Feeding Consultations

 
DURING TIME OF THE COVID-19 VIRUS...in order to keep everyone as healthy as possible, HIPAA-compliant video consultations are available in addition to masked in-person office visits in Northborough or home visits (for babies under 6 weeks of age, except twins or those with special circumstances).
 
 
Feeding babies can be done in different ways: breast, chest, finger, cup, spoon, syringe, bottle...and with parent's milk, donor milk or formula. Of course, the most important thing is that babies are fed enough to help them grow and thrive BUT here at Babies in Common, we want to help you in all the ways you want to feed your baby (and sometimes we have to talk about alternatives to what you want).  If you need help with any type of feeding, we're here to help. No judgment--it's all about meeting your goals through information and techniques to support those goals.
 

When is a Feeding Consultation Needed? 

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 and feeding counseling):

  • 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? Schedule 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 (we 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 the undivided attention of an International Board Certified Lactation Consultant

What Happens During a Feeding Consultation?

An Initial feeding consultation usually includes:

  • receiving a medical history for you and your baby 
  • 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 flange, nipple healing product, etc.)

What Happens After a Feeding Consultation? 

  • You will receive a special receipt (called a CMS 1500 form) to submit to your health insurance to request reimbursement.  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.   Note that home visits include a non-reimbursable travel fee.
  • You will receive a written plan and resources after your first visit (sometimes after follow-up visits) that you can read online and/or print out and use at home as a guide for implementing actionable changes.
  • You are able to stay in touch with your IBCLC-lactation consultant after your consultation via the Chat function within Practice Better, the electronic health record platform you'll be using, which is HIPAA-compliant. This is the same platform you'll fill out your Consent Form and Intake Questionnaire on BEFORE your consultation.
  • Follow-up visits are appropriate for most clients (at least one follow-up is typical). Follow-up visits are available for an additional fee. 

Preparing for Your Feeding Consultation

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

2) Fill out the forms below, ideally by the evening before your first consultation--having this filled out in advance is required, because it saves a lot of time so the focus can be on the issues once we are together vs. answering basic questions.

3) Have extra milk or formula ready if you are supplementing or have been supplementing recently.   Also have whichever bottle or other device you have been using when feeding baby (bottle, cup, syringe, tube, nipple shield, etc.)

4) If we're talking about pumping at all, have your pump and all the parts (including bottles!) 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!

8) If having a home visit, don't worry about cleaning up much, BUT please do keep dogs or angry cats in another room so they don't interrupt us or eat your lactation consultant's shoes or other stuff. :) 

Additionally, due to COVID-19, everyone must be wearing masks the entire visit (although babies don't wear masks).  Please don't have additional people there besides the parents of the baby. If you have any symptoms of contagious illness or known exposure to COVID-19, then we will reschedule to a virtual visit.  Your IBCLC-lactation consultant will use appropriate protective equipment, sanitize any equipment she is bringing into your home, wash her hands often, stay further way from you when possible and wear gloves when appropriate. 

 

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. No one except your health insurance company representative can guarantee reimbursement but your IBCLC-lactation consultant will try to help as much as possible.  Please see this blog post, written by another IBCLC, on why insurance doesn't pay and why sometimes they do but won't tell you that they will in advance. Additionally, we 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. 

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, click here for more info), Unicare-GIC and Neighborhood Health are saying they will reimburse you fully, but CONFIRM WITH THEM DIRECTLY (but if they say no, DEMAND to speak to a supervisor!!).  Other insurances may or may not reimburse, it depends both on your plan AND how many times you appeal a denial.  We cannot guarantee anything.  As stated above, we will help as much as possible, but the fee is expected to be paid at the time you schedule the visit online.  You will be provide with a special receipt (CMS 1500 Form) within a week or two of your consultation.  Call your insurance 6 weeks after you consultation if you haven't yet received reimbursement.  To appeal to your insurance plan if you have a claim that is rejected. Click here for that.   Note that the travel fee for home visits is NOT reimbursable by your health insurance.

 

Notes About Fees

  • The fees for consultations should be paid at the time of scheduling the consultation (you'll have an opportunity to pay when you sign up online or we'll send you an invoice via email that is expected to be paid by the day before your consultation).  
  • Note that the consultation fee is discounted if you have a consultation in the Babies in Common office in Northborough, Massachusetts.  There are two different regions served and a different price for each.  Within 20 miles of the office vs. more than 20 miles away from the office.
  • There's a travel fee associated with home visits and that is not reimbursable for home visits.  Travel fee within 20 miles of the Northborough office is $25, more than 20 miles is $50.
  • 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, we offer:
    • 60% discount for those on the WIC program (enter WICAPPT as your discount code and send jeanette@babiesincommon.com a photo of your WIC card) (but travel fee still applies)
    • 40% off for MassHealth subscribers (enter MASSHEALTHAPPT and send a photo of your MassHealth card to jeanette@babiesincommon.com) (but travel fee still applies)
    • 20% discount for military families (if either parent is active duty, your IBCLC, Jeanette, is an Army Brat herself!, just enter MILITARYAPPT and send jeanette@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, we offer a 30% discount. (enter MAKEMILK as your discount code)
  • If you are transgender and want to induce lactation or work on chestfeeding, we offer a 50% discount (enter TRANSPRIDE as your discount code)

 

Schedule Your Consultation...

 

If 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 is 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. Your baby's latch and suckle will be reevaluated, we'll look at your hold and positions and come up with comfortable options, and we'll talk about your concerns. Let's see what happens when feed baby.  If you have questions before scheduling a consultation, please text Jeanette Mesite Frem, Babies in Common's International Board Certified Lactation Consultant, at 617-686-0052 or email jeanette@babiesincommon.com.  If you are ready to schedule, click on the appropriate photo below.  Virtual Initial Feeding Consultation $250.  Initial Consultation at Northborough office $300. Initial Home Consultation (20 miles or less from Northborough) $325.  Initial Home Consultation (more than 20 miles from Northborough) $375.

         

 

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.  Ideally, we'll continue to work together until you feel your issues are resolved. Virtual $200. At the office $250.  Your Home (less than 20 miles from Northborough) $275.  Your Home (more than 20 miles from Northborough) $325.

       

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 Jeanette to discuss via text or email (contact info is above and below, but please do NOT leave a voicemail--text or email are best) or sign up now by clicking on the photo at left.  Virtual, $125.

 

 

You're getting ready to start pumping and just want to be sure you're doing it right and have the right fit for your flanges or you are already pumping and want pumping to be more comfortable and/or more efficient (and maybe yield more milk, too!).  Then a pumping consultation is a good idea.  If you aren't yet making enough milk for your baby, an Initial Visit is appropriate.  A Mastering the Pump Consultation is for those who don't need any additional help with milk production or latching--the focus is ONLY on the pump and doing a flange fitting during a full pumping session (we have the flanges to try).  To register, click on the photo at left. At Northborough office.  $245.00  

 

 

 

     

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.  We'll assess of your baby's suckle and oral anatomy, observe a feeding and discuss strategies to help you and your baby have a more peaceful feeding without tears! This visit includes a care plan.  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 clicking on the appropriate photo to the left.

Virtual, $200.  Office $225.

 

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

Call/cellphone: 617-686-0052

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

Secure email: jeanette@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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