Feeding Consultations

When Do You Need a Feeding 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 flange fitting to see if there's a flange 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 flanges 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 or leaking from bottle or gagging when feeding on 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 Feeding Consultation?

An Initial feeding 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 Feeding Consultation? 

  • I will email you a special receipt (called a CMS 1500 form) for you to submit to your health insurance to request reimbursement (along with the form that they may require, call them or check your insurance company's website for their form). If your claim for reimbursement is denied (you should call them 6 weeks after the visit to check the status of the claim), then see this page for information on how to appeal.  
  • I will fax or email a written report to the baby's medical care provider and/or parent's care provider (for at least the first visit; only for the second visit to the baby's doctor if there is any new information to report)
  • I will email you a written plan and resources that you can read online and/or print out and use at home as a guide as things get better
  • You can contact me after the visit via the Chat function within my electronic health record software, Practice Better.
  • 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 may 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 Feeding Consultation

1) Have your baby with you (unless you are doing the Mastering the Pump consultation, you could come without baby if that's possible/desired).

2) There is a consent form and an intake questionnaire that I require to be filled out in advance--having this filled out in advance gives me important information and saves us a lot of time so we can focus on the issues once we are together.

3) Have extra milk or formula if you are supplementing or have been supplementing recently.

4) If we're talking about pumping at all, 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.

5) If you've been tracking your baby's feedings and diapers, please have that record handy, too.

6) 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)

7) Dress comfortably and don't feel pressure to shower on my account.

8) If I'm coming to your house, don't clean up just for me, BUT please do keep dogs or angry cats in another room so they don't interrupt us or eat my shoes. :) Thanks!

 

Where Do Feeding Consultations Happen?

aetna ad

I do consultations in your home or my office:

  • Your home, best for those who...
    • gave birth within the last 2-4 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
    • if your baby is old enough you are already taking baby out and about for shopping runs and seeing friends, then I'd prefer you schedule an office visit...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!

 

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 Feeding 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 will in 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 time prenatally, if you choose...they are also supposed to reimburse some or all of the fee for my prenatal Breastfeeding Ready 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. 

 

Notes About Fees

  • The fees for consultations 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 my consultation prices are discounted price if you have a consultation with me in my office.  I have two different regions I serve and a different price for each.  Within 20 miles of my office vs. more than 20 miles away from my office.
  • If you pay via HSA or FSA, you must reimburse that account if your health insurance reimburses you for the visit.
  • If you are on MassHealth, WIC or a military family, I offer:
    • 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)
  • If you are inducing lactation for an adopted baby or as baby's other nursing parent, I offer a 30% discount. (enter MAKEMILK as your discount code)
  • If you are transgender and want to induce lactation or work on chestfeeding, I offer a 50% discount (enter TRANSPRIDE as your discount code)

 

Types of Consultations

 

Initial Consult Office Box       Initial Home Furtheraway BoxIf you just aren't feeling like feeding your baby is easy yet and you are having some issues that are making breastfeeding, chestfeeding or lactation not-so-much-fun (see list above), it's time to schedule a consultation. Let's sit down and really figure out what's going on. I'll evaluate your baby's latch and suckle, your positioning, possibly do a before-and-after-feeding weight and talk about your concerns. Let's see what happens when feed baby. 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 or your baby's care. Feel free to contact me to discuss via phone, text or email (contact info below) or sign up now by choosing one of the options above. 

At the Northborough office, $300. At your home less than 20 miles from the office, $325.

If you'd like a home visit and you live more than 20 miles from the office, the fee is $375...and click here to schedule your visit).

 

Follow-up Consult Office Box         Follow-up Consult Home Box

We've already met and now it's time for a follow-up to see progress and tweak some issues that still aren't resolved. Some folks need a follow-up and others don't.  I hope we can continue to work together until you feel your issues are resolved. Sign up online by clicking one of the options above (but click here to schedule a follow-up more than 20 miles from the office at $325.

 At the office, $250.  At your home less than 20 miles from the office, $275.  At your home more than 20 miles from the office, $325. 

 

Prenatal Consult Office Box      Prenatal Consult Home Box 

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 and we'll create an early postpartum strategy for breastfeeding/chestfeeding and lactation to help you feel ready for your baby's arrival. It's customized to YOUR specific needs and situation. Also consider taking the Breastfeeding Ready class instead or in addition to a prenatal consultation! This is particularly appropriate for those who have a 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 but clicking on one of the options above.

At the Northborough office, $175.  At your home less than 20 miles from Northborough, $200.

If you live more than 20 miles from the office, please schedule an office visit or contact me for a referral to one of my colleagues closer to you.

 

          

Bottlefeeding Consult Office Box      Bottlefeeding Consult Home Box

Whether you are feeding human milk or formula to your baby, sometimes there are struggles with bottlefeeding. Babies may refuse the bottle, may gag while drinking, may leak while drinking...all of these are things I can help with. I'll do an assessment of your baby's suck, suckle and oral anatomy, observe a feeding and give you strategies to help you and your baby have a more peaceful feeding without tears! I also have bottles with me that I find helpful, so if you need a better bottle, we can try one of those.  This visit includes a care plan and report to your baby's care provider.  This type of visit does NOT include help with nursing or pumping. Your health insurance may reimburse for this visit if you are breastfeeding, nursing or pumping. Sign up now by choosing one of the options above.

At the Northborough office, $225.  In your home 20 miles or less from the office, $250.  If you live more than 20 miles from the office, please schedule an office visit or contact me for a referral to one of my colleagues closer to you.

 

Pump Consult Office Box     Pump Consult Home Box

Want to making pumping more enjoyable and possibly yield more milk or yield milk in a shorter pumping session? Bring your own pump, of course, but I have several different closed-system pumps we could try, several manual pumps we could try, 20+ different flanges (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.)  We'll also talk about bottles and bottle-feeding and updated practices that may be new to you. NOTE: this visit does NOT include an evaluation of your baby's latch or coming up with a plan for addressing low milk supply--while having a pumping consultation is likely to help with milk supply because finding a better way to pump, a better pump or better flanges can help with milk supply.  If you want to discuss baby's latch or a strategy to increase milk supply in addition to pumping, schedule an Initial Visit (and we may have time to do pumping during that visit or at a follow-up visit). This type of visit also does NOT include a Care Plan nor a note to you or your baby's care provider. It DOES include a special receipt to submit to your health insurance to request reimbursement.  Sign up now by choosing one of the options above.

ANOTHER NOTE: If you can't do an in-person visit but want to do a video pumping consultation, this is possible, too--just schedule a video consultation (but of course, we'll only be able to see your pump and any flanges you have in action, so it's not as good as an in-person consultation but sometimes it's better than nothing!) 

At the office, $245. In your home 20 miles or less from the office, $275. 

 

Phone/Video Consult Box

Have an issue that you want to discuss 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, your baby's latch or pumping 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.  We'll decide in advance which modality is best for YOU! Includes a brief 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 type of consultation makes sense for your situation: text or email (contact info is above and below) or sign up now by choosing the option above. 

$80 for one hour.

 

 

Other Resources for You

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jeanette mesite fremAbout Your IBCLC, Jeanette Mesite Frem

I started my journey helping families feed babies in 1992, serving as a health volunteer in the Peace Corps in a village in Côte 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, which focused on nutrition for maternal and child health, including lactation.

After having my first child, I became a birth doula (attended ~120 births), childbirth educator (teaching in hospitals for 7 years and then on my own since 2006) and volunteering as breastfeeding counselor for over ten years. After studying and fulfilling many requirements, I became certified as an International Board Certified Lactation Consultant in 2013. 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 have been honored to work with thousands of families over the years in different capacities and absolutely love getting to know parents and babies and doing what I can to help them achieve their feeding goals through breastfeeding and pumping, but also using donor milk and formula when needed. 

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 other times 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 memberships and workshops

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

 

 

 

 

 

The 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

 

 

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