A postnatal consultation is an expert tuition session which offers detailed postnatal breastfeeding advice.  It addresses any problems, builds confidence and improves feeding outcomes. For most new clients this will last a minimum of 2 hours.

The consultation covers:

  • Detailed antenatal, delivery and feeding history;
  • Examination of infant’s oral anatomy*;
  • Examination of maternal breasts if clinically indicated*;
  • Observation of current attachment technique;
  • Determination of factors adversely affecting current feeding and practical solutions taught;
  • Optimisation of the latch and addressing suboptimal attachment (this is a common factor for most scenarios);
  • Multiple assessments of attachment, with hands-on approach to optimise this;
  • A detailed, individual feeding plan;
  • A follow up complimentary telephone consultation within 24 hours to allow for minor amendments;
  • Further follow up visits can be arrange if indicated.
  • Please note: All examinations of either infant(s) or mother are undertaken with consent.

Typical scenarios or issues which clients experience include, but are not limited to:

A postnatal breastfeeding consultation

Management of painful, prolonged and ineffectual feeding

This is a common difficulty at different ages of the baby. Jane has considerable experience in elucidating the key underlying problem and building strategies to ameliorate it.

This may include working through:

  • Supporting clients to overcome sore/damaged nipples – assessing if this is purely technique or caused by other contributing factors – i.e. small gape and or undiagnosed tongue tie;
  • Assessing if prolonged feeds are due to insufficient milk transfer – caused by suboptimal attachment and or challenges due to the infants oral anantomy – i.e. high palate, small gape, or anterior/posterior tongue tie;
  • Assessment of mothers anatomy – flat, and or inverted nipples;
  • Raynaud’s syndrome – how to feed with this;
  • Undiagnosed breast tissue hypoplasia.

A postnatal breastfeeding consultation

Diagnosis of mastitis/thrush secondary to poor attachment

As part of difficulties with attachment there is often a secondary effect on the mother’s breasts. Mastitis and/or candida (thrush) of the nipple can be a recurring sign of this.

Jane provides:

  • Clinical diagnosis with associated feed observation;
  • Alteration in attachment (as required) to minimise trauma thus mastitis;
  • Practical immediate management techniques to reduce the pain/inflammation of mastitis;
  • Recommended onward referral to GP with suggested treatments;

A postnatal breastfeeding consultation

Breastfeeding of twins or triplets

Whilst not relevant to most families, the feeding of twins or multips can be more involved than singletons. For those who have not sought help antenatally, it is still possible to provide successful postnatal methods to feed twins/triplets.

Jane has significant experience in successfully helping parents to establish and maintain breastfeeding for these cases and can assist with:

  • Facilitating tandem feeding;
  • Ensuring adequate milk supply;
  • Feeding techniques in public.

A postnatal breastfeeding consultation

Safe management of low milk supply

Concerns about milk supply can arise from a variety of triggers (weight gain in the infant, inconsolable crying, prolonged, ineffective feeding).

There are a multitude of factors which affect maternal milk supply; these are well-documented5.

A small proportion of this group, however, have a previously unknown physiological reason why they have low milk supply, once all other factors are accounted for. This can be missed, or mis-diagnosed, during the pregnancy/immediate post-natal period.

Jane is able to:

  • Determine if this is primarily a maternal, or infant cause; physical or physiological;
  • Address methods to optimise correctable physical causes;
  • Discuss methods to provide immediate amelioration, whilst planning to work on long term realistic goals;
  • Properly assess for breast hypoplasia and suggested onward referral if needed;
  • Liaise with GP surgeries for those who require a further medical assessment.

A postnatal breastfeeding consultation

Slow or poor weight gain or concerns around milk production

Infants are seen where concerns have been raised about weight acceleration. Whilst these often represent ‘normal’ developmental changes in feeding, for some there is an underlying issue.

The following would be considered during a consultation:

  • Clinical assessment on current status and feeding techniques and patterns;
  • Clinical assessment of milk transfer;
  • Assessment of milk supply; methods to increase this, where indicated;
  • Developmental age of the infant and predicted impact on breastfeeding;
  • Management strategies to optimise feeds, if needed.

Advice and support will also be given to clients who wish to relactate.

A postnatal breastfeeding consultation

Assessment of tongue-tie (ankylogossia) with regard to feeding and onward referral when indicated

Tongue-tie has become increasingly recognised as one factor which can adversely affect a baby’s ability to latch.

NICE recommends that tongue-tie release (frenulotomy) may be beneficial for attachment and for maternal pain associated with poor latch. However, this procedure should only be considered following appropriately trained assessment of latch/attachment. This is because the tongue-tie may not be the primary cause of sub-optimal feeding6.

A Cochrane review of the 5 available randomised controlled studies was published in 2017. This noted that frenotomy reduced breastfeeding mothers’ nipple pain in the short term. Investigators did not find a consistent positive effect on infant breastfeeding. They did note that the small number of suitable studies, and methodological shortcomings of those found, limited the certainty of their findings7.

Conservative measures to ameliorate this

Gables Breastfeeding Clinic has significant experience in using conservative measures to ameliorate the adverse effect on feeding.  Please see our Testimonials for details.

Onward referral for tongue-tie release (frenulotomy).

  • For babies for whom frenulotomy may be indicated, this Clinic does NOT offer this service. However, Clients are referred to appropriately-trained clinicians with an expertise on division (and redivision, if this is the presenting problem).
  • Referrals can be private or NHS.
  • No renumeration is received by us for referrals made.

Follow up assessments

Following her previous work in a specialised tongue-tie clinic, it is Jane’s standard practice to offer 2 follow up appointments post frenulotomy.

These are additional appointments which are considered important to ensure that after-care is being appropriately administered and to assess if further changes are required with the latch.

Jane advises a day 2 post-procedure and a day 7-10 subsequent follow up.


The following evidence is cited in the consultation advice above:

5. https://www.nhs.uk/start4life/baby/breastfeeding/breastfeeding-challenges/things-that-can-affect-milk-supply/ [Accessed 23rd November 2019]

6. National Institute for Health and Care Excellence (2005) Division of ankyloglossia (tongue-tie) for breastfeeding [IPG149] Available at: https://www.nice.org.uk/guidance/ipg149 [Accessed 23rd November 2019]

7. Cochrane. O’Shea J, Foster J, O’Donnell C, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst. Rev., 3 (2017), Article CD011065. doi.org/10.1002/14651858.CD011065.pub2