Melanie Venuti
“Our job is to always support families on their level. I encourage families to keep me in the loop if they're feeling particularly overwhelmed, because we can always make changes to [their feeding goals], versus waiting for overwhelming feelings to fester and lead to darker thoughts. I think the biggest thing is really to just make sure that families understand that their goals are their goals, and your baby's going to love you no matter what. And I'll shout it from the rooftops: support, support, support! Just having somebody in your corner to support you is so important.”
Melanie Venuti is the owner and IBCLC of MV Breastfeeding Support, a private practice offering clinical lactation care in the Boston area and surrounding suburbs. Melanie has worked in many aspects of maternal and child health including nutrition counseling and parental education over the last decade, plus. She prides herself in offering a casual and laid back approach to clinical counseling, offering families practical advice based on their individual goals.
Melanie is the President of the Massachusetts Lactation Consultant Association (MLCA).
Melanie has a degree in Nutrition and Didactics, and before becoming an IBCLC in 2011, worked for the DPH Women, Infants and Children (WIC) program. During her time at WIC, Melanie advocated for individual care plans realizing that infant feeding is not “one size fits all,” helping families make realistic expectations and define their own success.
Melanie lives in Dedham, MA with her husband and 2 busy, sports loving boys.
This blog is made possible by a sponsorship from Sage Therapeutics, Inc. and Biogen Inc. All content on this page has been curated by the Mass. PPD Fund without input from Sage Therapeutics, Inc. or Biogen Inc.
November 2024 | Interviewed and edited by Jessie Colbert, Executive Director, Mass. PPD Fund
Earlier this year, the Mass. PPD Fund was lucky to speak to not one, but two terrific lactation professionals as part of Breastfeeding Awareness Month, so we are revisiting this key topic with a conversation with private practice IBCLC (International Board Certified Lactation Consultant) Melanie Venuti this month.
When it’s going well, breastfeeding is associated with better maternal mental health outcomes. But breastfeeding challenges can have the opposite effect. Here, Melanie shares her low-key, empowering approach to lactation support, and how putting families in the driver’s seat of their own breastfeeding journey can be a win-win for feeding and perinatal mental health. We also discussed widely held misconceptions about medication and breastfeeding, and the vital importance of support and access to care when it comes to lactation care and all types of perinatal healthcare.
Let’s jump into your career as a lactation consultant. What inspired you to get into the field, and how has your work developed over the years? What are your goals for the future?
I initially went to college for nutrition and didactics, with the idea of becoming a registered dietitian. I wanted to work in community nutrition, so I knew my end goal was to work either at SNAP or WIC or somewhere like that. Immediately after graduating from college, I was lucky to get a job at St. Elizabeth's Hospital with the WIC program. As you know, WIC works with women during their pregnancy all the way up until their kiddos turn five years old, as long as they continue to be eligible.
During my time working as a nutritionist [with WIC], I had the opportunity to take a lot of continuing education in nutrition, but also in infant feeding, both in specialized infant formula and also breastfeeding. Being a young 20-something, I didn't have an enormous knowledge base of breastfeeding, so it really opened my eyes to how incredible and fascinating the human body is to be able to produce food for our babies! I know that sounds very cliche, but I was like, Wow, how do I get myself involved in this even more? To sit for the IBCLC exam you have to do a significant amount of clinical hours. I finally did it, and then was able to morph my career into more of an infant feeding specialist.
I worked for ISIS Parenting, which was essentially an outpatient clinic for everything prenatal and postpartum. I was doing individual lactation consults with them, and teaching various classes and group education and support groups, and then they went under. That's what forced me into private practice. Thankfully, it has been a really wonderful career, and the opportunity to be able to be in the homes of families is like nothing else.
To touch upon goals, [they are] just to continue to build my community and support families. And also, being on the Board of the Mass. Lactation Consultant Association, [I want to continue to] increase recognition of our career, because we're still this itty-bitty community of healthcare providers that isn't quite recognized as an essential piece of the postpartum experience.
Research tells us that a successful nursing relationship helps postpartum mood, but conversely, breastfeeding challenges can contribute to moms feeling like they’re not meeting expectations, which can create a downward spiral. And sleep is often a factor, too. How do you address these challenges as a lactation professional?
I think there is this common misconception among moms that lactation consultants are the people that tell them they have to do something, or that if you don't breastfeed, you're a bad person. That's not our job as healthcare providers! Our job is to always support families on their level, and make sure that we're creating expectations for their goals. In my practice, that is really number one: creating realistic expectations. I spend a lot of time talking with families about their individual goals and how we can create a plan together.
I encourage families to keep me in the loop if they're feeling particularly overwhelmed, or if they're concerned about something that is in the plan, because we can always make changes to those plans, versus waiting for those overwhelming feelings to fester and lead to darker thoughts. I think the biggest thing as a lactation provider is really to just make sure that families understand that their goals are their goals, and your baby's going to love you no matter what.
I appreciate that balance. Could you share an example of a time you had to modify a mom’s goals based on particular challenges?
There are various reasons why a parent may choose to end their feeding relationship. Most recently, I had a mom who was having reoccurring clogged ducts and mastitis, which can be really tough on your body, and for that reason, she is choosing to wean at a month old. And one of the things that we talked about was how proud I was of her for being able to prioritize herself in that situation. Just knowing that you gave it your all, and that what you've done for your baby this last month is incredible, and now you're making an educated choice to do something for yourself.
I've also had situations where families had past mental health issues, and have voiced to me that sleep is incredibly important to their mental health. We might create a plan that includes a partner or a night nurse or a grandmother doing the nighttime feedings so mom can have that full night's sleep. If you were to look at a textbook and see what an ideal breastfeeding plan is, that wouldn't be it, but this is the goal that this family had, and we're there to work with them to reach that goal.
Are there other ways we can be proactive about supporting both breastfeeding and mental health?
I'll shout it from the rooftops: support, support, support! Just having somebody in your corner that is there to support you is so important, rather than feeling judged by your providers, because that happens a lot. Here’s the thing: when breastfeeding works, it's amazing. It’s easy, it's convenient, it's lovely. But when it doesn't work, it's really, really hard. So I think early support prenatally, early support postpartum is so, so crucial.
Sometimes we may talk about, you know, it really sucks right now. [I try to give] that light at the end of the tunnel; that can sometimes be what helps families feel like, Okay, I can do this for another week, and hopefully by then I'm feeling better. I might even share my own experiences of when I wanted to give up, even as a lactation consultant. That can be very powerful for families.
If one of your patients has signs of a perinatal mood disorder, how do you identify it? What do you do next?
The online charting system that I use has the Edinburgh Scale, but that feels a little bit impersonal. The beauty of being an in-home, private practice LC is I'm in the comfort of their own home, and connecting with families on more of a personal level. If the screening is just one or two points lower than what we would expect, I’ll incorporate questions of, How was your pregnancy, how was your labor, how was your delivery? How are you feeling now? Asking those sort of laid back questions that might open up the conversation for the harder questions. In terms of referrals, it's not within my scope of practice to offer any guidance, but I have a referral statement that goes to almost everyone, like, if you ever need help, please reach out to these people.
How do you address medication management/safety, psychiatric and otherwise, with your clients?
We may feel generally like, medications and breastfeeding: we don't want our baby exposed to those things. But as a healthcare provider, we are trained to understand the interactions between medications and breast milk, and how they're delivered to baby, if at all. There is an incredible database that rates medications based on research studies, the InfantRisk Center. I typically check that and send families research-based information that will allow them to make a decision together with their care team.
There’s a very small list of medications that completely contradict breastfeeding. Sometimes the benefit does outweigh the risk, especially when we're talking about a mental health issue or a significant health issue where this medication is required. That isn’t general knowledge for physicians. A lot of times we’ll hear people say, My doctor told me I couldn't breastfeed with this type of medication, or, I had dental work and they told me to pump and dump. That's wild misinformation. We always hope that families reach out to us to give them up-to-date research.
As an IBCLC, you have a unique window on families’ experiences in the early moments of parenthood. What are your thoughts about how we as a society/medical system can best support parents, especially during the first year of life?
Oftentimes the lactation people are the first to meet babies in the hospital immediately postpartum. Sometimes I'm doing clinical visits three to five days after a baby's born. During the COVID pandemic, families were like, My parents didn't even meet the baby yet! We do have this incredible privilege to be able to be part of this family's journey from very early on.
I will repeat my horn of support, support, support. And access is another word that I think is incredible in this situation. The unfortunate thing is, right now parents do have to pay out of pocket for IBCLC care and wait for insurance reimbursement, and not all families have the privilege to be able to afford that. Thankfully, WIC has this incredible program that they established over the last couple years where they have IBCLCs in all of their clinics. The Boston Breastfeeding Coalition has been doing incredible things as well.
So there’s a lot of support out there, but we really do need to push for quality lactation care that's accessible for everybody. Hopefully the maternal health bill will touch upon this. I do think it's going to be somewhat of work in progress, just like anything else that changes in the healthcare system.
Definitely. Is there anything else you’d like to add?
LCs are here to support families – we’re not the breastfeeding police. I think that once people have us in their homes, they learn that we're part of the care team, and we’re hoping that families have great outcomes regardless of their choices.