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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.

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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.  🙂

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.

Adoption and Breastfeeding

14 Feb

I am seeing and hearing more on this topic.  Adoptive moms are hearing about it and want to see if it will work for them.  Birth moms are able to take a more active role in the adoption and are also requesting to be able to breastfeed.

This is an emotionally charged topic for both women.  We are surrounded with messages when we are “expecting”.  The best way to parent.  The best way to feed, sleep, discipline, birth, etc.  ad nauseum.  There are books all over the place.  But not so many on adoption and lactation, whether it be inducing a milk supply for a baby who is coming to you or pumping for a baby you have already placed.  Myth abounds in this arena.

I will attempt to provide you with a well-rounded review of your options.

For adopting moms:

It is really important before you begin this process to know your motivations!  Why do you want to induce lactation?  Is it so that you can feel the bond to your baby?  Is it to make it more “normal”?  Is it to do everything perfectly?  Is it to help mitigate the losses you all will feel as the baby is placed with you?  Knowing this is very important.  Even if just to articulate to yourself your true motivations.  None are inherently wrong or right.  It can help you make choices and find direction during those tough times and times when things need to change.  Knowing why you are doing things is a great motivator.  🙂  Once you know this, the rest tends to iron itself out much more quickly.

One of the biggest helps I’ve seen for other moms is that they find support.  It can be online support where they talk to other moms who have chosen to nurse their adopted babies, or your local LLL group, which may or may not have adoptive moms, but they are great cheerleaders.  🙂

Adoption and breastfeeding resources:

These are the best places that include the most accurate information about inducing lactation.  The first one is simply the nuts and bolts of inducing lactation.  There are several different choices that she has listed and be aware that you can tweak and change as you see fit, just be aware that you may change how you respond to the interventions as well.

The second is just a really great clearinghouse of resources as well as real women and their stories.

Newman-Goldfard Protocol

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Both of these websites have their merit for different reasons.  If you are nursing (whether it be with an at-breast supplementer, full-time, part-time, or just for comfort), you are a nursing mother.  The Newman/Goldfarb protocol can be rough.  It certainly is not the easiest way to feed a baby, but if it is what you want, then go for it.  Any piece of it will increase your chances of providing species-specific milk for your baby.  If you choose to follow all or part of it, it is your choice.  The second website is how that protocol (along with other things) works in the real world with real moms.  Some of the pieces are expensive and you have to decide what your motivation is and what you need (along with your HCP)  Consider the costs of Artificial Infant Milks (AIM) and how feeding your baby at the breast will offset that cost along with the reduced health care costs.  Many health risks of AIM are dose-dependent.

Call and enlist the help of your local IBCLC.  She can help you maximize your milk-making potential in a way that works for your family.

Spending lots of time skin to skin will help your baby make the transition to his new home.  It will help him learn your smell, sounds, and warmth.  It is an amazing healer that babies can never get too much of.

Depending on why you chose to adopt, you may or may not be able to induce a full supply for your baby.  That is okay.  Every drop you can provide is helping him to reach his potential.  Every minute he spends at the breast helps his brain to grow and body to thrive.

For BirthMoms:

This is an emotional time for you too and maybe it just occurred to you that you might want to nurse your baby before placing him.  It is always best to talk about your wishes with your adoptive parents.  In most places there is a time for you to spend with your baby before placing him.  Usually it’s 36-72 hours.  This is a time for you to smell, touch, and see your baby.  It is also your choice to nurse your baby.  You will not have a full milk supply when the baby is born.  This is normal.  What you will have is colostrum, which is very nutrient dense and the perfect, normal first vaccination for your baby.  Worrying about the right positioning is not a priority as you will not be nursing long term.  This time is for you to just *be* with your baby.  Spending time skin to skin will help your baby make the transition to his adoptive parents.  It will help his brain know that the world is a safe place, even in the midst of a difficult situation.

Usually your milk will “come in” after your baby is placed.  There is no way to keep this from happening.  It is driven by the hormones that cascade after your placenta is delivered.  What you choose to do with this milk is your choice.  Some birthmoms choose to pump for their babies in a way that works with their lives and they gradually cut down until the milk is gone.  If the adoptive family does not want this milk, you can donate it to your local milk bank so it will go to babies who need it most.  Some birthmoms choose to dry up their milk immediately.  Any end of that spectrum (and anywhere in between) is just fine.

When you decide that you no longer want your milk, you can make it dry up in a few different ways.  Usually, the most comfortable is to do it gradually while slowly eliminating or spacing out your pumping sessions.  Sometimes it must be done more quickly and there are several things that help different women.  One is simply to stop removing the milk.  You may need to hand express simply for comfort, but don’t remove more milk than you need to or your body may continue to make more.  Herbs like peppermint and sage have been known to dry up milk along with cabbage leaves and antihistamines.  There used to be a medication designed specifically to dry up milk and it was taken off the market due to its side effects.

If you have any questions about what to use, call your local breastfeeding helper or IBCLC.

This is an important piece of adoption that I am glad to see taking a more center stage role.  Breastfeeding is the normal way that we care for our babies, and it makes sense to continue that across the parenting spectrum.  I hope this helps you navigate this precious and short-lived part of adoption.

Birth and Breastfeeding

12 Jan

Penelope 3 weeksSo many times, I hear women telling other pregnant women to “educate yourself about your birth options”.  This is important.  It is not the whole picture.

Having a good birth is good.  It is ideal.  It is normal.  But we often forget what comes *after* the birth.  Of course I want to breastfeed and they will help me with that at the hospital.  Right?

The truth is, the people who care for you during birth often only have a cursory education in breastfeeding.  And they often do not need to keep up with current research on breastfeeding, so if you get an amazing nurse who is helpful for your birth because she has been doing the same job for 30 years, chances are, her breastfeeding knowledge is that old as well.  Back then, we were talking about “ramming the baby on” and using articial baby milk to “entice” baby to the breast.

Newer nurses are often afraid of bilirubin (which is physiologically normal to some degree) and low blood sugar (did you know the Academy of Breastfeeding Medicine actually advocates *not* checking blood sugars without a medical indication? Here is that protocol ) and get hypervigilant to the extreme detriment of nursing motherbaby pairs.

The good news is that even if you have a crappy birth, breastfeeding can be salvaged.

Because we are mammals, we have instincts and programmed conditioning that requires certain behaviors to take place to breastfeed.  Because we are humans we are extremely adaptable. 🙂 even if things don’t work out quite the way we intended, we can still have the breastfeeding relationship we wanted.  The trick is: to find the right help.

This starts in the hospital by requesting to see an IBCLC as soon as possible after your baby is born. This breastfeeding professional has recieved extensive education about normal breastfeeding and continues to receive that. There are so many people who can call themselves “lactation consultants” or “lactation specialist” that you really have no idea if they have even taken a breastfeeding class.  Only the IBCLC has an internationally consistent credential.  If she says or does something that just doesn’t sit right with you, then get a second opinion.  There should be multiple IBCLCs in your area and even if there aren’t some will work by skype or email.

Here in Ogden, Utah, moms have a choice of which hospital they use to give birth.  All hospitals have lactation programs, although they are not all created equally.  Hopefully, as more hospitals in Utah become Baby Friendly, that will improve even more.  Women in Utah want to breastfeed.  We have a breastfeeding initiation rate of over 85%.  The problem is that either women are not asking for help or they are not finding it.

There are people poised to help with your with breastfeeding challenges.  🙂 Whatever your issues, whatever your income, whatever your culture or beliefs, there are people who are trained and ready to help you.  You just need to ask.  Utah Breastfeeding Coalition (or your state’s coalition)is a great resource if you just don’t know where to start.  They can hook you up with the right helper, whether it be a community-based helper, or someone with a little more training.