The Tongue Tie Experts Podcast
Who Decides the Value of Lactation Care? Episode 138
In this episode, Lisa is joined by her friend Olena Dobchansky, MSN, RNC-MNN, IBCLC, C-ONQS, LCCE, for a spontaneous and honest conversation about something weighing heavily on many lactation professionals right now: What is the value of the care we provide, and who gets to decide? What started as a morning text about Lisa’s own frustration with the state of lactation care quickly became a much bigger conversation about insurance, reimbursement, healthcare systems, professional identity, and the emotional toll of trying to provide deeply personal care within systems that do not always support it. Lisa and Len the RN (her Substack handle), discuss current conversations around lactation reimbursement, why traditional healthcare models do not reflect the time and complexity of lactation care, and the differences between hospital-based care, private practice, breastfeeding support, clinical lactation care, and breastfeeding medicine. They also explore what happens when systems fail to connect families with the care that already exists. Lisa shares experiences from her years working within hospital systems and reflects on the frustration of seeing mothers continue to struggle despite increased attention to breastfeeding initiatives. The conversation goes beyond reimbursement to the emotional side of this work: birth trauma, maternal anxiety, feeding struggles, informed choice, and the importance of really listening to what families are experiencing. This is not an episode with easy answers. It is a candid conversation between two longtime clinicians asking bigger questions about the systems surrounding lactation care - and what needs to change if we want both families and the professionals who care for them to be better supported. In this episode, Lisa and Olena discuss: What it really means to value lactation care Why insurance reimbursement does not always reflect the complexity of the work Current conversations around CMS, lactation care, and reimbursement How healthcare systems can influence the care clinicians are able to provide The differences between breastfeeding support, clinical lactation care, and breastfeeding medicine RN IBCLCs, non-nurse IBCLCs, and the different backgrounds professionals bring to lactation care Why hospital breastfeeding initiatives do not always translate into meaningful support after discharge The importance of strong referral pathways and interdisciplinary connections The emotional and physical demands placed on lactation professionals Moral injury and what happens when clinicians cannot provide the care they believe families need Birth trauma, breastfeeding distress, and the experiences mothers may not be saying out loud Why listening to the mother has to remain central to lactation care Olena’s question: “Are you in a functional breastfeeding relationship?” Why different families may need different levels of breastfeeding and lactation support What may be at stake for the future of lactation care Sometimes improving a system starts with being willing to question it. And this conversation asks an important one: Who decides the value of lactation care? Find Olena Olena Dobchansky on substack here: https://substack.com/@thepartumconnection More from Tongue Tie Experts Explore additional resources, including downloads, free guides, and links mentioned in this episode—along with access to our courses and new book: www.tonguetieexperts.net/Links Use code PODCAST15 for 15% off all offerings. This podcast is meant for education and conversation only. It is not medical advice and does not replace formal education, professional training, or individualized care from a qualified healthcare provider. Always seek appropriate guidance for individual concerns. The views and opinions shared by our guests are their own and do not necessarily reflect those of the host or Tongue-tie experts.
