information about practices that promote successful breastfeeding and lactation

— preventing and managing common concerns such as poor latch, inadequate milk transfer or supply, nipple or breast pain, and calming a fussy baby

— milk expression and storage for parents who must be separated from their babies

— strategies for breastfeeding and lactation after returning to work

— breastfeeding and lactation in challenging situations, such as feeding twins or triplets, a premature or sick infant, or infants in special medical situations, baby with tongue/lip tie/cleft palate

— baby looking weak and underweight (IF THIS IS THE CASE, IT IS BEST TO TAKE BABY TO A DOCTOR FIRST BEFORE HAVING A LACTATION CONSULTATION — AND TO LET YOUR DOCTOR KNOW YOU HAVE ARRANGED TO HAVE A CONSULTATION).

— painful latching/sore nipples/engorgement that does not subside after THE FIRST FEW HOURS/DAYS after delivery.  If the latching continues to make your nipples feel sore after a few days, chances are that the latch still needs correction. If nipples are sore from bad latching, they can continue to be a bit sore for a few more days once the latch is corrected, but correct latching will not continue to injure your nipples.

— ANY evidence of poor latching — even if mom’s nipples DO NOT HURT. Poor latch can often be noticed if:

— baby nibbles at the breast

— baby has trouble finding or reaching the nipple

— baby constantly slides off the nipple

— nipples are compressed, folded or blanched after feeding

— baby makes clicking or fussing sounds at the breast

— baby has trouble breathing while breastfeeding

— baby latches but then always falls asleep or won’t actively suck after latching, or acts unsatisfied after feedings

— baby latches well but is breastfeeding almost constantly AND acting unsatisfied most of the time afterwards

— baby sleeps many hours at a stretch, does not make eye contact during breastfeeding and latches poorly for feeds, and then falls asleep again almost right away

— baby fusses when milk isn’t flowing and then fusses when milk flows too fast, and has trouble keeping up with the flow

— baby has digestive problems, green poop instead of mustard-y, or has minimal pooping/peeing, or dark, highly concentrated urine

— or if you just think something is wrong.

It’s better to be safe than sorry, and if things seem like they need improvement, it’s always easier to resolve them and learn new habits sooner rather than later.

IN MANY CASES, RESOLVING A SERIOUS BREASTFEEDING CHALLENGE WITHIN A FEW DAYS AFTER BIRTH, RATHER THAN WAITING FOR WEEKS, CAN MEAN NOT HAVING TO PUMP OR SUPPLEMENT THE BREASTFEEDING.

Why should I have a HOME visit?

There are many advantages to a home visit:

• I offer my service for a flat rate fee, so this means I can see you when it is convenient for you, with no time restrictions. I can see you any time of day — even during the evening or at night if you prefer. My fee is the same no matter what time of day I see you.
• You do not have to travel with a crying, unhappy baby, or perhaps with other children in tow. You can have the luxury of a consultation in the comfort of your own home.
• When I am at your place, I have the opportunity to meet your family and talk with others in your immediate support network if you want them to be there. There are advantages to having your friends or family around. This gives me the chance to help them learn how they can best support and assist you with breastfeeding. Sometimes very well-meaning but misinformed family or friends might make suggestions or do things which are not helpful to your efforts to establish good breastfeeding habits or to increase your body’s ability to make more milk.
• So when I meet them and see how they relate to you, I can help them understand what breastfeeding entails, and how best to help you — and meeting them also gives me the chance to listen to what THEIR concerns are. Of course, meeting the family members is entirely optional and your choice, but if you want this, it is easier if I go to your home than for all of them to go to a clinic.
• A house call allows me to see what actual furniture you have and how this might impact your breastfeeding. For example, maybe you have a very soft couch that makes it hard for your baby to reach your breast, and things need to be adjusted so that you are more comfortable and baby can latch easier. Sometimes a mom can get plenty of help in an office but then have difficulty replicating the positioning at home. I can show you how to work with the actual pillows, footstools, blankets and things you have in your home so that breastfeeding will work for you on an ongoing basis.
• I can show you how to comfortably breastfeed lying down. Hospital beds are narrow and mothers are discharged fast in a lot of cases. Sometimes women do not get the hang of getting the baby latched effectively while lying down, before they are discharged. This lying position can come in very handy for breastfeeding at night or daytime naps or if you have a really fast milk flow. Once you know how, breastfeeding while lying down is the most normal, natural and comfortable way to breastfeed at night.
• If you are using a breast pump or other device, I can help with those, too. But these things take time to learn or to perfect, and with the non-time-restricted service I offer, we can take all the time you need!
• Sometimes it does take time to get a thorough history of your birth and previous breastfeeding experiences, if any. But this is important to do, because often there is something that happened which caused or contributed to the problems you are now having. Knowing these details helps us to understand what the nature of the issue is, and helps point the way to a breastfeeding solution that will work for you.
• If we encounter some special situation where you will need additional support other than what I can offer, I can work with the other professionals involved to provide feedback and develop a game plan that will best assist you, and I will be able to follow up with you. This allows me to offer continuity of care that might not occur in other situations.

Contact me anytime. Leave a message, 24 hours, at 604-682-3269, mailbox 7840 or email me! We can set up a time for me to come to your place.

What happens during a consultation?

First, it’s best if you try to relax as much as possible, first before I come over, and to help your baby relax too. This might be hard if you are feeling anxious or experiencing pain, but take a deep breath, have a glass or water or a snack or shower — or maybe all of the above!

Whatever happens, feel good that you are on your way to finding out what you can about your situation, getting facts, exploring what will improve the breastfeeding experience for both you and your baby, and making the best decisions you can about how to reach your breastfeeding goals.

Remember that this is about resolving whatever your challenges are. So in all probability, even if you are feeling apprehensive at first, the idea is to make things better! For example, you might be a little scared of breastfeeding on a nipple that is sore. But it is a good time to realize that when I help you with latching, for example, sometimes it can start feeling better immediately. And realize that an effective latch will not make your sore nipples any worse. It can start feeling much better right away and you have that to look forward to.

It is best to dress in comfortable, casual clothes that provide easy access to the breast, such as a housecoat. You can also decide if you want anyone there with you, such as a friend, your husband, your mom. Or if you prefer to be on your own. Or even a combination (eg start off alone with just your baby and me, and have your husband involved later on). Whatever works best for you.

Once I come over, if your baby is sleeping, we can start to talk. You can tell me what you think the problem is or might be. I can start asking you questions about your birth experience, previous breastfeeding experiences, if any, and other important details that will help me to understand what might have gone wrong — and that gives me the chance to help guide you about what to do to solve it for yourself, and how we will tackle the challenge together.

This is also a time to meet your family or partner (or even a friend, if you have someone there with you for moral support, or to take notes, or whatever).

If the baby wants to breastfeed at any time, we can switch gears, and return to the history later. Or I can email you the questions ahead of time, and you can have them at least partly answered by the time I get there.

In any case, I like to observe at least some breastfeeding before making suggestions. This gives me a chance to see what IS ALREADY working, so that I can show you how to build on that, and increase your confidence and understanding about what works best for you and your baby. For example, you might have already discovered that you like sitting a certain way or holding baby in a certain position that seems to work better — so this will give you the chance to show me that.

If there seems like an easy way to start improving the latch or do whatever else might be needed (such as relieving engorgement if you have it, or whatever else might be presenting itself as a concern, we can look at it and start to address it).

If possible, I try to observe a whole feeding, so that I can see how baby latches, see what happens during the feeding, and see how the baby detaches from the breast — and see whether it seems like a good time to switch sides or offer the same breast again.

Each mother and baby is different — because every baby sucks differently, and breasts are different. So the advice and information varies depending on each individual situation.

If you are already giving supplements, and it looks like they won’t be needed eventually and that you can start cutting down, we can discuss how to give those supplements so they won’t interfere with your milk production, while at the same time ensuring your baby gets the nutrition she needs until your milk production can meet your baby’s requirements.

Depending on how long you have supplemented and what your individual situation is, you might need to continue with the supplements while you also continue to breastfeed. But partial breastfeeding is still breastfeeding — remember: after six months, most babies are starting to eat solids, so they are not fully breastfeeding either.

If you have what looks like a medical problem in addition to classic breastfeeding problems such as positioning and latching, discomfort with breastfeeding, and so on, then I will encourage you to see the appropriate professional who can help you with that, usually your own doctor. And if you have concerns about your baby then I might encourage you to take the baby to a pediatrician.

If you have contacted me on a doctor’s referral, I can report to the doctor to give her/him an opportunity to see what I have observed and the recommendations I have made, in order that your physician can use this information to also give you the best support possible.

If you have come to see me on your own, you might want me to write a report for your doctor anyway, for the reasons mentioned above.

I also like to make sure that parents have a good list of current resources such as good websites to help guide them if they have additional concerns or questions. I will remain in touch with you if you like, and follow up with another (price reduced) house call if you feel you need to see me again, to make sure that things are going the way you like. Sometimes it takes more than one visit to make sure that everything is going smoothly, and to review the new things you have learned.

However, many parents find that one visit is enough to give them the tools and the confidence they need to handle any further challenges that might come up. Sometimes, once you’ve had a consultation, all that is needed is a phone call or two.

I do offer phone consultations to remote areas, but if you are in the Greater Vancouver area, I only offer in-person consultations, which I think are much better anyway, as I can offer the best advice when I meet you and your baby in person (and your family or support person too if you like) and then I can see what’s really going on and give you the best help possible.

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If you have had any breastfeeding challenges, even if they are being resolved, it is strongly recommended that you return to your health care provider to get your baby weighed and examined during regular check-ups, and to follow up with any of the strategies that you have decided to do, to make sure the breastfeeding continues to go well and that your baby stays healthy and happy.