Lactation Consultations

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)
  • tongue-tie & lip tie (suspect tongue or lip tie? Scheduled a visit before you decide what to do about it, and/or one before and/or after you've had it released)
  • 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?

An Initial 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 nursing parent's breasts/chest
  • 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 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 recommendations of other care providers that might assist in the nursing relationship or otherwise
  • written report to the baby's medical care provider and/or parent'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 if you want to chat beforehand, that's totally fine, just let me know. I may message you beforehand, but always remember to try to fill out my forms ahead of time (link at the bottom of this page). 

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, I'll let you know if I think a phone call is enough or whether an in-person follow-up visit is warranted. 

Preparing for Your Consultation

Have your baby with you and anything you need to have for feeding. If we're talking about pumping, have 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 be there, too. If you've been tracking your baby's feedings and diapers, please have that handy, 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?

aetna ad

I do consultations in three places:

  • Your home
    • best for those who
      • are healing from a Cesarean birth or traumatic birth and are trying to limit leaving the house to optimize healing
      • those who gave birth within a week or two of the appointment and would rather have a home visit
      • those who have other children at home and have no one to care for those other children (although having a consultation when you can focus on our work together is definitely the best option if at all possible)
      • cannot travel to Northborough for some reason
  • my office in Northborough  
    • I opened an office again in June 2017 because I find I can help more people if I see most of my clients in my office. To get into my office from the parking lot there are NO stairs if you walk up the walkway of stone pavers to the door there (there's a sign outside that lists Babies in Common on it).  Additionally, I created my office space with you and your partner in mind...with a super-comfortable couch, coffee/tea/water, a nursing pillows if you need one, a scale to weigh your baby, muslin blankets, pillows and an easy way to set up your pump if you want to bring it. There's even a sink inside the office for easy hand and pump-accessory washing. It's super comfy!
  • at Chang Dental Group in Natick if your child is having a laser frenectomy there. 

You may schedule a visit 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 typically last 1-2 hours (depends on what's going on!) and follow-up visits are typically 1 hour or so. Prenatal visits are scheduled for 1.25 hours. Working & Pumping Consultations are 1.25 hours.  You will be given a special receipt to submit to your health insurance to request reimbursement for all visits.

For Aetna subscribers, your plan should include SIX visits with an IBCLC-lactation consultant (check with your plan to confirm)--and I am an in-network provider for Aetna so visits are at NO COST to you! I can see you six times (including one prenatal private visit AND a prenatal group class)

For all others, your plan SHOULD reimburse you after you submit a specialized receipt I will provide to you. Right now, Harvard Pilgrim, Fallon, Tufts, Blue Cross Blue Shield and Neighborhood Health are saying they will reimburse you fully. Other insurances may or may not reimburse, I'm not sure, depends both on your plan AND how many times you appeal a denial.  I cannot guarantee anything. I'll help you as much as I can...but the fees you pay me up front (cash, check or credit card) are as follows:

  • at my office at 6 Maple Street in Northborough: $275 Initial, $165 Follow-up, $150 Prenatal, $185 Working & Pumping Visit
  • at your home (Central MA, Blackstone Valley, MetroWest): $275 Initial, $165 Follow-up, $150 Prenatal, $185 Working & Pumping Wisit. If East of Natick, ADD $75 per visit
  • at Chang Dental group if your child is having their frenectomy there, $150. If you'd like me to attend your child's frenectomy elsewhere, I may be able to do that as well but would need to talk to the provider about being there in advance.
  • 50% discount for those on the WIC program, 30% off for MassHealth subscribers
  • on the phone or via video, $40 for 1/2 hour, $80 for 1 hour
  • 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.   Feel free to contact me to discuss via phone, text or email (contact info is above and below) or sign up now:

        sign me up button

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. Feel free to contact me to discuss via phone, text or email (contact info is above and below) or sign up now:

        sign me up button

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.

Feel free to contact me to discuss via phone, text or email (contact info is above and below) or sign up now:  

        sign me up button

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! Feel free to contact me to discuss via phone, text or email (contact info is above and below) or sign up now:

         sign me up button

Phone/Video Consultations: Need a consult but can't wait for an in-person visit? Live too far away for an in-person consultation?

Have an issue that might take a 1/2 hour or an hour but doesn't necessarily warrant an in-person consultation? Going back to work and just want a customized plan but you already love your pump? Want a second opinion about what's going on with your milk production or your baby's latch but aren't sure an in-person consultation makes sense for you yet? The list could go on. Of course, many situations would be better for an in-person visit with me or one of my colleagues, but sometimes a phone/video consultation makes sense. Please note it is difficult to get reimbursed by your health plan for a phone/video visit.
We'll decide in advance which modality is best for YOU! Includes a care plan for you to follow and may include a report to your doctor or your baby's doctor, depending on the situation.  Feel free to contact me to discuss via phone, text or email (contact info is above and below) or sign up now:  
 
     30-minute phone/video consultation  sign me up button
       
     60-minute phone/video consultation   sign me up button

What to Do BEFORE Your 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 & Conversation 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.       

        intake forms button

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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 
Cellphone: (617) 686-0052

Email: jeanetteibcLc@babiesincommon.com

My office location:  6 Maple Street, Northborough, MA 01532 (inside Northborough Chiropractic Center). If you have an appointment, you can enter through the door at the end of the stone walkway...my office is the first door on the left. Just knock if the door is closed. OR, you could enter through the main door (which goes past the restroom)...go up the steps in the front of the building, then go a few steps down into the first floor. Walk straight down the hallway to Northborough Chiropractic Center and ask for me. If needed, have my phone number ready (text first) at 617-686-0052.

Towns I Serve

If seeing you in my office in Northborough doesn't make sense for you (see above for reasons for a home visit), I am happy to do home visits in the following towns (if your town isn't listed here, call me, I may be able to come anyway or refer you to one of my colleagues):

Central MA: Worcester, Auburn, Barre, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dudley, East Brookfield, Fitchburg, Gardner, Grafton, Hardwick, Harvard, Holden, Hopedale, Hubbardston, Lancaster, Leicester, Leominster, Lunenberg, Mendon, Milford, Millbury, Millville, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Petersham, Phillipston, Princeton, Royalston, Rutland, Shrewsbury, Southbridge, Spencer, Sterling, Sturbridge, Sutton, Templeton, Upton, Uxbridge, Warren, Webster, West Boylston, West Brookfield, Westminster, Whitinsville, Winchendon...

Rhode Island or Connecticut: I have been known to travel to Woonsocket, RI or Thompson, CT or nearby...just ask.

MetroWest: Ashland, Framingham, Holliston, Hopkinton, Natick, Sherborn, Southborough, Sudbury, Wayland, Westborough

Boston-area: Boston, Brookline, Newton, Waltham, Wellesley, Weston

The map below shows the 20-mile radius...I will do visits outside of this radius for an additional $75 per visit.

Click here to get occasional email updates!

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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jeanette, kids and 1-day-old niece

me, my kids & my 1-day-old niece

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