Lactation visits
Breastfeeding mothers often need encouragement and support, particularly in the first weeks postpartum as this is a critical time for milk production. Among other maternal and infant health benefits, breastfeeding is particularly significant in protecting infants against infections. Telehealth offers a safe and effective opportunity to assess latch, observe milk transfer, weight check the infant (if parents have a scale), assess elimination and offer advice around sore nipples, engorgement, and maternal medications. If there are any concerns, the infant and mother should be scheduled for an in-person visit. The following sections provide guidance around telehealth lactation visits.
Prepare for consultation:
- Props (breast puppet, baby doll, etc)
- Consider preparing an online intake form
- Virtual platform selection
Prior to consultation:
- Consider sending an email or having a phone conversation prior to virtual visit to set expectations and/or setting up a secure pre-visit intake form
- Suggest using a handheld mobile device which may be easier to position for evaluation of latch and infant oral anatomy
- Consider having a ‘helper’ adult present for the visit to aid with holding device while mother sets up for feed
- Schedule visit around anticipated feeding time and be flexible
- Materials that mother may want to have for the visit
- Notes/questions or concerns
- Pillows
- Manual pump or collecting container for hand expressed milk
Steps for a Successful Virtual Consultation
- Allow mother to set goals for the visit and prioritize concerns
- Oral assessment
- Positioning and latch demonstration
- Close observation
- Signs of effective milk transfer
Difficult Situations
- Baby not gaining weight well (consider purchase of low cost scale or use food scale to track weights)
- Tongue tie – video assessment of oral anatomy can be challenging
- Baby not latching – aided by having a helping adult present with mother during the session
Post-Visit Guidance:
- Library of videos/helpful links
- Partner with local organizations: WIC, La Leche League to provide ongoing breastfeeding support
- Contact information and Warm Lines for questions outside of clinic hours
- Follow up for WCC or weight/bilirubin visits in-person as necessary
General resources for families:
- A guide for mothers and partners to breastfeeding: https://firstdroplets.com
- Stanford Newborn Nursery site with helpful videos: https://med.stanford.edu/newborns/professional-education/breastfeeding/abcs-of-breastfeeding/
- WIC breastfeeding resources and access to local support : https://wicbreastfeeding.fns.usda.gov
- Lactation Warm Lines:
- National Office on Women’s Health Helpline – 800-994-9662 (TDD 888-220-5446) – the US Office on Women’s Health staffs both English and Spanish speaking peer counselors
- La Leche League USA Breastfeeding Helpline – 1-877-4-LALECHE (1-877-452-5324)
- InfantRisk Center Helpline – (806) 352-2519 – the InfantRisk Center, headed by Dr. Thomas Hale (author of “Medications and Mothers’ Milk”), is dedicated to providing up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding.
- Breastfeeding Education Videos on latch, paced bottle feeding, cup feeding and others by IABLE: https://www.youtube.com/channel/UCrcZPu83FDKsj1mrz9paNEA/videos
References:
- “Breastfeeding Guidance Post Hospital Discharge for Mothers or Infants with Suspected or Confirmed SARS-Cov-2 Infection.” AAP Interim Guidance: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/
- California breastfeeding coalition (COVID-19 Learn Series Webinars): http://californiabreastfeeding.org/focus-areas/covid-19-coronavirus/
- Breastfeeding Medicine Podcasts. “Adapting the Practice of Breastfeeding Medicine during the COVID-19 Pandemic.” https://podcasts.apple.com/us/podcast/adapting-practice-breastfeeding-medicine-during-covid/id417009927?i=1000469292712
- Academy of Breastfeeding Medicine Resources: https://abm.memberclicks.net/resources
- Santos, Laura Ferraz dos, Rosália Figueiró Borges, and Denise Antunes de Azambuja Zocche. “Telehealth and Breastfeeding: An Integrative Review.” Telemedicine and E-Health, October 18, 2019, tmj.2019.0073. https://doi.org/10.1089/tmj.2019.0073
By: Pooja Kakar, MD IBCLC
Last updated: January 2021