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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.

Clinic is Back!

10 Jun

I am headed back to clinic today and it will take a a bit of a different format.

There will be a one hour class beginning at 1:00 and then more targeted short discussions for nursing dyads beginning at 2:00.  The class will be free and the targeted time will still be $20.

Come join us at Ogden Chiropractor’s at 1900 S Washington Blvd.  🙂

ACA and Breastfeeding in Utah

11 Feb

 

Breastfeeding baby Ogden

Newborn

Breastfeeding and the Affordable Care Act

Many of the new breastfeeding provisions of the Affordable Care Act
(some also call it Obamacare) went into effect on January 1, 2013.

There are some great provisions.  One is the workplace pumping laws
that require an employer to provide adequate time to pump and a place
that is -not- a bathroom for pumping.

Another one is no cost-sharing to the patient for breastfeeding help
and supplies.  This means that every woman with health insurance
should have access to knowledgeable breastfeeding helpers and a pump
if she needs it.

As you read these, you will notice that they are very vague.  This is
one of the best and worst parts of the whole law.  It means there is
wiggle room.  It also means that nobody yet knows how this is going to
look.  It will probably be different in every state.

In Utah, we are still struggling to figure out how it all works.  Since there are so few out-of-hospital IBCLCs, we are still not sure how to even go about asking for reimbursement.  We are in the process of reaching out to other IBCLCs to investigate licensure issues and other advocacy for getting breastfeeding help into the hands of those who need it most.  If you would like to help in any way please join and become involved in the Utah Breastfeeding Coalition.  There is much work to be done and only a limited numbers of hands to do the work.

One of the issues many are having is that the ACA is so big.  When new and already frazzled parents call their insurance company to request information about their benefits, the person on the the end of the line is not 100% sure about what is required by the ACA in regards to breastfeeding support.  I’m not so sure that the attorneys who drafted the act even know everything that is in there.  It is simply too comprehensive for everyone to know.  I know the breastfeeding bits, because they pertain to my situation as an IBCLC, but I certainy don’t even know the lion’s share of the other stuff in there.

Because of this, insurance companies themselves are floundering as to who will actually provide this “breastfeeding support” spoken of in the ACA.  It makes sense that the people to help mothers with breastfeeding issues should be the ones who have had training and education in breastfeeding, right?  Well, we are not yet on provider panels and there is no infrastructure yet to have us on panels.  Some of us in this great state of Utah are trying to fix that.  Here in Ogden, there are no official lactation clinics at all.  The two main hospitals in Ogden have lactation staff which can occasionally provide outpatient care, but that is neither their purpose nor their responsibility.  Once a mother/baby dyad has left the hospital, they are officially discharged as patients and are now “in the community”.

In other states and cities, IBCLCs work in tandem with pediatrician offices and are part of the staff.  Babies can be seen as part of their well baby visits and insurance companies are doing pretty well at reimbursing for that.  But here in Ogden, that is not the case.  It will not likely improve unless we all work together to change the landscape of breastfeeding support in our wonderful town.  We need more trained IBCLCs who are ready to help mothers after discharge.  We need more physicians to have IBCLCs in their offices and we need more breastfeeding clinics that give *all* mothers access to knowledgeable care.  We need more mothers to demand these changes from their doctors and hospitals.

The last time I looked, according to the International Lactation Consultant Association (ILCA), there were only 3 IBCLCs registered as members of this professional organization in Weber County.  Yes, that is right: 3.  Only 3 people to help all of Weber County mothers with breastfeeding.  A county with over 236,000 people.  Now, it’s true that there are more people than just the 3 of us who are providing breastfeeding support.  And its a good thing.  There is WIC (who has a couple of peer counselors providing direct care to mothers), the hospital lactation staff at both hospitals, and doulas who are providing breastfeeding support.  And it simply is not enough.

Moms, look for your local help.  Ask your doctor for referrals to IBCLCs.  Studies are showing again and again that IBCLCs do matter when it comes to improving breastfeeding outcomes.  You can do it!  We all have to work together, but we can help our babies earn their birthright when it comes to health.