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Milk Blister/Bleb

1 Jan
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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.

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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.

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Breastfeeding and Sex Abuse

18 Sep

Empowering Fearless Birth Conference Breastfeeding and Sex Abuse

I will be speaking at this great event. Use my code: karinhardman for discounted tickets.

Breastfeeding Classes in Ogden Area

3 Sep

We are gearing up for Fall.  And that means classes.  🙂   I will be giving several classes and talks coming up in the next few months.

September 12th and 20th I will be giving a basic breastfeeding class.  Sep 12th will be at Arrivals Birth Suite in Ogden and for the Powerful Birth Group.  The time is 7:00 pm and pregnant moms as well as babies in laps are welcome to attend.  Sep 20th will be at 5:00 pm at Honey Bump Maternity in Layton.  Call if you need more info about these classes.  They are great refresher courses or as an intro to breastfeeding.  They are free and dads are welcome too.  Tell all your pregnant friends and I hope to see you there.  🙂

Sep 21st I will be a speaker at Empowering Fearless Birth in Provo, Utah.  I will be speaking on “Healing Sexual Abuse through Breastfeeding, Your Way.”  This is going to be a great event and has speakers and vendors from all over the state.  You can get tickets through the website here.

I look forward to seeing you at these events.  🙂

Introducing our new Walk-In Clinic

21 Aug

In an effort to reach more moms, we are excited to announce the opening of the first ever Drop-in Clinic for breastfeeding mothers.

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The Arrivals Birth Suite is located at 1190 East 5425 South Suite 330 in Ogden. The clinic is from 10:00am to noon every Wednesday for Mothers with mild to moderate breastfeeding issues.  You can meet with an experienced and professional IBCLC (International Board Certified Lactation Consultant) The fee is $20 or $5 with Medicaid.

Edited to add: as of July 16th, 2014, the Clinic will be held Wednesdays 1-3pm at Ogden Chiropractors at 18th and Washington in the Madison Square Office Complex. Please call for appointments, but the price will be the same.

Breastfeeding Help in Ogden, Utah

8 Jan

January is when we can take a breath and take a new look at parenting.  Often, December is a time of frantic activity, rich foods and little time for

baby (other than being passed around at parties).  Our bodies will often force us to remember to slowdown by getting plugged ducts, mastitis and even abscesses.

It’s okay to rest with your baby.  You are forming neurons when you sit and just smile at him.  🙂 La Leche League has a great FAQ about mastitis.

Mastitis

If you feel like you have been run over by a truck, or just plain yucky, go to bed.  Honor your body’s wisdom and allow it to heal itself.  Your baby will love the time and attention.

And of course, if you aren’t getting better with normal home remedies, please call your health care provider or local IBCLC for help.

Here in Ogden, and along the entire Wasatch Front, we are having such a terrible inversion that a good snuggle with your baby isn’t such a bad idea even if you don’t have plugged ducts.  Breastfeeding protects your baby against RSV, Asthma, and other respiratory illnesses.