When To See A Lactation Consultant Vs When To See A Doctor

When To See A Lactation Consultant Vs When To See A Doctor

Breastfeeding, although natural, is also a learned skill.

As with all new skills, breastfeeding can take some time to master.

Lots of mothers experience breastfeeding challenges, especially in the early weeks.

Getting timely and knowledgeable support is important to overcome breastfeeding problems.

But how do you figure out whether you should see your doctor or a lactation consultant about the breastfeeding problem(s) you’re facing?

Well, before going into more detail about specific breastfeeding problems, you may be interested in reading here about the level of breastfeeding education different health professionals obtain – the difference is staggering. As you can see, International Board Certified Lactation Consultants (IBCLCs) are by far the gold standard when it comes to the provision of breastfeeding assistance and information. It’s similar to having a Masters degree in Breastfeeding.

Here are 9 common breastfeeding problems with details about who you should see when faced with them and why.

Breastfeeding Problem #1: Cracked Nipples

Cracked nipples are a common problem faced by mothers in the early weeks of breastfeeding. The main cause of cracked nipples is suboptimal positioning and attachment. When a baby isn’t positioned or attached optimally, your nipple can get compressed between your baby’s tongue and hard palate. This can lead to nipple damage.

It takes a trained eye to figure out if a baby is positioned and attached well and provide tips about how to optimise it positioning and attachment. IBCLCs have had countless more hours observing and helping mothers breastfeed than most doctors.

Occasionally, a cracked nipple may be slow to heal or show signs of infection. If this is the case, a doctor may prescribe a particular cream or medication.

Occasionally, a mother may have nipple damage despite optimising positioning and attachment. This may be due to a baby having a tongue-tie. An IBCLC can assess a baby’s oral anatomy and suggest who to see for possible tongue-tie release (e.g. some doctors) if a degree of tongue restriction is found.

Who Should I See? Most commonly, cracked nipples are due to suboptimal positioning and attachment. Hence, seeing an IBCLC is approriate. An IBCLC can suggest seeing a doctor if need be.

Breastfeeding Problem #2: Baby Won’t Attach

Breastfeeding is instinctive for babies. However, there are various things that can cause attachment difficulties after birth. For example, if your breasts are very engorged, this can make it hard for some babies to attach. Sometimes, pain relief used during labour, or other birth interventions, can contribute to making some babies extra sleepy and perhaps even dull their feeding behaviours – all of which can make attaching more difficult.

IBCLCs have a thorough understanding and first-hand experience with things such as how breastfeeding works  and how to get breastfeeding off to the best start possible. This means IBCLCs are well placed to troubleshoot why a baby may be having trouble attaching and help work out the best ways to:

  1. Ensure your baby continues to receive enough milk
  2. Support your milk supply
  3. Provide ongoing guidance about what to do as things progress/change

Occasionally there may be medical issues surrounding a baby’s difficulty attaching to the breast. However, the care involved with helping a baby attach is best placed with an IBCLC.

Who Should I See? An IBCLC’s extensive breastfeeding knowledge and experience can provide you with all the information and support you need to help your baby attach and feed.

Breastfeeding Problem #3: Engorgement

Breast engorgement is when there is an accumulation of milk and tissue fluid in your breasts. It can make your breasts feel very full, tight and painful.

A thorough understanding of how breastfeeding works, positioning and attachment and how to assess if a baby is removing milk effectively are important when helping mothers with engorgement. A lack of understanding of any of these factors can lead to poorer outcomes for a breastfeeding mother and her baby.

Hence, IBCLCS are the most qualified to be able to assist mothers with the treatment of engorgement.

Who Should I See? An IBCLC thoroughly understands how breastfeeding works and is best placed to be able to treat the engorgement, support your supply and help ensure your baby is feeding well.

Breastfeeding Problem #4: Mastitis

Mastitis means breast inflammation is present. Mastitis may or may not be accompanied by an infection. Whether there’s an infection present or not, milk stasis is usually the main cause of mastitis.

Mothers sometimes receive incorrect information about mastitis, for example, mastitis means the breastmilk is infected and should be pumped and dumped or if antibiotics are needed, she should also pump and dump.

An IBCLC ‘s detailed understanding of the factors mentioned above for engorgement are crucial to help recognise how the mastitis may have developed in the first place, how best to treat it and how to help prevent it happening again.

For infective mastitis, the most common causative organism is Staphlococcus aureus. The prescription of antibiotic treatment for mastitis lies in the hands of a doctor. Therefore, it’s advisable to see a doctor if you develop symptoms of mastitis. For more information, see our article on mastitis.

Who Should I See? An IBCLC is best placed to be able to help you resolve the mastitis and to reduce the risk of it occurring again. A doctor (ideally one with breastfeeding knowledge and experience) also needs to be seen in case antibiotics are needed.

#5: Blocked Duct

A blocked duct is where milk banks up behind a blockage in one or more of your milk ducts which can cause pain and inflammation.

For the same reasons as mastitis, an IBCLC is well placed to assist with the treatment and prevention of blocked ducts.

If a blocked duct doesn’t clear within 24 hours, seeking advice from your doctor is advised to rule out anything that may require further medical attention or investigation.

Who Should I See? An IBCLC can help you get rid of a blocked duct and can provide tips about how to reduce the risk of the reoccurring. An IBCLC will be able to provide you with information about when a doctor may need to be seen.

#6: Nipple Vasospasm

Nipple vasospasm  is where tiny blood vessels in your nipples tighten up and as they do so, reduce the blood flow to your nipples. This can cause nipple pain.

There are a variety of causes of nipple vasospasm. An IBCLC can help work out what may be causing the nipple vasospasm in your situation. Treatment for nipple vasospasm works best when the cause is found.

In some of the more severe cases of nipple vasospasm, a prescription medication may be required. In which case, a doctor should be consulted. Also, if a medical condition or a medication is thought to be contributing to the nipple vasospasm, medical advice should be sought.

Who Should I See? For most cases of nipple vasospasm, an IBCLC only needs to be seen. An IBCLC can suggest seeing a doctor if necessary.

#7: Nipple Thrush

Nipple thrush is due to a fungal infection (where a bug called Candida albicans is the culprit).

Regardless of the cause of nipple pain, optimising positioning and attachment is important and can often help reduce the pain. Also, nipple damage increases the risk of nipple thrush. For these reasons, seeing an IBCLC for nipple thrush is important.

Prescription medications may be required for the treatment of nipple thrush. Hence it may be important to consult a doctor.

Who Should I See? Sometimes thrush can be treated without seeing a doctor, but often a doctor is required for prescription cream or medication.

#8: Concern About Low Supply

Most mothers are able to make plenty of milk for their baby or babies. Most of the time when a mother is worried about her supply, it’s a perceived low milk supply rather than a true low milk supply.

This is why it’s important to rely on the reliable signs, and not the unreliable signs, to determine if your baby is getting enough breastmilk.

IBCLCs have a thorough understanding of how breastfeeding works, positioning and attachment, about how to assess if your baby is removing milk well from your breasts, expressing, methods of supplementation etc. This makes an IBCLC well placed to be able to help work out whether a mother truly has a low milk supply and if she does to help her take steps to increase it.

If a baby’s weight gains  are slow, an IBCLC’s input is important to optimise your breastmilk production and intake by your baby. Medical investigation may also be required to assess whether there may be any medical reason for the slow weight gains.

Who Should I See? Seeing an IBCLC is most ideal when you are worried about your milk supply. An IBCLC can suggest seeing a doctor for a prescription galactagogue if necessary.

#9: Oversupply

An oversupply is where a breastfeeding mother is making too much milk.

An IBCLC can help work out whether you have an oversupply and if so, provide treatment suggestions. It’s important for treatment for an oversupply to not start unless it’s certain you have an oversupply, otherwise you could end up with a low supply! For this reason, it’s also important for the treatment for oversupply to cease once it’s under control.

Occasionally, an oversupply may be due to a medical reason (e.g. hyperprolacinaemia). In which case, medical investigation would be needed.

Who Should I See? Seeing an IBCLC is important for an oversupply as you want to be sure that’s what it is. An IBCLC can guide you about seeing a doctor in the unlikely situation it’s necessary.

IBCLCs are not vested in pushing breastfeeding at all costs. They meet you where you’re at and work with you to help you achieve what you want. If you decide you want to wean or use formula or if formula is needed for any reason, an IBCLC will help you do so. If exclusive breastfeeding is important to you, IBCLCs know many tools and solutions to help you be able to do so. Those who are less skilled and knowledgeable about breastfeeding, however, may be quick to suggest formula as a ‘solution’ to many breastfeeding problems.

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Renee Kam is mother to Jessica and Lara, an International Board Certified Lactation Consultant (IBCLC), a physiotherapist, author of 'The Newborn Baby Manual' and an Australian Breastfeeding Association Counsellor. In her spare time, Renee enjoys spending time with family and friends, horse riding, running and reading.


  1. I am an experienced GP and Obstetrician who works closely with a team of Lactation Consultants, and Child Health Nurses caring for mothers and babies. I can reinforce your view that the qualified Lactation Consultants are the better and first stop for breast feeding issues of all sorts. They definitely have better experience than the majority of doctors in the challenges facing mothers with breast feeding. However, the only area where the doctor should be consulted early and urgently is in the area of mastitis. An experienced GP will have good experience in this condition and understand the need for prompt and effective treatment including but not only with antibiotics. A team approach where the Lactation Consultant and the doctor work hand in hand is the better way to go for mothers with breast feeding challenges.

    1. Hello Leon, thanks for stopping by with a comment! Fantastic to hear that you support and practice collaborative care, I only wish it was the norm! We do need more doctors working this way with women and other health professionals, so the best outcome can be reached for mother and baby. All the best!

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