Hurdles Archives - Milk Maven, LLC

April 16, 2020April 17, 2020

Look ma, No hands: Home Visits via Telehealth

The Bad News

I know a telehealth consultation with an IBCLC isn’t what you were expecting. It wasn’t what you had in mind when you made plans for the first couple of weeks home with your baby. You knew that if you had issues with breastfeeding, that you could call me, and I would be there within 24 hours, ready to offer hands on help, a shoulder to cry on, and gentle words that would guide you through the difficult first days. I know you feel alone, and scared, and maybe in pain, and I am so sorry for that.

To be honest, this is not what I was expecting either. I love going to your nest and helping you in an environment that makes you feel safe and supported. I love holding your baby, and holding you, the parent, if you need it. It feels unnatural to counsel you through something so physical without using my hands.

The Good News

I don’t need to use my hands to help you learn how to feed your baby. I don’t need to use my hands to teach you how to latch comfortably, check your baby for oral ties, or to help you prepare for the next steps in parenting. Using my props, and my words, I will guide you through all of this. Think of it this way, if I used my hands to place your baby where they needed to be, to hold your breast while they ate, we may be able to quickly get the baby to eat. However, when my hands left your house, you would be no better off than you were in the first place. My job is to teach you how to do these things, to empower you through feeding for the rest of your parenthood journey, and I can do all of that through telehealth.

Mother And Baby Playing With Digital Tablet At Home Smiling

How does Telehealth Work?

You book an appointment the same way you always did! Go to my website and select the type and time of the appointment that works for you.
If you are with Aetna, don’t worry! They will still pay for telehealth! If you are paying out of pocket, telehealth is cheaper than a home visit.
Once you have booked, I will send you a link to all your intake and consent forms. Fill those out and I will send you the link for our call. I use Google Meet which is HIPPA compliant. I will never film or take pictures without your consent. To be honest, I don’t know how to do either of those things anyway.
When it is time for our meeting, click on the link in your calendar for our appointment.
Enable both the video and microphone so I can see and hear you!

Some Tips on Telehealth

Have a camera person. This can be a partner, a family member, or friend but it absolutely makes a difference to have someone hold the phone, ipad, or computer so that you do not have to. You will need access to both your hands and I will need access to more than one angle to properly assess the baby.
A well lit room is better than a dark one, but I will work with where ever you feel comfortable.
If pumping is getting you down, have your pump parts out, washed, connected, and ready to go. This saves on “dead air” time and we can easily assess the fit and effectiveness.
Have all your questions written down. Of course, you will always think of more at the time of the call, but this way you don’t forget anything. Your brain is set on baby mode right now, and this isn’t the best time to trust your memory!
Have the baby changed, and in a clean diaper with no clothes on. I usually do this for weighing reasons but skin to skin feeding has numerous benefits and often that is all we need to get a baby who is unwilling to latch, to suddenly be interested.
Choose to have the consultation in the room of the house you feel most comfortable in. If that is your bedroom, let’s learn to nurse in there. There is no reason for you to be in an office chair in a room you never nurse in, just because this is a telehealth call. If you are using a nipple shield, pillow, etc. have it ready to go!

Why Should I use Telehealth?

Besides the initial, postpartum, OMG-my-nipples-are-on-fire-and-the-baby-won’t-open-wide-enough appointments, there are a ton of reasons why calling an IBCLC during this time for a telehealth visit might be a good idea!

Prenatal appointments to get you ready for your baby
Weaning or weaning delay
Relactation (if you are regretting weaning early and want to try to start again)
Induced lactation
Exclusive pumping help
Solid introduction
Sleep help
Suck training after a tongue tie

Ultimately, I am here for you through this crisis and beyond to help make sure that you meet your feeding goals and you feel supported and uplifted. No one should be alone at this delicate time of their lives as new parents, and I am here for you.

December 29, 2016

Expecting a Lactation Consultant

Congratulations! You have a baby! Babies come with sweet smells, lovely eyes, and soft skin. What they do not come with is an instruction manual. Luckily, lactation consultants are here to help! Now, I must admit, the idea of a stranger coming in to my home and manipulating my breasts and holding my baby would have made me incredibly nervous as a new mom. I want to write this blog to make that step of reaching out a little easier and help you make the most out of your appointment.

1. Fill out your paperwork ahead of time. Good news! All of my paperwork is online, needs no printer, and I will send it to you as soon as you book an appointment! Giving a full history for both yourself and your baby can help your Lactation Consultant know exactly what tools to bring, what information and handouts to prepare. It can also give them an idea of what they are walking into. Either way, a full medical history will need to be taken. If you fill out all your paperwork ahead of time, your consultation to begin immediately, and your baby won’t have to wait to eat.

2. Go into the consult with a hungry, but not frantic baby. As part of my consult, I will need to see your baby eat normally. I like to do a pre and post feed weigh to see how much milk your baby is getting. If we are working with a baby who is asleep for half your scheduled time, you won’t get as much bang for your buck. My suggestion is to try to feed your baby about an hour before our scheduled appointment for best results.

3. Put your animals away. I am an animal lover! Cats, dogs, reptiles, tarantulas, it makes no difference to me, I love them all! That said, some beloved pets, no matter how loving and calm normally, can turn into a fur-ocious guard when a new baby arrives on the scene. So please, have them outside, in crates or in another room when I arrive.

dontclean

4. DO NOT CLEAN YOUR HOUSE You just had a baby. As a home visit only Lactation Consultant, I am very aware of what a newly post-partum house looks like, and it does not look like a page from Living Magazine. As long as I have a place for my scale to sit, and a place for my butt to sit (the floor works!) I can do my job. I would rather see a mother who is resting and a baby who is feeding, than a scrubbed kitchen.

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5. Don’t be embarrassed, I’ve seen it all. I have seen all manners of family structures, living arrangements, housing types, and income levels. I have visited moms who were in full make-up and heels and I have seen moms who are on bed rest and haven’t showered in days. I do not care what your hair looks like, your breath smells like, or whether your kids/partner/mother are in the room. One of my favorite things is visiting people in their actual, real life environments, and I can’t wait to meet you in yours.

March 20, 2016

Tongue Tied Kiddo: An Interview

12030433_10156160218250585_5542793718285012433_o — Henley, age 5

This is my daughter Henley. She is six years old. She loves Barbies, her pink scooter, and dresses with leggings. She was also born with a class 1 tongue tie, which means her tongue was heart shaped. It couldn’t move past her gum line, or lift at all from the bottom of her mouth. She clicked constantly when she was breastfeeding. We had it scissor clipped by an ENT when she was three days old. She was then able to nurse, but couldn’t handle my milk flow, never comfort nursed, and was addicted to pacifiers. She weaned at 21 months. She has always had trouble with balance (didn’t walk until 16 months), swallowing solids without choking, saying certain consonant sounds, and had recently developed a stutter. I knew her tongue was tied, and that it needed to be revised before it caused lasting orthodontia issues or speech pathology. We decided to take her to a pediatric dentist to have her tongue released via laser this time. Here is the interview I conducted with her after the procedure.

Me: So, tell me about your tongue.

Her: My tongue was tied, which meant I couldn’t touch my teeth with my tongue. The string under my tongue was too tight and it hurt when I chewed or talked a lot. [It should be said she said nothing about pain to me until she was in the parking lot of the dentist’s office and I told her what to expect. She said, “Mommy, will this help the string on my tongue not hurt so bad?”]

Me: So what happened at the dentist’s office?

Her: They let me watch Rio 2, and put special lipstick [chapstick] on my mouth so it wouldn’t dry out, and I wore cool shades.

Me: Did it hurt?

Her: It wasn’t ouchy because they gave me stuff to breathe that made me feel funny, then poked my tongue and it went to sleep.

10371690_1003385976395869_6213134941763165461_n — Laughing gas and shades

Me: Did you see what they cut your tongue with?

Her: The laser looked like a TINY pen with a light on the end. Like a flashlight for a mouse.

Me: Were you scared?

12795449_1003385966395870_3376381465614869851_n — Tongue Tie, before and after

Her: No. The dentist was nice, and covered me with a comfy blanky, and you were there the whole time watching.

Me: What was your recovery like?

Her: My tongue was weird all day, and then that night it hurt. Then, I got ice cream to lick and Popsicles, and grape medicine [Children’s Advil] that made it go away.

Me: You know, I work with babies who are too little to take medicine for the pain, what would you say to them about your tongue and the procedure you had done?

Her: To not be afraid, and to stay close to your mommy all day so she can give you milk to make you feel better. Oh, and don’t ask to watch Frozen because it doesn’t work on their TV.

By the next day, her stutter was gone. She is still lazy about saying some of her letter sounds, but I have no doubt that will remedy itself with time and as her tongue heals. She likes to show everyone all the things she can now do without her tongue tie. She can stick it out, move it from side to side, and say Ls!

March 11, 2016

Beware of Sleep Trainers

Sleep. She is a wicked mistress.

A few days ago, I received a panicked call from a very worried mama. She was concerned her milk supply was dropping, her baby was losing weight, was upset at the breast, and wouldn’t latch. The mother was getting plugged ducts and worried about mastitis. After the course of the call, we tried to pinpoint what it was that went wrong. Decongestants were used once, not long enough to make a huge difference, her pump broke while she was away from the baby, but that should have been remedied the moment she got back with her baby. The baby was teething, so that could make a bit of a difference in the latch, causing the ducts to clog, sure. Then she dropped the bomb. She admitted she had seen a sleep consultant a month ago (when her baby was 5 months old) to help the child sleep 12 hours at night. She was told by this trainer to spread out feedings to only 4-5 times a day, and never to feed at night.

So, a little background on how milk supply works. When you drop your feedings in half overnight (no pun intended) your milk supply will drop by (anyone, anyone? Bueller?) half. It is a supply and demand relationship. The baby or pump demands, your breasts supply. If you stop demanding, they stop supplying.

10525631_10154797444825585_2863247910875511009_n — Sleep finds a way

Let’s do the math shall we? An average baby 5 months old, needs 24oz-32oz of milk a day to continue growing and being healthy. They get 100% of their calories and hydration from this milk. So, when a mother is told to bar on demand access to the breast, the baby is still only going to take in about 3oz per feed because their tummies are still the same size, but only four or five times a day. Now, what if you took everything you ate normally and cut the portions in half? What if you also drank half the water you should? What do you think would happen to your body? Science tells us malnutrition and dehydration would set in, and you would become very weak, and really sleepy…huh. Yes, it turns out that a baby getting half their nutrition become quiet, sleep a lot, and become very “good” babies. As opposed to those awful “bad” babies with their punk music and their bar room shenanigans.

65145cf805be60149a36cfdfeb69c363 — Bad Baby!

Many of these sleep trainers, in fact ALL the trainers I found in my area, take babies as young as a couple months old. We know from research in this area that babies must nurse on demand to establish milk supply, and grow correctly. We also know that babies are not made to sleep through the night at this age, and in fact it can be extremely dangerous for babies to sleep too deeply.

Nobody likes to miss sleep. In fact, sleep deprivation can be used as a form of torture!However, starving your baby is not the solution. If you value breastfeeding, and would like to figure out how to continue and get some sleep, hire an IBCLC with years of education on child development, infant nutrition, and breastfeeding management. There could be several reasons your baby is having trouble settling, is nursing more often than is normal, and keeping you up at night. An IBCLC will look at sleep arrangements, schedules, anatomy to check for ties, check weights to check for intake at the breast, work with your other health providers, follow up with you and your little one over the next couple of weeks, help you get reimbursed by your insurance for her visit, and will charge about a QUARTER of what these trainers are charging. The thing is, the person who referred this mother to me once things went south, WAS the sleep trainer.

10527338_10154410700720585_999572687711978630_n — Now they snuggle each other

It is absolutely normal and healthy for your baby to wake up at night. Don’t you? Sometimes you need some water, sometimes you need to pee, sometimes you have a bad dream, and need a snuggle. Would you deprive your husband of these things? Your dog? Yourself? I am 33 years old and I don’t remember the last time I slept through the night. It just stopped being my mother’s problem at some point.

December 9, 2015

Don’t Panic: Hitchhikers Guide to Parenting

I remember seeing a book on my parents’ shelf when I was young, called Parenthood is Not For Cowards. I assumed this meant that it meant that in order to be a good parent, you had to listen to nightmares, and not be afraid of them. Then I became a parent. I realized that parenting meant being scared to death, every single day, and doing the right thing by your kiddo anyway. It means doing the hard thing, making the hard choices, it means never giving up, and never surrendering.

During pregnancy, we read all the books, we make all the plans, we do all the research. We attend classes, and force our partners to go with us, we pick out the perfect layette, and apply to receive the perfect breast pump. We interview 15 different pediatricians, we find the numbers for lactation consultants, parenting support groups, and visit every daycare center in the tri-state area. But things go wrong. Labors stall, emergencies happen, daycares fill. And when they do DON’T PANIC! There are far more than 42 things that could go wrong, but let them be hurdles, not walls.

Of course, as soon as you think you have breastfeeding down, something is going to change. Your milk comes in, the baby grows, you go back to work, the baby is teething, or baby goes on a nursing/sleep/solids strike. When this happens DON’T PANIC. All of these things are normal, and part of breastfeeding and in no way means that you are insufficient, or doing something wrong, or a bad mom. Here is the thing about bad parents, they never wonder if they are being a bad parent. Just by you being scared to death that you have somehow inadvertently broken your baby, you are being a good parent.

No one expects you to have all the answers. Historically, we never were expected to have all the answers. We used to raise our babies in tribes. Where all the aunties, grannies, mothers, sisters and friends were all around us, informing, encouraging, and supporting us. We used to see breastfeeding everywhere we went. We saw women latching, unlatching, babies sucking and swallowing, and crying and sleeping all the time. Many of my clients have never seen a baby fed at the breast. We no longer have access to this education. We no longer have this tribe. We try our best to fill in the gaps with social media and blogs, lactation consultants, nurses and doctors, and books and books and books.

We must be discerning between good and bad advice, we must be savvy about science v placebo affects, we must trial and error every choice we make and we must do it all while Instagraming our bliss, for beware if someone catches on that we are struggling to stay above water.

Here’s the thing people. You are doing a good job. DON’T PANIC if something goes wrong. DON’T PANIC if you don’t have the answers and you need help. DON’T PANIC if your idea of what parenthood should look like doesn’t exactly match with your life. Let go of your expectations and the expectations of others, and just do the best you can.

Oh, and always carry a towel.

November 15, 2015

Engorgement, You, and What to Do

You get home with your baby, everything is going really well. Your baby is latching, and nursing, and happy. And then it happens.

You look like the star of Buxom Beauties 4. Where exactly are the triplets you are supposed to be feeding!? Milk is everywhere. Your baby is sputtering and choking if they are able to latch at all. It is possible that your nipples may sort of disappear into the mass that is your breast tissues, and for the baby, this is a bit like trying to fit a bowling ball into their mouth.

What I am describing is called “engorgement” and though it is common in the early days of lactation. Usually starting the day you get home or the day after. You know, when all your hospital help disappears. Latching a baby on an engorged breast can be difficult, painful, and complicated, so it is a good idea to soften that breast with hand expression or pumping first.

It may be It is possible that you may not even be able to pump to relieve some of that pressure because of all the fluid compressing your milk ducts. If this happens, contact your IBCLC for help, the milk must be removed from the breast to avoid clogged ducts, mastitis and drying up.

For most women, this feeling of being constantly over full is over in a few days/weeks. However, sometimes supply doesn’t really ever regulate downwards. In this case, you may have an oversupply.

November 13, 2015

Low Supply

The most common reason women start supplementing is a fear their supply is low. This perceived issue and incorrect diagnosis can start a real issue with supply if allowed to continue. Supplementation can start babies and moms on a downward spiral of overfeeding, under emptying of the breasts, and ultimately, a perceived problem becomes a real one. So, how do you know whether your baby is getting enough from the breast? Our breasts don’t have ounce markers on them, so how do we tell whether our supplies are enough?

max-stomach-capacity — How much milk does a baby’s stomach even hold?

Is your baby gaining well? If your baby has regained their birth weight by 2 weeks and are they gaining about an ounce a day after that, there is not an issue with supply.

Is your baby pooping and peeing normally? Babies should have one wet diaper on day one, two on day two, and so on. By day five, babies should be having 5-6 wet diapers minimum a day, with 2-3 quarter sized poops. Sometimes poops do space out a bit, and that can be normal, but those wet diapers must remain. If you are changing diapers frequently, there is no supply issue. After all, if there isn’t anything going in, there can’t be anything going out. A trick I tell moms to do if they are worried, is to put a stack of six diapers on the changing table, if they run through them in 24 hours, they don’t need to worry.

The following things are NOT a sign of low supply.

The baby nurses frequently
The baby suddenly nurses more often and/or for longer
The baby nurses more frequently and is fussy in the evenings
The baby wakes often in the night to feed
The baby decreases the lengths of feeds
The baby gulps down a bottle of milk or formula after a breastfeed
Your breasts don’t leak anymore, or feel softer
You pump very little
You stop feeling, or never have felt a letdown feeling

If you truly do feel that you have a low supply, due to hormonal issues, early mismanagement of breastfeeding, or over supplementation, talk to an IBCLC about how to get back on the right track. The nice thing about supply is that it is almost always fixable.

April 4, 2015

The Lip Tie that Binds

The below story was written by one of my warrior mamas, and reposted with permission.Below you will find her story regarding upper lip tie.

Our upper lip tie story:

The first two weeks without the shield left my nipples cracked, bleeding and in agony. That first night feeding I remember doing it every 30 minutes. In the hospital, I asked the nurse for help, it was a weekend and the lactation consultant wasn’t available. The several nurses I had weren’t very helpful. For two and a half months we used a nipple shield because nursing without it was just too painful.

Nursing with the shield worked for a while. I still would feed every hour for the whole two months. We’d have good days and bad. Baby had awful acid reflux and gas. I thought it was the dairy so I cut it out. Turns out it could have been due to the lip tie. I’ve been off dairy for months and I’m not about to rule it out and start it back up though. I wondered if baby was colicky and after several attempts at bottle feeding with no luck, I was forced to quit my job. Nursing was the only thing that would soothe him. Acid reflux got a little better, but never fully went away.

As baby began to grow, his suck power increased. At 2 months old, the nipple shield started to hurt, pulling my skin through the holes with his incredible sucking strength. Over the next two weeks I started trying to feed with out the shield as often as I could. I began researching lip ties and found his. When feeding without the shield would hurt too much, I would switch back for a day or so to heal. Then I would try again.

That brings us to this 10 week mark. Baby has been really fussy nursing, getting worse every day. I made an appointment with our Lactation Consultant. She came by next day on Tuesday and saw all of my struggles. Baby was refusing to nurse and acting like he was in pain when he latched. She agreed with me on the lip tie and also felt that this was the problem. The relief of her support was emotionally overwhelming. Finally, someone listening to me! She checked his milk transfer by weighing him before and after a feeding and it was really low. This is why I’m having to feed so often. Baby isn’t getting fully satisfied and isn’t taking good naps during the day because of this. She said that if I hadn’t been so persistent in feeding when baby demanded, he would have had poor weight gain and I would have probably had mastitis, clogged ducts and a damaged milk supply.

Here is a picture of his class IV upper lip tie.

We had a frenectomy done two days ago to release it. Immediately after the quick, easy procedure, I was able to nurse him for the first time pain free!

Several people tried to help (bless them) with advice on letting baby cry it out, but I absolutely refused to do this. I followed my new mom instincts and consoled my baby with nursing 24/7. Feedings use to take half hour to an hour, then he’d be hungry again in half hour to an hour. Now they take 15 minutes, with a satisfied baby at the end! We’ve even been able to go 2-3 hours without a feeding!

The pediatrician said, “In 15 years I have never seen a case where upper lip ties effect breastfeeding.” And maybe usually it doesn’t, but in my case it did.

I followed my instincts, did my research and found a huge lacking in the diagnoses of upper lip ties relating to breastfeeding issues.

Pretty much feeling like a super hero mom now and so glad I was so head strong on sticking to breastfeeding. If I hadn’t worked so hard and if I hadn’t found the solution, I don’t know what I would have done. There needs to be more support for this in the pediatrician and pediatric dental world. I have come across many many many stories similar to mine! I can only imagine the amount of women who don’t even know they have this same issue, feeling defeated, they switch to formula when they don’t really want to.

Thank you Rebecca for sharing with us your story! Click here for more information on lip tie symptoms and solutions.

December 16, 2014

I Hate Breastfeeding

I am not sure when we got the idea that all good mothers love breastfeeding. Today, there seems to be a cult of motherhood. New mothers are expected to sit around the house contented to look like a painting from the Renaissance complete with tranquil smile, perfect cherubic baby latched to the breast and halo atop both of their heads. As any real life mother can attest, this is almost never the case. The baby won’t latch, your nipples hurt, your c-section incision aches, or it hurts to sit down for too long because of your birth. The baby seems to be so wiggly you need at least six more hands and a dozen more pillows, and HOW THE HELL DOES THIS PUMP WORK?!! You miss your old life, your old self, your old body. You are wracked with feelings of fear, love, guilt, anger, frustration, and pride, sometimes all at the same moment. New parenthood is hard work, and it isn’t ever perfect.

And here is my point. It is okay to hate breastfeeding. You can still be an amazing mom and give your baby the best food for their body and totally despise the act of breastfeeding. Lots of women (I suspect) feel this way, but no one talks about it. We are trying so hard to look like a painting that we don’t talk about how we are actually feeling because we are worried about being judged. I have three kids, and I really hate certain things about parenting. Playing tea party with my daughter is akin to shoving bamboo shoots under my nails, only less exciting. Changing my two year old’s poopy pants is not my idea of a great afternoon. Listening to my seven year old describe the structure he created on Minecraft makes me want to scream (to the tune of Minecraft that is constantly stuck in my head!!!!). I do these things any way, because they are ways I can show my kids that they are important, loved beings. It is part of my job as mom.

To me, breastfeeding is just a way of getting premium food and comfort to a baby. It was the way parenthood was designed to go. It is part of the job, not a magical act that will transport you to a place of blissed out tranquility immediately. It is okay if you hate it, you will hate a lot of things about parenthood. However, it is important that you do it anyway because your baby needs you and your baby needs your milk to grow normally and healthfully. Mama milk is important! As fundamental to your baby as a clean diaper, a warm bed, or your love.

Push through mamas, it won’t always be fun, but I promise you, it will always be worth it.

November 22, 2014

The Price is Right

If you broke your foot, you would get an x-ray. If your tooth hurt, you would see a dentist. If you had a heart attack, you would see a cardiologist. Most likely, you wouldn’t even balk at their fee. Why? It’s because we know that good, quality help from educated, caring, medical professionals is worth every penny. Why then do we gasp when we hear the price that comes with “natural” healthcare?

Lactation consultants, are often times accused of charging exorbitant amounts for their services. I have been told to accept all offers, to provide a sliding scale, to barter, and to offer my services for free for a time. When was the last time you bargained with your doctor? One large problem is that insurance will gladly cover your echo-cardiogram, but they may not even know what a lactation consultant is. The undervaluing the services of these people by the healthcare mainstream doesn’t do people any favors. Some insurances may technically cover IBCLCs but their “preferred providers” might be not easily accessible.

When you hire a private practice International Board Certified Lactation Consultant (IBCLC) you get someone with years of lactation focused experience and education. Someone who, most likely, is available to you day or night, through texts, phone calls, emails, and home visits. They will sit with you, help you, and make you feel sane and in control again. They feel as passionate about breastfeeding as you do, and they are there to facilitate your goals. We are required to continue learning all the time, combing through research papers, attending conferences, and networking with other IBCLCs to make sure that you get the latest and greatest breastfeeding knowledge available. Not too shabby for $100/consult, even if your insurance carrier disagrees.

Consider for a moment all the other things that we happily spend on babies. How much is your baby’s crib? Their highchair? Their stroller? Now how much would you pay to insure that your baby has the best food available to them? If an IBCLC can help you breastfeed successfully, think of all the money you will save by avoiding bottles, formula, and having a statistically healthier child.

Having a support team doesn’t make you weak, it makes you strong. And a strong mother and baby seems well worth every penny to me.