Tag Archives: IBCLC

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.

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.

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.

Breastfeeding Class in Ogden

17 Jan Breastfeeding classes

I’m not sure anything like this has been offered in Ogden in several years.  Or even north of Salt Lake for that matter.  I will be offering the Breastfeeding for Birth Professionals class next month.  This is a 4 hour class designed for those who will be present in those first crucial hours after birth with a mother/baby dyad.  This class will count as the breastfeeding education needed for DONA certification.  All of the particulars are located in the link.  If you have any questions, please contact me.

Hope to see you there!

Working and Breastfeeding in Utah

4 Mar

I was asked to do a guest post for a friend.

If you have ever had any questions about working and breastfeeding, head on over to read.  🙂

Working and breastfeeding in Utah

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

fourfriends.com/abrw

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.