Archive | January, 2016

What happens at an IBCLC appointment?

11 Jan
Mother With Baby Talking With Health Visitor At Home

Mother With Baby Talking With Health Visitor At Home

Going to an IBCLC appointment may be a little nerve-inducing.

What does she expect?  What will she say?  Will she be nice?  Will she “manhandle” me?  Will she make my baby cry?

Hopefully, it will be a smooth, easy, empowering experience.  What I am writing will be specific to my office visits in Ogden, Utah, but they will likely be similar with most independent IBCLCs.  Hospital LC visits will probably be a little different as they usually only have about 30 minutes with a client rather than the more relaxed visit of a private practice IBCLC.

IBCLC stands for International Certified Lactation Consultant. This is the gold standard for breastfeeding care. Just like car mechanics or doctors, you can find really good ones with less credentials and really bad ones with credentials. That being said, if you are experiencing breastfeeding difficulties that your local LLL Leader or Health Care Provider cannot help with, it is generally time to call an IBCLC.

When you first make an appointment, I will ask some very general questions over the phone, but not much that will help unless it is simply to get you through until we meet. There is a reason for that. I have a Code of Professional Conduct and a Scope of Practice which gives me legal obligations for the care of my clients. This means I need to have an established client relationship in order to take those obligations and risks.10500391_10152593291157741_4625631599968962240_n

When we make the appointment, I will send an email link for both my consent form and an intake form. They are both HIPAA-Compliant. Read the consent and sign and then fill out the intake form. It may take a few minutes, but it means we have more time during the consult to discuss things. It includes items like your birth and breastfeeding history, your exposures (both chemical and emotional), feeding patterns, and support network. All of these are important facets of your feeding success. If you wonder why a question is being asked, then please talk to me about it. A thorough history is an important part of every lactation visit. Each dyad is different and will have different challenges. It would be sad for you and a waste of time if you only made plans to correct one problem when multiple issues were causing breastfeeding difficulties, but nobody noticed.

Bring everything that you use for baby feeding. For some, that means a nursing pillow or alternate feeding device. For others, it is bottles and pacifiers, pumps, and for some it is nothing. It is all within the realm I see. If the baby does receive milk by bottle, please make sure that you bring at least one feedings worth to the appointment.

Once that is completed, you will come to the consult. In my practice, I suggest bringing somebody with you. It can be anybody you wold like. I like having an “extra pair of ears” since many of my clients are so very newly postpartum and often have so many things they are trying to keep track of, or emotions and hormones are so high, that not much gets remembered of the visit. If you don’t have anybody to come, that is fine. All of the things we talk about are also included in an email after the visit.

Many IBCLCs require payment at the time of service. There are a few who will bill your insurance company, but not very many. This is from some very political strong-arming that is happening with the care providers and insurance companies, even though breastfeeding services are supposed to be covered 100% with no copay to the client. I (and many other IBCLCs) can provide a superbill which you can turn in to your insurance for reimbursement. If they refuse to pay anything, please report it to the Women’s Law Center.

I have a scale where we weigh the baby and I go through the intake with you and clarify anything that may need clarification. Then we talk about anything that may help the difficulties you are facing in your breastfeeding relationship. Sometimes I have paper information sheets, but I always have electronic resources for you as well. Some parents do better with electronic info and others like paper. It all works.

1493468_669927979755026_8643327488634811141_oI will watch a feeding. It is rarely necessary to withhold feeding the baby just prior to the consult since it is 90 minutes long and most human milk fed babies are happy to eat sometime in that timeframe. If baby wants to eat just as you are walking out the door, try just feeding him about half what you normally would. We do the feeding assessment whenever baby needs it. I often do the intake questions later in the consult because we have a hungry baby walk through the doors. At some point, I will also look at your breasts. Depending on the circumstances, it may not be something that you as a client will even notice. I also will do an exam of the baby’s mouth. I usually do this about halfway through a feeding.

Using your breastfeeding goals as a guideline, we talk about a few options that you have and suggestions to try to make breastfeeding more doable for you. If any of them don’t work or don’t work enough, please contact me so they can be reworked.

Breastfeeding is not always easy. But with support, information and a little determination, it can almost always be made a better experience for you.

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Milk Blister/Bleb

1 Jan
COLOURBOX2711301

Blebs hurt!

Persistent Blebs

Blebs can be an annoying part of breastfeeding. Sometimes they cause a mother pain, but not always. Often, when they are not causing pain, there is no treatment necessary for them. However, when they cause irritation and discomfort, it may be more comfortable for the mother to treat them.

A bleb is a small amount of epidermis (skin) covering one of the outlets of milk on the nipple. It was once thought that every mother had the same number of outlets. New research shows this to be inaccurate. While the average number of outlets is about 9, normal can be anywhere from about 4 to about 15. Many things can cause a bleb and we are not really sure why some women get them and some don’t.

Often, changing position, keeping skin moist with oil in between feedings and other comfort measures are enough to get a bleb to go away. If these things are not working, here are some other things to try:

  • Try using a sterile needle to open the bleb and then very gently express the bleb. If it has been there a while, it is highly likely that the milk coming out will be granular, thick, gooey, or clumpy and maybe even a different color than your “normal” milk.
  • Try putting olive oil or coconut oil on nipple and after it has made skin nice and soft (sometimes hours or even days) try nursing, expressing or needle aspiration.
  • Soak in epsom salt or saline soaks to soften skin and keep it from getting too irritated. Try this before or after feedings; or both. See what works for you.
  • Use warm compresses with the moisture so that the baby can remove the bleb while feeding. (This is completely harmless for the baby, even if the milk is clumpy, he probably won’t even notice it.)
  • If it keeps coming back or just won’t go away, try lecithin. It can be obtained in capsules, liquid or granules; in soy or sunflower. Lecithin is an emulsifier (something that helps the fat to mix with the other liquids) which may help it to become “unstuck” from the duct walls, so it can flow more freely into the milk. Dosages vary by source. Some say 2 T per day all the way up to 3 T 3 times/day. If a lower dose doesn’t work, try upping it.
  • Try breast massage while nursing. Sometimes, it just needs a little coaxing to come out.

If none of these things work, it might be important to start exploring other reasons for the bleb. A persistent bleb can be a sign of yeast. It can be a sign of a low grade, but persistent bacterial infection. It could also be a sign of tongue tie in your baby.

Here are some possible resources for persistent blebs:

http://www.llli.org/docs/0000000000000001WAB/WAB_Tear_sheet_Toolkit/17_dealingwithplugsblebs.pdf

http://kellymom.com/bf/concerns/mother/nipplebleb/

If you are nearing the end of your rope, or even just needing some support to sort through your bleb, please call your IBCLC. She may be able to find something you haven’t thought of.