Private 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 (see below about whether your health insurance will cover or reimburse for lactation support):

  • 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 or just to have a phlange fitting to see if there's a phlange that would help you yield more milk (I have many types and if we find something that works better than what you have, you'll usually leave with the phlanges that work for you at no additional cost)
  • 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 so we can focus on the issues at hand)
  • 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
  • any products that I provide to you are provided at no additional cost (for example, if you need a different nipple shield, a temporary supplementing tube/syringe, pump phlange, nipple healing product, etc.)

What Happens After a Consultation? 

  • I will provide you with a special receipt (called a CMS 1500 form) for you to submit to your health insurance to request reimbursement and, if needed, will help you fill out the claim form your insurance requires you submit WITH the CMS 1500. If your claim for reimbursement is denied (you should call them 6 weeks after the visit to check the status of the claim), then you can use this link to file an appeal.
  • I will fax or email a written report to the baby's medical care provider and/or parent's care provider
  • I will provide you with a written plan and resources that you can print out and use at home as a guide as things get better
  • You can contact me after our consultation via a HIPAA-secure app called Spruce--Care Messenger with any questions or updates (email and phone may be okay, too, but I'm much faster with Spruce!).
  • Follow-up visits are appropriate for most clients (at least one follow-up is typical). Follow-up visits are available for an additional fee. 
  • You can continue contacting me throughout your baby's first year with simple questions but if a new issue comes up, it may require a follow-up visit. 

Preparing for Your Consultation

Have your baby with you and...

  • Have extra milk or formula if you are supplementing or have been supplementing recently.
  • If we're talking about pumping, have your pump and all the parts and the cord and any records of your pumping schedule and output, if you have been tracking that.
  • If you've been tracking your baby's feedings and diapers, please have that record handy, too.
  • If at all possible, have a partner with you (or a helpful family member or a friend who will be with you a lot in the following days)
  • Dress comfortably and don't feel pressure to 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 Do Consultations Happen?

aetna ad

I do consultations in three places:

  • Your home, best for those who...
    • gave birth within the last 2 weeks or so and would prefer a home visit because they are still pretty much homebound
    • those who are healing from a Cesarean birth or traumatic birth and are trying to limit leaving the house to optimize healing
    • 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 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).  
    • I created my office space with you and your partner in mind...with a super-comfortable couch, coffee/tea/water, different nursing pillows if you need one (although we'll work on how to NOT use one), a scale to weigh your baby, muslin blankets, 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.

 

Does Health Insurance Pay for Lactation Consultations? 

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 wilin advance. Additionally, I have set up an easy way for you to appeal to your insurance plan if you have a claim that is rejected. Click here for that. 

  • 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 request for reimbursement.  Right now, Harvard Pilgrim, Fallon, Tufts Health Plan, Blue Cross Blue Shield (New England and MA), United (with a referral with my name on it, click here for more info), Unicare-GIC and Neighborhood Health are saying they will reimburse you fully, but CONFIRM WITH THEM DIRECTLY. 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 fee is expected to be paid at the time you schedule the visit online or you can pay when I see you (cash, check or credit card).  I will provide you with a special receipt (CMS 1500 Form) and help you to fill out your insurance company's Claim Form if you need help. Call your insurance 6 weeks after our visit if you haven't yet received reimbursement.  I have set up an easy way for you to appeal to your insurance plan if you have a claim that is rejected. Click here for that. 

What Does a Consultation Cost?

Prices differ based on location and type of visit.

  • at my office at 6 Maple Street in Northborough: $300 Initial, $220 Follow-up, $175 Prenatal, $240 Working & Pumping Visit
  • at your home (if you live less than 20 miles from my office in Northborough): $325 Initial, $245 Follow-up, $200 Prenatal, $265 Working & Pumping
  • at your home (if you live more than 20 miles away from my office in Northborough): $375 Initial, $295 Follow-up, $315 Working & Pumping 
  • at Chang Dental group if your child is having their frenectomy there, $200. 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.
  • 60% discount for those on the WIC program (enter WICAPPT as your discount code and send jeanetteibcLc@babiesincommon.com a photo of your WIC card), 40% off for MassHealth subscribers (enter MASSHEALTHAPPT and send a photo of your MassHealth card to jeanetteibcLc@babiesincommon.com), 20% discount for military families (if either parent is active duty, I am an Army Brat myself!, just enter MILITARYAPPT and send jeanetteibcLc@babiesincommon.com a photo of your active duty military ID)
  • on the phone or via video, $40 for 1/2 hour, $80 for 1 hour (discount codes also apply)
  • Fees may be paid via cash, check, credit card or HSA credit card. Payment in advance for consultations is appreciated and saves time during the visit. Note that payment in advance is required for phone/online consults.

 

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 pre-existing condition that may lead to problems making milk (PCOS, infertility, previous breast surgery, low milk supply with a previous child) or with baby's latch (flat/inverted nipples, previous child had tongue tie). 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. At my office, $175.  At your home less than 20 miles of my office, $200. 

          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. At my office, 300. At your home less than 20 miles from my office, $325. At your home more than 20 miles from my office, $375.

          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.  At my office, $220.  At your home less than 20 miles from my office, $245. At your home, more than 20 miles from my office, $295.

          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! NOTE: this visit does NOT include an evaluation of your baby's latch or support with making more milk--this is for folks who already are nursing well and making enough milk but want support with pumping specifically and doing a phlange fitting (I have 15 different phlanges, although it's NOT expected that I would try all of them on you, I'll pick the ones I think most appropriate to try.) If we find phlanges that work better for you than what you already have, I will give them to you (if I have them in stock) at no additional fee.  At my office, $240. At your home less than 20 miles from my office, $265.  At your home, more than 20 miles from my office, $315.

          sign me up button

Phone/Video Consultation: 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 whether this option makes sense: 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 

  • Please check out the Breastmilk & Conversation group and the two videos on this page related getting a better latch  and this page about breast massage and hand expression. The group and videos are not a replacement for a consultation if you are having any of the issues listed above, but may help. Of course, not all parents need a lactation consultation, so the group is a great way to meet other folks and learn more about breastfeeding and pumping.
  • Check out the Resources tab for lots of great information and referrals to many community-based providers of varied types.
  • See my Notice of Privacy Practices (HIPAA) statement here.
  • Fill out the intake forms:
    • Please install the Mobile Lactation app on your Apple or Android tablet or smartphone.   
    • Press on "client access" from the login screen (upper left-hand side of the screen). 
    • Enter Babies in Common for the practice name.   
    • OR, click on the pink button: intake forms button
    • Within the intake forms app, please include a photo of yourself and, if possible, take a photo of the front and back of your insurance card. Also, ensure that you fill in and SIGN the Consent Form.

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jeanette mesite fremAbout 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 (8-15 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 

Call/cellphone: 617-686-0052

Fax: 833-229-2297 (833-BAY-BAYS)

Secure text/photo/voicemail, HIPAA-compliant: 508-714-7121

Secure email: jeanetteibcLc@babiesincommon.com

 

My Office Location

6 Maple Street, Northborough, MA 01532 (inside Northborough Chiropractic Center).

If you have an appointment with me, 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. If needed, have my phone number ready (text first) at 617-686-0052.

 

 

Babies in Common lactation office