Interview with a Lactation Consultant
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Show notes:
For patients, breastfeeding can be an emotional topic.
It’s often framed as a natural skill that breastfeeding parents and babies somehow magically know how to do after birth — but honestly, that’s not always the case.
While some breastfeeding parents — and babies — pick up this skill quickly, it isn’t always easy. Sometimes, support is needed to ensure breastfeeding works for both of them.
This leads us to the question: As a primary care nurse practitioner, what knowledge and resources do you need to support families choosing to breastfeed?
Lactation Consultants and Primary Care Nurse Practitioners
August is Breastfeeding Awareness Month. This week, we're talking with Joanna Kreyling, an International Board Certified Lactation Consultant (IBCLC), pediatric nurse practitioner, and clinical director at Nest Collaborative. In our interview, we explore:
Who lactation consultants are and how they help families
When you might want to refer your patients to them
And some important pearls and pitfalls to watch out for
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well hey there it's liz rohr from real
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world np you are watching np practice
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made simple the weekly videos to help
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save you time frustration and help you
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learn faster so you can take the best
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care of your patients it is
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breastfeeding awareness month in august
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2021 at the time of this recording and
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i'm talking today with a lactation
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consultant joanna crayling she is also a
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pediatric nurse practitioner and i
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brought her on the channel for an
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interview to ask her about
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what lactation consultants are what they
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can help with when you would want to
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consult with them or refer your patients
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to them and lots of pearls and pitfalls
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to keep in mind when it comes to
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breastfeeding and supporting your
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patients both the parent that is
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breastfeeding and the little kiddo that
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they are caring for so i really hope you
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enjoy this interview lots of pearls of
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practice and resources and takeaways
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without further ado i'm going to share
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my interview with you all right well
What are lactation consultants
0:58
welcome thank you so much for being here
1:00
can you start by introducing yourself
1:03
yeah yeah i'm joanna kreiling i am a
1:06
pediatric nurse practitioner and a
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board-certified lactation consultant
1:11
i'm the director of clinical operations
1:13
for nest collaborative
1:15
um i live in ohio and i have four kids
1:20
awesome awesome so um
1:23
let's start with what um what are
1:25
lactation consultants and what do they
1:27
do like square one
1:30
so
1:30
um that's a really good question
1:33
there are different certification levels
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um so an international board certified
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lactation consultant
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um can see um
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you know internationally we can see
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clients so it's unlike you know when
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you're a nurse and you can only or a
1:49
doctor or whatever and you can only
1:51
practice in that one state
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um so
1:55
to be a an international board certified
1:58
lactation consultant there is quite a
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bit of
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lactation related
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education
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that you are required to complete
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there's a couple different pathways um
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to
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get the experience hours um
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so
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that
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you know that can really
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um
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be something that
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can be difficult or it could be more
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easy for different people to obtain
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um and then it's also where are they
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obtaining that experience from is it
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just hospital based you know initial
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latching on or
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is it you know all the way through
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weaning you know maybe seeing children
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two two years older
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um so
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experience is is
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wide um
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and uh basically what lactation
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consultants are trained to do
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is to
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um
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assist in whatever
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goals that the family has whether that
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is um increasing milk supply or
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um
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you know not nursing or
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you know what pumping and nursing
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exclusively pumping you know it's it's
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whatever that particular family has
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um
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has a desire to
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to do
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cool cool
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and um
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uh
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what um
Becoming a lactation consultant
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i guess maybe segway uh into this
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question um what had you you became a
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nurse practice you were a nurse
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practitioner first and then you became a
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lactation consultant what had you become
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a lactation consultant specifically like
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get that additional training and
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certification
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well
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in
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um in my nurse practitioner program we
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did have some imp we did i remember
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learning a bit about breastfeeding um
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and i think um you know some programs
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don't have it at all and and some
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programs do
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um you know to the extent of what
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they're covering i'm not
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sure it varies um so
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by the time that i actually had my first
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child
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um
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i realized that you know
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it's
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i didn't know enough to help my clients
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because i certainly needed help and
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you know i
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you know i did the triple feeding for
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two months until i decided enough was
4:30
enough with my first one because nobody
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gave me a plan no one said you know this
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we want you to do this and you know you
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should see results by this and no one
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helped me re-evaluate if things were
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working or not working
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um i certainly didn't know that a
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lactation consultant like i guess i
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don't know i thought that they were for
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like that initial postpartum period or
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i didn't i don't know that i considered
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it all reaching out when the baby was
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two months old to see if there was
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anything else i could do i think i just
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kind of made the decision on my own
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because i felt overwhelmed and
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knew i couldn't um continue doing that
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um so
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you know it's definitely something that
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was challenging and
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i think
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my second child is when that went
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better and so
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but in that process is when i really
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got my um
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got my certification hours and all of
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those things and and became
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um certified so
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yeah it was definitely it was between
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kid two and three i think about it for a
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minute
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but yeah i mean just when clients in the
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office in the pediatrician's office
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would
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have breastfeeding concerns um
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you know we we
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didn't really
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you know have i didn't know well enough
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what a good feed looks like and um how
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to assess latch i mean you know and
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and i think a lot of my male um cohorts
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would call me and to do the
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breastfeeding stuff
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and it was just like well you know just
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because i'm
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a woman or
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you know have had children or whatever
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doesn't make me a breastfeeding expert
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um
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so it was really something that i wanted
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to be able to help um
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my clients because they were asking and
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i was like i don't know
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and um
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just really wanted to give them
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more information and better information
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that i than i received definitely
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definitely and on that note kind of
When to contact a lactation consultant
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tying that together like
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um
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when so i'm trying to take the
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perspective of so for me just like
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anecdotally i shared this with you a bit
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before that i i have a child and i
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breastfed and i had a really challenging
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experience and i feel like i learned so
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much
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through that challenging experience but
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so but i'm trying to take the frame of
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reference of like
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it like nurse practitioner education
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alone without having any experience with
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breastfeeding or parenting like if we
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can like bring it back to that like when
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if somebody is like not familiar at all
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with lactation consulting like when if
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they're an mp student our new grad mp
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when would they want to contact a
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lactation consultant or think about
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referring their patients to one in your
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kind of experience and perspective
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i think what i i would really encourage
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people to do would be
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to find lactation consultants in their
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area or
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to identify those that they really trust
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um
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and
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realize that
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you don't
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need to be a breastfeeding specialist
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firstly if you're if you're
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you know we know this that you know if
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you step back and think about it if you
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are doing
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um you know primary care for example you
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have to know
8:14
a lot
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about a lot
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of things you have to know
8:19
a whole bunch yeah so
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you know it's
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you know you could give the example if
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someone's child needed
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help um
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because they're having difficulty
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walking
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we wouldn't say okay you know as the
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pediatrician i want you to put on braces
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and i want you to have your child walk
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from this side of the room to this side
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of the room
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um five times daily and come back in a
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week no we refer out right we refer out
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to physical or occupational therapy we
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refer to a specialist someone who's
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really good
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at recognizing
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normal
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not normal
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what can that particular family what
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will work for that particular particular
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family that particular child
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um
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to meet whatever their goals are so
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you know just that like i said you don't
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have to be an expert if someone has
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questions
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if they are unclear if they just want to
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learn more if i mean
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if you have questions give them a call
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like you know
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just just
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give yourself that permission to
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if you're not sure
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have have that really good resource um
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available to you
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um
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and and you know use it and um
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i think that uh that's you know really
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the best i
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advice is you know
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they are the specialists um
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they should be able to work specifically
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and and be in unison as you know that's
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with nest collaborative we're really
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proud of our continuity so we
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we work with pediatricians we work with
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obstetricians and we work with you know
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all of these different health care
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providers because we want to all be on
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the same page
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with with these clients um
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you know and i think that
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recognizing that and then also
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recognizing it's okay
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to be preventative one of the
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one of you know one of the things that
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we're really passionate at this
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collaborative is
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preventative care so
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what are the time periods
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in a journey that
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are potential pitfalls
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for example my golden example is always
10:49
around six weeks your breasts may become
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a bit softer because your
10:54
body has
10:56
gotten
10:57
you know in tune with your baby so
10:58
you're supplying meets their demand a
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lot of women though they don't realize
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this
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is the reason so they think oh my gosh
11:07
my breasts are softer my milk supply is
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going away i need to supplement yeah
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well
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yeah you know if they start
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supplementing it's going to throw off
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the breastfeeding and the actual milk
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quantity that she does have and
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so so let's talk to
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clients let's let's talk to these
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families and
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say you know be be preventative let's
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see them at three to five days let's see
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them at two weeks let's see them at you
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know whether they're before they go back
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to work before they start solids before
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before
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we don't have to be
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problem-based care yeah i was gonna
How to prepare for a lactation consultant
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that's one of the things i was gonna say
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is like i think that if you have no
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experience
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like i was i was a nurse practitioner
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when i had my daughter and like i
11:53
in my mind only sought lactation
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consultant care when i had a problem and
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i think that
12:00
i knew as a patient and as a provider
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that i was like i'm really worried about
12:05
breastfeeding i should probably have
12:06
this conversation like what do i do to
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prepare and i was a little bit like not
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um
12:11
listened to in a way where it was kind
12:13
of like oh it'll be fine i'll show you
12:14
how to do it'll be fine but it's like
12:16
like you said like
12:18
it doesn't have to be problem based it
12:19
can be like let's think about this
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before delivery let's think about it
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right after delivery let's think about
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it at those pitfall potential moments
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yeah and especially if you have those um
12:31
clients you know
12:33
um that things don't go well the first
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time where
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they have um
12:39
you know
12:42
maybe they have mom has a health
12:44
condition and she's concerned about
12:46
the medications or health you know
12:50
something associated with with her body
12:53
um or maybe there's a
12:55
diagnosis with the child already like
12:57
the child is going to have a cleft
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palate or so these are all reasons why
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it's really good to meet with
13:05
a prenatal
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consultation i love that we do ours
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one-on-one because we can ask the
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clients okay well what have you heard
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what are you worried about and usually
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it's low milk supply and
13:22
pain
13:23
yeah and um
13:25
so you know yeah i was going to say
13:27
especially for first-time mothers but
13:28
even like multiple times excuse me
13:30
first-time parents or multiple time
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parents like like
13:34
they're there's so much to think about
13:36
at every interval like you as a parent
13:40
who has a child
13:41
in front of them for the first time
13:44
might not have the brain space or sleep
13:46
capacity to think about learning a new
13:49
skill right and so like how can we make
13:51
this as easy as possible for our
13:53
patients to like think about it
13:54
beforehand when they are relatively well
13:56
rested right before delivery and then
13:58
after and
13:59
you know that whole that whole piece
14:01
yeah yeah and like you said just just
14:03
normalizing like you know let's let's
14:06
see them you know the aap recommends
14:09
that there's a breastfeeding assessment
14:12
yeah in the office you know days three
14:14
to five and i'm thinking well
14:17
how many how many healthcare providers
14:19
um feel comfortable doing that how many
14:21
healthcare providers
14:22
um
14:23
can do that and and really know if a
14:26
latch looks good or not or you know how
14:30
to help with that
14:31
um
14:33
so you know that's that's a great reason
14:35
to just have them check in and um you
14:39
know they think everything is going
14:40
great
14:41
they just want to make sure
14:45
and you know we can a lot of times um
14:48
just reinforce
14:50
what um
14:52
they're already doing and give them that
14:54
support because
14:56
we have initiation in the united states
15:00
we do not have duration of processing of
15:03
breastfeeding yeah no for sure for sure
15:06
um and one one thing i was going to ask
15:08
you about um
15:10
was uh well i guess i guess two two one
15:13
point in a question so one one thing
15:15
this is reminding me of is that i did an
15:17
interview with a physical therapist and
15:19
i think in primary care
15:21
and maybe in you know pediatric practice
15:23
as well i think that sometimes we
15:24
misunderstand specialties
15:26
whether it's a provider specialty or if
15:28
it's a um like associate medical field
15:31
like physical therapy occupational
15:32
therapy because we don't understand what
15:34
they do i think it's easy to dismiss
15:37
like whether or not they need that right
15:39
so i think a lot of like you and i were
15:41
talking about before but sometimes
15:42
providers feel like they feel
15:43
comfortable enough with breastfeeding
15:45
but it's like oh that's enough but also
15:47
just like not underestimating just
15:49
because we don't fully understand what
15:50
it is what it means and what it's like
15:52
to be a lactation consultant doesn't
15:53
mean that there isn't like this whole
15:56
range of services that can help right
15:58
because i think that's one thing one
16:00
thing that i really aim to help us do as
16:03
like a profession is like connect with
16:04
our other
16:05
uh multi-disciplinary professions right
16:08
and so even if you don't know what a
16:09
lactation consultant does just like
16:11
trusting that there's like a whole
16:12
training process there's like a whole
16:14
knowledge base there's like all these
16:15
other things that we can do so like just
16:17
don't underestimate that so that was
16:19
like one point i wanted to connect but
16:20
then the other question i had for you i
16:22
am not savvy about this
16:24
at at this moment but what is your
16:26
experience of um like
16:29
insurance coverage
16:31
with um lactation consulting if you can
16:32
speak to that a lot of the a lot of the
16:34
people in the audience of real world np
16:36
struggle with patients having limited
16:38
access to resources
16:40
right so that is a really big one and
16:43
that's something that nest collaborative
16:46
um is is very
16:48
um
16:50
feels very strongly about you know our
16:52
founder amanda she really
16:54
works to
16:57
insurance companies that
16:59
should be following the affordable care
17:02
act and covering the minimum of six
17:05
visits
17:07
we will be you know working doggedly to
17:10
get those visits covered because
17:13
they are
17:14
you know part of that and they
17:17
have you know they should be covered so
17:19
um
17:21
you know that that is huge and a lot of
17:23
um
17:24
a lot of lactation consultants the way
17:26
that they work is they'll give the
17:29
clients the super bowl and they'll
17:31
encourage them to turn it into their
17:33
insurance
17:34
well
17:35
that's not
Local resources
17:37
possible for a lot of it may not be
17:39
possible or i mean what happens if the
17:41
insurance
17:42
company comes back in says we're not
17:44
going to cover this i mean a family mem
17:47
you know this family that they have a
17:49
new baby you know they're getting all
17:52
these bills and
17:53
did they know how to
17:55
i don't know that
17:58
as a first-time parent that i would have
18:00
known like well i can fight this like i
18:02
don't i don't know
18:04
um
18:05
so
18:06
you know
18:07
i think that um
18:08
[Music]
18:09
figuring out the local resources like
18:13
um whether it's you know encouraging
18:15
them to go to um
18:18
or to find
18:19
in their area lactation consultants that
18:22
do
18:23
take the different types of insurance
18:25
and you know keeping a list of it or you
18:27
know you can check again you can check
18:29
with nest collaborative
18:30
but really
18:32
really looking to see what you can do to
18:35
support because it's just so so
18:38
important
18:39
there's a part there's a point in
18:41
breastfeeding where it's like
18:43
you kind of just have to trust and let
18:44
it go because you're
18:47
you know it's not
18:49
precise yeah so
18:51
that is a lot of what
18:53
lactation consultants do actually is a
18:56
lot of counseling and a lot of education
18:59
um because they're you know especially
19:03
lately with covid and all of this you
19:06
know these these families are really on
19:09
edge so having
19:11
that lactation consultant there to say
19:14
you know
19:15
your positioning looks wonderful you
19:18
know you're so good
19:21
you know your your baby is having six to
19:24
eight wet
19:25
diapers and you know two to three bowel
19:27
movements a day and look at their little
19:29
double chin like oh my goodness your
19:32
baby is beautiful
19:33
and you're doing such a good job and i
19:36
know this is a really hard time period
19:39
so let's talk about some ways that you
19:41
can get some more rest or so there's a
19:44
lot you know
19:46
with the even with the telehealth
19:47
there's a lot of questions in terms of
19:49
well how can you do breastfeeding over
19:51
telehealth you can't do a way nurse way
19:53
you can't do this you can't do that and
19:55
that that is true we can't we can't do a
19:58
weiner's way
19:59
but
20:00
we
20:02
can
20:03
we can help with positioning and we can
20:06
um
20:08
you know we can see i mean i've
20:10
definitely you know we can have
20:12
consultations where at the beginning the
20:14
baby is like this
20:16
and by the end of the feed they're like
20:18
loose like spaghetti you don't need a
20:20
weiner's way to know that that baby is
20:23
completely
20:24
filled to the brim and happy you know so
20:27
yeah and just to clarify for people who
Weighing the baby
20:29
aren't familiar with that is like one of
20:30
the things lactations consultants can do
20:32
is weigh the baby on a scale nurse them
20:34
and then weigh them again to see how
20:36
many ounces they've consumed
20:38
is that correct yeah yeah and you know
20:40
that in itself is a bit problematic
20:43
because
20:45
babies feed for a variety of reasons i
20:48
mean if you've ever breastfed you you
20:50
can you know that and you know the dog
20:53
barks and wakes the baby up and they
20:55
need to nurse for like two minutes just
20:57
to go back to sleep where
20:59
you know they're in a strange
21:01
area you know they're
21:02
not in their home environment so they
21:04
nurse differently or you know their
21:06
schedule gets off or you know all of
21:09
these different factors so
21:11
we do a lot of just teaching you know
21:15
these are hunger cues yeah this is the
21:18
time to feed your baby
21:20
um this is normal output this is you
21:23
know this is normal this is not normal
21:26
um giving them those tools giving them
21:28
that confidence to know that they're
21:30
doing a great job and
21:33
you know just so you know you know
21:35
babies start to cry and do some cluster
21:39
feeding in the evenings that doesn't
21:40
mean that your supply is low let's talk
21:43
about that you know giving them that
21:45
education that reassurance guidance on
21:48
you know their the baby's positioning
21:51
how mom can be more comfortable when
21:53
she's nursing
21:54
what can the support people i have been
21:57
like i just have the one nice thing
22:00
about covetous like all of the support
22:02
people that have been on on the visits
22:04
and having them be part of it
22:06
you know hey you know jeff can you get a
22:08
pillow and put it under you know the mom
22:12
you know under the baby do you see how
22:14
you know the baby's um face is now
22:18
facing facing mom's body you know we eat
22:21
facing the dinner table so babies do too
22:23
make sure that the baby is you know so
22:25
involving these other people has been
22:28
just so wonderful because they're there
22:30
we're not there 24 7. totally and maybe
22:34
maybe the support people are more
22:35
arrested and can remember things later
22:38
that's
22:39
it's true and like what a beautiful
Nurse Practitioners
22:40
thing especially for nurse practitioners
22:43
watching or students who are watching
22:44
that have no experience with lactation
22:46
anything like just just imagining what a
22:50
beautiful extra layer of support we're
22:52
always looking for more support and
22:53
education for our patients and our
22:54
limited time windows like what a
22:56
beautiful thing to have a theoretically
22:59
covered insurance
23:01
covered by insurance service where
23:02
somebody is like giving such positive
23:04
energy and
23:06
education and support to to meet their
23:09
health goals right and the and the
23:10
child's health health goals as well so
23:13
yeah and you know those are all things
23:15
you're right that we
23:16
we will talk to them about as well you
23:18
know the positive health benefits for
23:21
um
23:22
for the mom for the baby
23:24
um you know we also do um like a mental
23:28
health assessment so we're you know
23:30
checking in
23:31
on that and you know really talking
23:33
through
23:34
um the whole and that's one of the
23:36
things i love about or i really want
23:39
reasons why i wanted to be a nurse
23:40
practitioner is because i really feel
23:42
like nurse practitioners are so
23:44
good at that education piece and we see
23:47
that client and the whole picture of
23:49
that client their
23:50
their whole family unit and all of the
23:53
different parts of that
23:55
that client and um it's just yeah it's
23:58
just been a joy
23:59
definitely so i think a wrap-up question
24:02
would be um i want to wrap up on some of
24:04
the takeaway points so i think a couple
24:06
of takeaways that i would share and you
24:07
can jump in with takeaways but i feel
24:09
like the main takeaways that i would
24:10
love to impart for people is like
24:13
taking them
24:14
just acknowledging lactation consultants
24:16
exist theoretically it's covered by
24:18
insurance um and that also it can be
24:21
from a preventative perspective and not
24:22
just a problem-based perspective where
24:24
you're jumping in when somebody's having
24:25
pain or the baby's losing too much
24:27
weight or something like that um and
24:29
then um you know the
Lactation Consultants
24:33
finding a lactation consultant group
24:34
especially for newer grads it's really
24:36
hard to get the lay of the land but like
24:38
if you can find a lactation consultant
24:40
you trust
24:42
that or that your that your clinic
24:43
already works with or trusts like
24:45
connecting with them getting to know
24:47
them
24:47
and collaborating with them i mean it
24:49
sounds like
24:50
you know and hopefully collaborating
24:52
with a a lactation consultant that
24:54
understands the clientele you work with
24:55
and you know with regards to insurance
24:57
coverage if you have challenging
24:59
insurance coverage situations that they
25:01
understand your clients but yeah any
25:03
takeaways you want to share and in
25:04
addition or like other resources that
25:06
people can look at to find
25:08
yeah i mean i would just you you did a
25:11
you did a really good job of summing it
25:13
up um i would just
25:15
say yeah if you have
25:18
questions or concerns then you check in
25:20
with a lactation consultant
25:23
and you know you could follow a
25:25
lactation consultant to learn more or
25:29
you know it's it's just uh
25:31
it's really great preventatively and
25:34
also if there is a problem um
25:37
and just that uh
25:39
we are here to help and
25:42
yeah that's it i mean really that's
25:44
about it and awesome
25:46
[Music]
25:47
well thank you so much um where can
Nest Collaborative
25:49
people um find more information from you
25:52
you work with the company nest
25:54
collaborative yes so we are at yeah
25:57
we're at www dot or https or whatever it
26:01
is these days um
26:03
we're at nest collaborative.com and um
26:06
you can see the insurance is there
26:09
we frequently have
26:11
people
26:12
who will
26:13
call or
26:14
message about um insurance coverage
26:18
but we do have it set up so that you
26:21
know we would notify if insurance was
26:23
not going to cover it
26:25
um
26:26
you know because that
26:28
that would you know that that's just
26:30
what the fair thing is to do to warn
26:32
people but
26:33
um yeah we're we're very much
26:36
um happy to help and to collaborate and
26:40
um to be part of carrot teams
26:42
um for for you know helping these
26:45
helping these
26:46
clients be successful in the in the long
26:49
term to meet whatever their goals are
26:52
awesome well thank you so much i
26:53
appreciate it
26:55
all right no problem
26:57
so that's our episode for today if you
26:59
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27:01
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27:03
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27:05
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27:09
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27:11
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27:13
so very much for watching hang in there
27:15
and i'll see you soon
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