One question I hear from students all the time is:
“How do you know when telehealth is appropriate for a lactation visit?”

It’s an important question. Telelactation has become one of the most powerful tools we have for expanding access to care—especially for families who face barriers to in-person support. But telehealth is not suitable for every clinical scenario.

Below, I walk through both what the research tells us about telelactation and how I decide which visit types work well virtually and which ones must be done in person. My goal is to help new clinicians build the confidence and clinical judgment needed to use telehealth effectively and safely.

Why Telelactation Matters

Telelactation refers to real-time, two-way audio-visual lactation support delivered through a phone, tablet, or computer. It offers families immediate, flexible access to skilled professionals when transportation, distance, or time constraints get in the way.

A mixed-studies review found that telelactation is widely accepted by parents and providers and frequently improves breastfeeding self-efficacy, perceived support, and overall outcomes (Chua et al., 2023).

The Italian Society of Neonatology similarly states that tele-support should be considered a legitimate, structured part of modern lactation care—especially when in-person appointments are not readily available (Davanzo et al., 2024).

And yet, beyond helping parents overcome barriers, telelactation plays a crucial role in addressing deeper inequities in breastfeeding support.

Telelactation’s Role in Advancing Equity

Black Families Experience the Greatest Measurable Impact

One of the strongest studies we have—the Tele-MILC randomized clinical trial involving more than 2,000 participants—found that while telelactation produced modest improvements overall, Black parents experienced statistically significant gains in both any breastfeeding and exclusive breastfeeding at 24 weeks postpartum (Uscher-Pines et al., 2025). This suggests that telehealth may help reduce longstanding racial inequities in lactation care.

Medicaid-Insured and Low-Income Families

Telelactation improves knowledge, confidence, and continuation in families enrolled in Medicaid—who often face the greatest structural barriers to in-person care (Jones et al., 2025).

Employed Mothers

A meta-analysis showed that real-time telelactation—especially proactive or mixed models—significantly increases exclusive breastfeeding for employed parents during the first six months (Iamchareon & Maneesriwongul, 2025).

Rural Communities

In many rural regions, IBCLCs are scarce and broadband access is limited. A spatial analysis in Ohio found that these dual shortages create large gaps in support (Grubesic & Durbin, 2020). Telelactation can bridge distance—but only if internet access is reliable.

Where Telelactation Shines: Visit Types That Work Well

So now, the practical side—what types of visits are actually well suited for telehealth?

Here’s how I explain it to students, with examples from real clinical scenarios.

Prenatal Breastfeeding Education

These visits translate perfectly to telehealth.
Imagine a parent at 37 weeks wanting to prepare for breastfeeding. Together we discuss:

• what to expect in the first hours

• how milk production works

• newborn feeding patterns

• early challenges and normal behaviors

No physical assessment is needed—just conversation, planning, and reassurance.

Pumping Help and Return-to-Work Planning

These are some of the best telehealth visits.
A parent might say, “My flanges don’t feel right—can you help?”
Over video, I can:

• look at flange positioning

• watch suction patterns

• assess pump settings

• help develop a realistic workday schedule

I once helped a parent who was returning to 12-hour shifts in the ER. We mapped out her pumping breaks and strategies—and telehealth made that conversation accessible at a time when she truly needed help.

Bottle-Feeding Support

Paced bottle-feeding works wonderfully over telehealth.
I can observe:

• how the bottle is being held

• whether baby is gulping

• the pace of the feed

• cues that baby needs a break

Parents often relax more in their own environment, making assessment easier.

Follow-Up After an In-Person Visit

Telelactation is great for:

• tweaking a care plan

• checking progress

• helping parents wean off a nipple shield

• answering new questions as they arise

Once I’ve already evaluated the dyad in person, virtual follow-ups are often seamless.

Where Telelactation Gets Tricky

Some issues can be addressed through telehealth—but only partially.

Mild Latch or Positioning Issues

Parents can show me their setup, and I can guide adjustments.
But if the issue is:

• a subtle tongue restriction

• weak suction

• poor vacuum

• early fatigue

…those nuances are difficult (often impossible) to capture on video.

Flange Sizing

I can approximate flange size visually, but elastic nipples, swelling, or shape changes often require in-person evaluation.

Nipple Shield Troubleshooting

I can help a parent apply the shield and discuss techniques.
But I cannot reliably assess:

• whether baby is transferring milk well

• whether the shield is compensating for an underlying oral limitation

• how the baby’s tongue is functioning under the shield

When Telelactation Is Inappropriate (and Why I Don’t Use It)

Now to the heart of what students ask: When is telehealth the wrong choice?

Latch Problems

If a parent says:

• “It hurts every time he latches,”

• “She keeps slipping off,” or

• “He won’t stay on the breast,”

I schedule an in-person visit.

Accurate latch evaluation requires:

• tactile feedback

• close auditory cues

• visualizing depth and mechanic patterns

• observing tongue and jaw function

Video simply cannot replace hands-on clinical assessment.

Poor Milk Transfer

When there’s a concern about weight gain or low intake, virtual visits fall short.
Telehealth can’t assess:

• suck–swallow–breathe coordination

• tongue cupping

• intraoral vacuum

• fatigue patterns

• whether the baby is actually swallowing milk

Weighted feeds at home help, but they’re not a substitute for a clinical exam.

Suspected Oral Anatomy Issues

Parents often ask via telehealth, “Does my baby have a tongue-tie?”
My answer is always the same: “I need to see you in person.”

You simply cannot evaluate:

• tongue elevation

• lateralization

• compensation strategies

• palate shape

• buccal tension

• oral strength patterns

Even trained specialists need hands-on assessment for oral anatomy.

Mastitis or Unexplained Breast Pain

Telehealth allows for good triage—but not diagnostic accuracy.
I cannot:

• palpate for induration

• differentiate a ductal plug from inflammation

• assess for abscess

• reliably evaluate skin temperature or texture

In these cases, in-person evaluation protects patient safety.

The Bottom Line for Students and Clinicians

Telelactation is one of the most powerful tools we have for increasing access, reducing disparities, and supporting families—when used appropriately.

Telehealth is excellent for:

• education

• pumping support

• bottle-feeding coaching

• prenatal counseling

• follow-up care

• emotional and informational support

But telehealth cannot safely replace in-person care for:

• latch problems

• poor transfer

• oral anatomy concerns

• complex breast pain

• mastitis assessment

This is the balance I want you to learn:
Telelactation expands what we can do—but it doesn’t replace the need to be in the room when clinical touch, precise assessment, or nuanced observation is required.

Used well, it makes your care more accessible, more equitable, and more responsive to families’ needs.

References

Chua, C. M. S., Mathews, J., Ong, M. S. B., Liew, K. K., & Shorey, S. (2023). Use of telelactation interventions to improve breastfeeding outcomes among mothers: A mixed-studies systematic review. Women and Birth, 36(3), 247–256.

Davanzo, R., Bettinelli, M. E., Baldassarre, M., Mondello, I., Soldi, A., Perugi, S., Giannì, M. L., Colombo, L., Salvatori, G., Travan, L., & Giordano, G. (2024). Tele-support in breastfeeding: Position statement of the Italian Society of Neonatology. Italian Journal of Pediatrics, 50, 240.

Grubesic, T. H., & Durbin, K. M. (2020). The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio. PLOS ONE, 15(11), e0242457.

Iamchareon, T., & Maneesriwongul, W. (2025). The effectiveness of real-time telelactation intervention on breastfeeding outcomes among employed mothers: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 25, 341.

Jones, C. D., Peng, C., Jones, R. D., Smith, D., Leal, K., Leal, M., Meyers, S., Bogulski, C. A., Porter, A., & Eswaran, H. (2025). Assessing the impact of telehealth lactation support on initiating and sustaining breastfeeding among Medicaid patients. Telemedicine and e-Health, 31(11), 1318–1326.

Louis-Jacques, A. F., Schafer, E. J., Livingston, T. A., Logan, R. G., & Marhefka, S. L. (2021). Modesty and security: Attributes associated with comfort and willingness to engage in telelactation. Children, 8(4), 271.

Uscher-Pines, L., Kapinos, K., Waymouth, M., Howell, K., Alvarado, G., Ray, K., Demirci, J., Mehrotra, A., Rogers, R., Floyd James, K., & DeYoreo, M. (2025). Telelactation services and breastfeeding by race and ethnicity: A randomized clinical trial. JAMA Network Open, 8(2), e2461958.