When Do You Need a Consultation?
While breastfeeding is "natural", there are two people learning how to do it. Some folks make plenty of milk and babies latch fabulously and grow well. Awesome!! That's wonderful! BUT if that's not the case for you and if you have any of the following concerns (this is not a full list of issues one might have, of course), then it's an appropriate time to schedule a consultation as soon as possible:
- sore or damaged nipples
- feeling like or knowing there's not enough milk to feed your baby
- oversupply of milk or baby choking on milk due to heavy spray
- thrush (yeast infection) in the nipple/breast or other nipple infection
- recurring plugged ducts or mastitis
- baby isn't latching (breast refusal)
- pre & post tongue-tie release
- pumping concerns
- baby isn't gaining weight appropriately
- learning about alternative feeding methods
- going back to work
- baby is refusing the bottle
- reflux, colic or excessive crying
- baby losing weight or not gaining when baby was gaining well previously
- you just want to ask a bunch of questions and have my undivided attention! :)
What Happens During a Consultation?
A full lactation consultation usually includes:
- receiving a medical history for you and your baby (ideally you would complete online via the Intake Forms button at the bottom of this page before we meet, which greatly helps to save time)
- visual (and sometimes physical) assessment of the mother’s breasts
- visual and physical inspection of the infant’s mouth anatomy (and assessment for symptoms and signs that indicate possible tongue tie and/or upper lip tie) and suck ability
- observation of the mother and infant nursing and/or baby feeding via finger, cup or bottle
- analysis of the data relating to the breastfeeding situation
- demonstration of techniques and tools for improving breastfeeding and
- demonstration of the use of feeding equipment (including pumps), if applicable
- make referrals to other care providers that might assist in the nursing relationship or otherwise
- written report to the baby's medical care provider and/or mom's care provider
- a written plan and resources that you can print out and use at home as a guide as things get better
- a receipt to submit to your insurance (see below for more information under Fees)
I’m available via telephone, email and text after the visit(s) for additional support. Follow-up visits are also appropriate for many and are available for an additional fee. If you schedule your visit online, please note that I will want to talk with you first (unless we have already met or communicated). I may call you to chat first.
Also included are unlimited follow-up emails and text support throughout your baby's first year (unless a new issue comes up which requires a follow-up visit). Focused and fee-based follow-up visits may be used for unresolved issues over time or for sleep or bottle-feeding issues later on.
Preparing for Your Consultation
Have your baby with you and anything you need to have for feeding. If we're talking about pumping, bring the pump and any records of your pumping schedule and output, if you have been tracking that. Partners or other helpful family or friends who will be with you a lot in the following days are welcome and encouraged to attend, too. If you've been tracking your baby's feedings and diapers, please bring that, too. Dress comfortably and don't shower on my account. If I'm coming to your house, don't clean up just for me. Please do keep dogs or angry cats in another room so they don't interrupt us or eat my shoes. :) Thanks!
Where are Consultations & What Is the Cost?
I can do consultations pretty much anywhere, anyhow. You may schedule it online but if you don't see a time that works for you, let me know and I may be able to do an evening or weekend visit. Initial visits are typically 1.5-2 hours and follow-up visits are typically 1-1.25 hours. Prenatal visits are 1.25 hours. Working & Pumping Consultations are 1.25 hours.
- at your home (Central MA, Blackstone Valley, MetroWest): $225 initial, $95 follow-up, $95 prenatal, $135 working & pumping visit. If East of Framingham, $300 initial, $135 follow-up.
- at my office (Babies in Common in Grafton, MA): $225 initial, $95 follow-up, $95 prenatal, $135 working & pumping visit. (NOTE: as of 2/25 visits at BinC are still not being held there due to a recent burst pipe...we hope reconstruction will be done in a couple weeks, so if you are seeing this message after March 10, please message me about it!). I can, however, also see you at Northborough Chiropractic Center if an office visit works best for you. Just let me know.
- on the phone or via video, $40 for 1/2 hour, $80 for 1 hour
- at Kids on the Common Pediatrics, if your baby is a patient of Dr. Rugo-Focht. We may be able to meet there but I need to arrange it with their office. Typically it would be on a Monday between 9:00am - 4:00pm or on Tu/We/Th/Fr after 2:30pm. Sunday afternoons may occasionally be possible as well. A visit here is free or a small co-pay, just ask the sweet folks at the front desk after they see your insurance card.
Fees may be paid via cash, check or credit card or PayPal. Payment in advance for consultations is appreciated and saves time during the visit. Note that payment in advance is required for phone/online consults.
Please note that while the Affordable Care Act of 2010 requires insurance companies to reimburse for "comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment", some insurance companies/plans are better than others at following the spirit of the law. I cannot guarantee reimbursement but I will try to help as much as I can. Please see my friend/colleague's blog on why insurance doesn't pay and why sometimes they do but won't tell you that they will in advance.
Types of Consultations
Prenatal Consultation: Expecting a baby and interested in a finding out how to increase your chances for success? Whether for your first baby or another baby, schedule a prenatal consultation with me and we'll create an early postpartum strategy for breastfeeding and lactation to help you feel ready for your baby's arrival. It's customized to YOUR specific needs and situation. Also consider taking my Breastfeeding Ready class instead or in addition to a prenatal consultation! This is particularly great for those who have existing condition that may lead to problems making milk or with baby's latch. Let's talk through it and come up with a strategy of how to handle the first hours, days and weeks of your baby's life. Includes lots of reading materials and ongoing communication if needed, but if help is needed after baby arrives, an Initial Consultation would be appropriate. Schedule online now or contact me to discuss via phone, text or email (contact info is above and below).
Initial Lactation Consultation: Let's sit down and really figure out what's going on. Let's see what happens when you nurse or pump or feed via bottle, cup or spoon. If you just aren't feeling like nursing is easy yet and you are having some issues that are making breastfeeding or lactation not so much fun (see list above), it's time to schedule a consultation. After the visit, I'll send you a care plan, I'll send a report to your baby's doctor (and, if appropriate to your care provider) and I'll send you lots of great reading and resources, including referrals to appropriate folks in our community that may be able to help with certain aspects of your concerns. Schedule online now or contact me to discuss via phone, text or email (contact info is above and below).
Follow-up Consultation: We've already met and now it's time for a follow-up to see progress, tweak some issues that still aren't resolved. Some folks need a follow-up and others don't. Once I do an Initial Consultation with you, I consider myself "your" lactation consultant. I hope we can continue to work together until you feel your issues are resolved. Schedule online now or contact me to discuss via phone, text or email (contact info is above and below).
Working & Pumping Consultation: Going back to work or already at work and want to make more milk or making pumping more enjoyable? Let's talk about what would maximize milk production, make pumping easier and come up with a plan for you. Bring your pump, of course! Schedule online now or contact me to discuss via phone, text or email (contact info is above and below).
I am sometimes available within 24 hours and sometimes can do weekend visits. However, I do lead groups and teach classes (generally Tuesdays daytime, Fridays daytime and Sunday evenings) but I try to make room otherwise for lactation consults. If I can't get to you in a timely manner, I'll suggest other lactation consultants who might be able to see you sooner.
Click here to see my availability and schedule a visit right now (of course, if there's not a time that works for you, let me know and I'll see what I can do!)
If you would like to talk before scheduling a consultation, please contact me directly via phone or text at 617-686-0052 or email at email@example.com. PLEASE NOTE that TEXTING me is the fastest way to reach me!
If you are ready to have a consultation, schedule it now by clicking here or feel free to contact firstname.lastname@example.org or call 617-686-0052 to schedule a visit. I also encourage you to check out the Babies in Common YouTube Channel (click on the YouTube logo on the upper right-hand side of this page), where you can find very helpful videos related to breastfeeding and other baby and parenting topics.
Additionally, please check out the Breastmilk & Cookies group and the two videos on that page related to pumping, breast massage and hand expression. The group is not a replacement for a consultation if you are having any of the issues listed above, but is a wonderful group to attend in addition. Of course, not all women need a lactation consultation, so group is a great way to meet other folks and learn more about breastfeeding and pumping. Also, please click on the Resources tab for lots of great information and referrals to many community-based providers of varied types.
Once you have a consultation scheduled with me please click on the pink button below and complete the initial intake forms on your computer, iPad or iPhone.
About Your IBCLC, Jeanette Mesite Frem
After volunteering as breastfeeding counselor for over ten years and studying and fulfilling many requirements, I became certified as an International Board Certified Lactation Consultant in 2013. I have worked with several hundred families over the years and absolutely love getting to know parents and babies and doing what I can to help them achieve their lactation goals through breastfeeding, pumping and sometimes even with donor milk.
In order to stay up-to-date on the latest research and techniques in lactation, I attend many continuing education conferences (6-8 days per year in-person plus online seminars). I also nursed my two children for more than two years each, I've been teaching childbirth classes in hospitals and on my own for a decade and I’ve attended over 100 births as a birth doula. I started my journey in maternal and child health working as a public health specialist with the Peace Corps. I worked for two years with a midwife and a nurse in a beautiful and friendly village in Cote d'Ivoire, West Africa. I continued my studies at the graduate level at Johns Hopkins School of Public Health and received my master’s degree in public health, focused on nutrition for maternal and child health, including lactation.
Hey, really, what I'm trying to say is that I have some experience and knowledge and I'll work my hardest to help you and your baby as much as I can to maximize your success, however you define it. Babies need to eat. Sometimes that means 100% human milk and othertimes it means formula is needed. Let's figure out what your story will be. I work for you and your baby and just give you my professional opinion and recommendations: you do the rest...because this baby is YOURS! :) I'm honored to be asked to be part of your parenting journey. Thank you for considering to invite me into your world.
Jeanette Mesite Frem, MHS, IBCLC, RLC, CCE, CD
Office Address: 28 Grafton Common, Grafton, MA 01519
Cellphone: (617) 686-0052
Towns I Serve
I am happy to do home visits in the following towns (if your town isn't listed here, call me anyway, I could come for an addition fee or refer you to one of my colleagues):
Worcester, Boylston, Shrewsbury, Grafton, Millbury, Auburn, West Boylston, Clinton, Holden, Natick, Sterling, Princeton, Rutland, Barre, Spencer, Leicester, Sturbridge, Charlton, Oxford, Framingham, Sutton, Douglas, Webster, Templeton, Gardner, Barre, Hardwick, Northbridge, Uxbridge, Milford, Upton, Hopkinton, Ashland, Westborough, Northborough, Berlin, Clinton, Marlborough, Hudson, Southborough, Bolton, Lancaster, Holliston, Leominster
Looking for information on a medication or a procedure?
Do you need to pump & dump? (Um, almost never!)
Check here for details on what science says:
OR, text me and we can talk about it.
OR, check out infantrisk.com--they also take phone calls!
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me, my kids & my 1-day-old niece
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