Los Angeles has world-class hospitals and pediatric care, yet many new parents leave the hospital struggling to feed their babies. Cracked nipples, poor latch guidance, and confusing pump instructions aren’t rare — they’re signs of a deeper breakdown in how lactation care is delivered.

Why breastfeeding guidance matters

Parents once affectionately described International Board Certified Lactation Consultants (IBCLCs) as “magical fairies.” They were trusted guides who brought calm and expertise when baby feeding challenges felt overwhelming. But in recent years, their role has been misunderstood, minimized or overshadowed by social media trends and underprepared providers.

Here’s what I see across Los Angeles:

• Some hospitals have shifted their lactation staffing models, at times relying on IBCLCs with varying levels of hospital-based experience.
  
• Overdiagnosis is growing. Many newly certified IBCLCs, lacking strong clinical backgrounds, tend to overdiagnose tongue-ties, “body tension” and other issues. Families are referred to multiple specialists unnecessarily. Pediatricians are increasingly frustrated with this wave of referrals, and as a profession, we risk losing their trust.
  
• Families are often left navigating inconsistent guidance. By the time some parents reach me, often after seeing two or more consultants, they are exhausted, discouraged and have received conflicting or even harmful advice.

The insurance gap

Insurance coverage has become another barrier for families seeking help. Several major insurers have stopped covering home visits, citing business concerns after some providers over-billed or abused the system. Unfortunately, it’s families who now pay the price.

The inequities are striking:

• WIC (Women, Infants, and Children Program) participants and some PPO (Preferred Provider Organization) policyholders can access 100% covered lactation support during the postpartum period.
  
• HMO (Health Maintenance Organization) members and some other PPO families are often left paying out of pocket, sometimes more than $200 per visit.
  

For many families, the type of insurance card they hold determines whether they receive timely lactation support or go without. At a time when breastfeeding is promoted as one of the healthiest choices for babies, this gap makes no sense.

Mentorship — the missing foundation

When I became a lactation consultant, mentorship was at the heart of the profession. Every new IBCLC trained side-by-side with seasoned experts who shared their clinical wisdom and modeled compassionate care.

These changes reflect broader pressures on health care systems — including staffing shortages, insurance constraints, and increased demand for postpartum support — rather than the commitment of individual clinicians.

Here in California, pioneers such as Binky Petok, Christy Whitesides, Sherry Mendelson, Ellen Steinberg,  Kittie Frantz, Linda Hanna and Corky Harve built baby-friendly hospital programs, NICU feeding models and university curricula that set the gold standard for how families should be supported.

Over time, this mentorship culture has faded. Many new consultants enter practice without years of guided bedside experience. For parents, this matters. Without mentorship, essential clinical judgment and confidence are lost — and the quality of care families receive becomes inconsistent.

When titles don’t tell the whole story

Another concern is that some people are becoming IBCLCs without ever receiving extensive, hands-on clinical training. Traditionally, consultants honed their skills in hospitals, NICUs and outpatient clinics under supervision. That’s how they learned to recognize subtle but serious issues such as poor milk transfer, oral restrictions or delayed weight gain in babies. 

Today, however, some complete coursework and exams without this real-world foundation and then begin offering house calls. While well-intentioned, these consultants may miss important red flags or provide advice that creates new problems. Simply being a nurse or having personal breastfeeding experience does not automatically make someone a qualified lactation consultant.

Respected IBCLC Christine Staricka, host of The Evolve Lactation podcast, recently discussed how families can spot “fake lactation support.” Her message mirrors what I see every day: Parents need clear, accessible ways to identify safe, skilled and evidence-based care.

A growing business-first mentality

Entrepreneurship has become a visible part of lactation consulting. Unfortunately, this has sometimes overshadowed clinical rigor. Too many new entrants in the field establish brands before completing mentorship, market courses without sufficient hands-on experience or promote products without clinical context.

This business-first model, amplified by platforms such as Instagram, TikTok, Facebook and YouTube, prioritizes monetization over the IBCLC’s public health mission: ensuring safe, evidence-based human milk feeding. Over the past two years, I have personally seen and corrected harm caused by misinformation, over-intervention and inconsistent care stemming from this trend.

As I often remind my mentees: “IBCLCs were never meant to be brands; they were meant to be clinical guides.”

What families can do

Parents should confidently ask a few clear questions before booking a home visit or making out-of-pocket payments to ensure they are working with a truly qualified lactation consultant. Questions such as:

• Are you an IBCLC? (Look for the letters “IBCLC” after the person’s name.)
  
• How many families have you successfully supported in reaching their breastfeeding goals in the last month?
  
• How long have you been working specifically in the field of lactation? (Not as a nurse, doula or other specialty, but as an IBCLC.)
  
• Do you have hospital or NICU experience?
  
• Have you been re-certified? (IBCLC has to recertify every five years.)

• How do you stay up to date with current practices? 
  

These questions help families separate genuine clinical expertise from limited or misleading experience. The answers can reveal whether a consultant is prepared to handle both routine and complex breastfeeding situations and whether your family will receive the safe, consistent care you deserve.

Every family deserves safe, compassionate and evidence-based lactation support. Los Angeles has a rich history of leaders and mentors who built the foundation of this profession, and we owe it to families to uphold those standards.

By asking the right questions, sharing their experiences and expecting high-quality care, parents can play a powerful role in protecting the integrity of lactation support in our community.

Mina Ognjanovic-Jasovic, MHA, IBCLC, PMH-C, CST, has supported Los Angeles families with breastfeeding for more than 20 years. She provides lactation care in two major hospitals and one of the busiest private pediatric offices in the region. She has mentored future IBCLCs for nearly two decades and leads community breastfeeding support groups that help families thrive long after leaving the hospital. Her mission is to deliver safe, compassionate and evidence-based care while protecting the integrity of the lactation profession.