IBCLC, Doula or Peer Counselor: Who to Call for Breastfeeding Help

Day three, and feeding is not going the way the class said

The class made it look simple. Then the baby is three days old, latching for a minute and sliding off, your nipples hurt, and someone in the family has already suggested formula while someone else insists you just need to relax. You are tired and unsure who to believe, let alone who to call.

You are not doing it wrong. The American College of Obstetricians and Gynecologists (ACOG) says breastfeeding is a natural process, but it can take some time for you and your baby to learn, and that peer counselors, nurses, doctors and certified lactation consultants can help you get started and give advice when you run into challenges. ACOG also says plainly that if you cannot breastfeed or decide not to, it is OK.

There are several kinds of feeding help, and they are not interchangeable. This guide explains what each one is for. For names, phone numbers and practices near you, see our list of Scottsdale breastfeeding resources.

IBCLC: the lactation credential

IBCLC stands for International Board Certified Lactation Consultant. The credential is awarded by the International Board of Lactation Consultant Examiners (IBLCE), which established the IBCLC certification program in 1985. IBLCE describes IBCLCs as members of the maternal-child health team who provide care in a variety of settings and make referrals to other health professionals and community support resources.

You will see other feeding titles too, such as lactation counselor or breastfeeding educator. Those come from other organizations with different training, so ask anyone you are considering which credential they hold. IBLCE offers a way to verify an IBCLC on its website.

An IBCLC is often the right call when feeding hurts, when the baby is not gaining well, when supply worries you, or when someone has raised tongue tie. Our post on tongue tie and feeding explains why a full feeding assessment comes first.

Free peer support: La Leche League, WIC and the state hotline

Peer support means help from people who have breastfed themselves and trained to support others. It is warm and practical, and it is not a medical service. In Arizona there are three main doors:

• La Leche League. La Leche League International says its meetings are led by an accredited LLL Leader, a volunteer breastfeeding counselor, and that all LLL support is free. LLL describes Leaders as volunteer counselors who have nursed their own babies. Meetings welcome anyone who is pregnant, nursing, pumping or combination feeding, and many groups also meet online.
• WIC peer counselors. The Arizona WIC program provides nutrition education, breastfeeding support and nutritious foods, and serves pregnant, breastfeeding and postpartum women, infants and children under five. Its policy manual says local WIC agencies offer to enroll pregnant and breastfeeding participants in the Peer Counselor Program. Peer counselors have personal breastfeeding experience, offer encouragement and basic education, and help plan a return to work. They do not diagnose, give medical advice or prescribe, and each agency employs or contracts with an IBCLC for problems beyond their scope. Ask your WIC clinic whether a peer counselor is available to you.
• The Arizona 24-Hour Breastfeeding Hotline. The Arizona WIC policy manual, published by the Arizona Department of Health Services, lists it at 1-800-833-4642. It is a good number to save before the birth, for the 3 a.m. question.

Your pediatrician and your own provider

Feeding is also a medical question, because it is how your baby grows. The American Academy of Pediatrics (AAP) tells parents having trouble breastfeeding to contact the baby's pediatrician and to keep asking for one-on-one guidance until they get the help they need. The pediatrician weighs the baby, and the AAP calls inadequate weight gain one of the strongest signs that a baby is not getting enough milk.

Your own body is a question for your OB-GYN or midwife. The AAP says that severe nipple pain or significant cracking calls for a physician or lactation specialist, who can check for an infection such as mastitis and help with latch. Do not wait it out alone.

What a postpartum doula does for feeding

A postpartum doula is the person who is there between the appointments. The Doulas of the Valley postpartum doula care page lists extensive bottle and combination feeding and newborn care instruction among the support for your baby. In practice that can mean sitting with you through a feed and helping with positioning and pillows, building a feeding routine that fits your day, washing and setting up pump parts, preparing bottles, and keeping a simple log of feeds and diapers for the pediatrician.

She also helps you follow the plan your clinicians set. If the IBCLC suggests a new position, a pumping schedule or paced bottle feeding, the doula helps you practice it at the next feed and the one after that, which is often where a new technique sticks. Our newborn care education page describes this kind of in-home teaching.

She does not diagnose tongue tie, assess milk supply or decide whether the baby is getting enough. When there is pain, a weight concern or a supply worry, she encourages you to call your pediatrician or an IBCLC, and our post on clogged ducts covers one common reason to call. For how visits run day to day, see what to expect from your first postpartum doula visits.

Putting it together, and when a doula is the wrong call

Many families end up with more than one kind of help. One way it can look: a hospital or outpatient lactation visit in the first days, the pediatrician weight check, the hotline number on the fridge, a La Leche League group or WIC peer counselor for the weeks that follow, and a postpartum doula at home if the household needs hands and rest as much as feeding help. Doulas of the Valley offers postpartum doula care and newborn care education in Scottsdale and across Maricopa County; we start with a no-pressure consultation to understand your needs.

A doula is the wrong first call if feeding hurts, the baby is not gaining, or you are worried about supply; that is your pediatrician and an IBCLC. She is also not the answer if what you want is free peer support, which La Leche League and WIC provide directly. If you are comparing the whole postpartum team, our guide to postpartum doula vs. home visitor vs. pediatrician lays out who does what.