Here in Canada, we are very blessed to have an excellent funded health system. However, there are still times when parents are able to get the support they need from publicly funded programs. This is where private practice lactation consultants come in.

Canadian Health Care System Leaves Moms & Babies Needing More

The Canadian Maternity Experiences Survey found that while 90% of Canadian women intended to and initiated breastfeeding, 21% began supplementing within 1 week of delivery. This suggests that hospital breastfeeding support practices are failing around a quarter of all breastfeeding women.

Very minimal hands-on and technical breastfeeding knowledge is taught in nursing, midwifery and medical schools. Shocking, right? When moms express frustration about breastfeeding or there are feeding issues with the baby, many well-intentioned providers recommend formula supplementation instead of asking the mom what her feeding goals are. Just like referrals can be made to an occupational therapist or dietitian, referrals can be made to lactation consultants.

There continue to be gender disparities when it comes to socioeconomic status and health care funding. Gender bias exists when researchers apply for federal grants, and we know twice as much about erectile dysfunction than we do about breastfeeding. According to Katy Hinde, lactation researcher and associated professor, scientists know more about what is in coffee, wine and tomatoes than what is in breast milk.

Why Are Private Practice Lactation Consultants Needed When There are Free Clinics and Peer Support Groups?

Let me annoyingly answer your question by asking you a question – “So then, did you feel supported to reach your breastfeeding goals?”

All of the private practice lactation consultants that I know became
International Board Certified Lactation Consultants (IBCLC) because they experienced a lack of breastfeeding support personally. Many of them started as volunteer peer counsellors in programs such as La Leche League, and are so passionate about helping other moms breastfeed.

Unfortunately it only takes a quick internet search for “lactation consultant jobs in Canada” (and I’m sure world wide) to realise that there are not enough paid positions for IBCLCs to possibly increase breastfeeding success rates.

Hospital lactation consultants are limited in the amount of time they are afforded to each mother, and cannot follow-up after discharge.

Public health lactation consultants offer awesome free clinics once a week and in-home visits to at-risk mother-baby dyads. These passionate lactation consultants are doing their best, but their services are restricted due to limited health care funding.

Private practice lactation consultants are there to bridge the gap – they are available at any part of the breastfeeding journey, can provide lactation support in an office, in the comfort of a mother’s home and online for those who cannot access support locally. They can spend as much time as needed for each mom and baby, and often their fees include follow-up text and email support. Because you are paying for their service, they will go above and beyond to enhance their skill set to provide the highest possible standard of care.

OK I Understand Why Private Practice Lactation Consultants are Important. But Why Do They Cost So Much Money?

Quality over quantity, remember? How much do you pay for a:

Plumber to come fix your leaky sink?

Breast pump that you may or may not need?

Monthly gym membership, a manicure or massage?

I know, “but why would I spend money on something that I can get for free?” What if you aren’t able to get the support you need from those services to succeed? What if you need help on Tuesday but the only clinic in your area is open Friday mornings? What if you have gotten free help, but it wasn’t enough? Don’t get me wrong, as a LLL leader myself, I know how important peer support is. But when you have nipple pain or your baby isn’t gaining enough, don’t you think it’s time to see an IBCLC?

IBCLCs have a highly specialised skill set. They deserve to be compensated appropriately, just like any other profession. Deep down, we all know this. No one deserves to work for free. Everyone needs an income to feel that they are appreciated and to pay their bills. Just because the government and private insurance companies do not understand the importance of specialised in-home lactation support, does not mean that IBCLCs are not worth their weight in gold.

The Cost of Doing Business

Private practice lactation consultants typically charge $150-200 per in-home visit, and it is not enough. They spend 1.5-2 hours completing a thorough health assessment for the mom and baby, complete pre/post-feeding weights, observe a full feeding, assist with latching and create a lactation care plan that supports the moms breastfeeding goals. In addition to these 1.5-2 hours, they spend time travelling, writing up consultation reports to send to primary care providers, and typically follow-up via text. They may spend their evening researching and reaching out to other IBCLCs regarding the case (with the client’s consent). They spend hours of their time providing pro-bono consults for low-income families and free information and support on social media.

There are countless small business costs that I am only just learning about – web hosting, advertising fees, paying for medical supplies, charting templates, using scheduling platforms, office space, regulatory and education fees.

$150 or more per visit may seem like a lot, but if you ever ask a private practice lactation consultant whether they run a successful business, they will tell you the truth. It’s a good thing that private practice IBCLC’s don’t choose their career for money – typically they do not start contributing to their family income until the third year of practice, and even then it is less than minimum wage once business expenses are factored in. Yikes.

Rachel O’Brien, IBCLC has written an excellent article that breaks down the cost of private practice IBCLCs.

I Know That Private Practice Lactation Consultants Deserve to be Paid, But Why Aren’t They Covered By My Health Insurance?

While private practice lactation consults are not covered by government funding (yet), some insurance providers in Canada such as Great West Life and Sun Life provide coverage if the IBCLC is an RN through a health spending account. Health insurance plans are employer-specific and the mom will need to call their health insurance plan to find out if they have coverage.

We need moms to start asking their employers and unions for lactation consults to be covered through their insurance plans! This is the ONLY way lactation consults will be covered more.

Did you know that it was only in January 1, 1994 that Ontario was the first province in Canada to recognize midwifery as part of the Regulated Health Professions Act? That wasn’t very long ago. I am hopeful that private practice lactation consultants will become recognised in the near future.

You may also be surprised to hear that only just this year, the British Medical Journal (BMJ) has made the decision to no longer accept advertising money from formula companies to a tune of more than $300, 000. Great job BMJ, but how many other trusted sources of medical information continue to be funded by formula companies? What about all the (lack of) breastfeeding research that was published those countless years the BMJ accepted money from formula companies?

60 percent of women don’t meet their own breast-feeding goals and are left feeling guilty and ashamed.¹ It is not their fault. It is the legislators, policy-makers, health insurance companies, unions, and uneducated health care providers who should be ashamed for not supporting mothers.
A recent review indicates that causes for lack of breastfeeding success included lack of “endorsement from local administrators and government policymakers, ineffective change leadership, lack of training of health care workers, lack of integrated hospital and community services, and the influence of marketing for formula”.²

Why Are You a Private Practice Lactation Consultant?

When I tell people that I have started a lactation consulting business, they look at me like I’m a little crazy. I have given up a full time, well-paying position in exchange for something that will take a long time to grow. This may sound scary for some, but this is the most exciting thing I have ever done!

So why am I doing this?

1. Helping moms breastfeed is my passion. There is no better feeling for me than when a new mom heaves a sigh of relief after her baby has latched pain-free.
2. I believe this is the start of something great. I am hopeful that IBCLCs will become recognised providers and that our services (in-home, office and virtual) will be included in government funding or at least the majority of private insurance.
3. The stars have aligned and I have been afforded the time to start this business. My husband has been super-supportive and believes in me when my strength wavers.

References

1. Public Health Agency of Canada. (2009). What mothers say: The Canadian Maternity Experiences Survey. Ottawa, ON: The Agency.
2. Semenic, S., Childerhouse, J., Lauzière, J., et al. (2012). Barriers, facilitators and recommendations regarding implementation of the Baby Friendly Initiative (BFI): an integrative review. J Hum Lact, 28: 317- 334.