Tag Archives: Lactation Consultant

Lactation Derailment Can Begin in the Hospital: 10 Tips for Avoiding a Trainwreck

29 May

I must preface this blog by explaining that

fourteen years ago I became a mother/baby nurse, and ten years ago I became the resident childbirth educator and “breastfeeding counselor” on staff at a local hospital.  We did not have an IBCLC on staff, so I was IT until we hired another educator.  My training as a nurse, some time as a member of La Leche League and my own personal breastfeeding experience was all I had in my arsenal.  Though I wasn’t “official,”  I worked the position of a lactation consultant.  And it wasn’t easy…so many moms…so little time…so many interventions.  That being said, please read the following with the understanding that I have been “on the other side,” doing my best as a nurse to help fresh babies latch…bending over beds as an educator positioning babies and sandwiching breasts for moms who were too sleepy on pain medication post-cesarean to do it themselves.

A week ago, I had the privilege of visiting a new family in the hospital to provide assistance with breastfeeding.  She has given me permission to share my observations.

When I arrived, I had dad undress baby down to diaper and in skin to skin with mom.  The baby was only 36 hours old and very sleepy after a long labor and difficult delivery.  Mom, Dad and I chatted for a moment then got to the business of latch.  The baby would not wake up.

A nurse came in to give mom pain medication.

Though I was not surprised at the baby’s behavior, he appeared jaundiced, and I knew it was important to get colostrum into him.  So, we proceeded to hand express and collect colostrum to spoon/syringe feed him.

Then the baby photographer came in to show the picture previews.

Mom asked her to come back later.  (Reminder:  Mom is sitting in hospital bed with her breasts exposed.) We continued hand expression and then fed the colostrum back to the baby.  He began to exhibit some hunger cues, so we put him back to the breast.

The OB came in to check on mom.

Once again, latch attempt without success.  More hand expression.

Knock, knock? Have you had a chance to look at your pictures? Baby photographer again. (Are you kidding me?)

More teaching, more skin to skin….fed baby more colostrum.

A different nurse came to check on mom.

Another latch attempt…

The first nurse came back to tell mom the baby’s procedure had been delayed.

We wrapped up latch attempts (and the baby) as we knew the nursery nurse would be coming to get the baby soon.  He was happily sleeping in Grandma’s arms as we discussed a care plan.

Persistent photographer, back again, insisting on showing the pictures.

I wrote out mom’s care plan.

Nursery nurse came to retrieve baby.

I ensured mom had my number for questions, planned to follow up with a home visit, and I made my exit.  Did you count the number of interruptions?  How long do you think I was there?

Eight interruptions in one hour and fifteen minutes. 

I left there concerned about derailment and feared I would encounter a trainwreck at her home visit.  Fortunately, when I arrived, breastfeeding was going well and she needed very little assistance from me at the follow up.

Now, I realize everyone that came in just saw me as a visitor.  They weren’t aware of who I was or why I was there.  However, my presence aside, feeding her newborn was mom’s priority, but what was the priority for the people that kept interrupting?  Definitely not feeding a 36 hour old, sleepy newborn who appeared jaundiced.

How can a mom even think about getting breastfeeding established when she is being bombarded by staff from all sides?  It’s sensory overload.  As a private practice lactation consultant, I see the outcome of this all the time….the trainwrecks…the result of the cascade of interventions.

What steps can you take to avoid the trainwreck?

  1. Take a prenatal breastfeeding class so that you know what’s normal for the early days of breastfeeding.
  2. Hire a Doula to minimize birth interventions which can lead to troubles breastfeeding.
  3. Find a breastfeeding friendly pediatrician who will support your breastfeeding goals.
  4. Research local resources for breastfeeding help that are available to you once you get home such as La Leche League or private practice lactation consultant that is an IBCLC (International Board Certified Lactation Consultant).
  5. Prepare your partner to be the gatekeeper after delivery to minimize interruptions in your breastfeeding. You may also want your partner to accompany your newborn to the nursery to keep watch and ensure your feeding preference is respected.
  6. Hand express your colostrum and feed back to the baby. Doing this up to 6 times a day can increase and speed copious milk production.
  7. Reinforce your desire to breastfeed without any supplementation to every nurse that you have contact with.
  8. Room-in with you baby to keep your baby close and to learn his hunger cues.
  9. Better yet, keep your baby “on” you to facilitate skin to skin contact which has been shown to stabilize temperature,
    heart rate and oxygenation. You are your baby’s best habitat!
  10. Ask to see the lactation consultant…and keep asking….getting help early is so important!
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A BABE Mom’s Story: 6 Tips For 6 Months

14 May

  Three weeks into her breastfeeding journey

we had the privilege of meeting this sweet momma and her precious little boy.  Our first contact was November 15, 2011.  She was our fifth client but our first real challenging case.  Over the phone, she described that she was having some pain and nipple damage with latch and decided it was time to get help as she suspected what she was experiencing was not normal.  This was her third baby to breastfeed yet the first time to experience this situation.

Baby was ready to eat soon after we arrived, so we had her proceed with breastfeeding in her normal fashion.  As she readied herself and the baby for latch, she was relaxed and calm.  We then got our first look and could hardly believe what we saw.  To date, we have yet to encounter nipple damage as severe as hers!  There were actual craters in the center of each nipple.  Leah and I could not believe she had made it this far.

Our assessment revealed that the baby had

a very shallow latch.  His mouth would stay open no longer than a millisecond to achieve latch, and once he did latch, his lips stayed pursed on the breast.  Our impression was that his jaw and mouth were hypertonic (increased muscle tone).  At rest, he kept his lips tight, and we could not even properly assess for tongue-tie (which we suspected right away because of the nature of mom’s damage) because his mouth was so tight!

Over the course of the next five or six weeks

we worked with Linda in person, via email and over the phone to assist her in getting to a comfortable and enjoyable place with breastfeeding.  Using a combination of breast rest, APNO, pumping, finger feeding, bottle feeding, chiropractic, time, and a lot of patience and determination, we were thrilled to hear from her late December that healing was complete and breastfeeding was finally pain-free!

Sweet, little Sam is now six months old.  He never had one drop of formula…how did she do it?  Keep reading for his mom’s advice:

1.  Let it go:  I had a hard time accepting that my house wasn’t always tidy, the laundry and dishes piled up, and gathering my hair into a ponytail was as close to “styling” as I could manage.  It took me a while to figure out that it is OK to not be able to accomplish everything I could pre-baby.  None of those tasks are as important as being able to meet the basic needs of my family and myself.

2.  Don’t be afraid to ask for help:  Asking for help doesn’t come easy for me but I learned to not be shy about telling others what needed to be done.  My husband was great at taking over the jobs he could do while I concentrated on my needs and the needs of the baby – but I needed to be sure to ask!  Something as simple as asking someone to look after the baby (and my 2yo and 4yo!) so I could take a shower or just have a few minutes to myself to eat a big bowl of ice cream in peace made all the difference in my outlook on life.

3.  Trust your instincts:  I think everyone who knew I just had a baby had an opinion on how I should be feeding the baby.  I had to believe in myself and my ability to know what will work for me versus what doesn’t feel right for my family.  My grandmother probably meant well when she told me that babies do just fine on evaporated milk, but after thanking her for her concern, I forgot she ever mentioned it.  I also had to trust my instincts enough to know that I needed outside help.  I figured that since this was my third, I should have known what to do on my own when he had problems – I didn’t.  My only regret was not getting outside help sooner.  I could have saved myself some addition pain.

4.  Find a cheerleader:  Having immediate family members and lactation consultants to tell me that I was doing a good job was priceless.  Affirmations are important – I needed to be reminded that I am strong and I could do it and that the sacrifices I was making were for the new little person I just brought into the world.

5. Set short term goals:  Even though it was baby number three for me, I was feeling overwhelmed about surviving the whole newborn period.  So I aimed to just make it through the week, the day, the next feeding session, or past whatever other hurdles were getting me down.  Once that was behind me, I would give myself a pat on the back, consider it an accomplishment and set a new goal.

6. Believe that does get easier:  It can be so hard to see past the present, but the first few weeks really are the most difficult.  I knew that if I could just make it past the hump, things would start to get better.  I had to cling to the knowledge that one day soon I would feel human again.  Six months down the road, I am grateful I stuck it out.

What most helped you get to where you are in your breastfeeding journey?

Confessions of Suburban IBCLCs: You Know You Are a Lactation Consultant When…

25 Apr

…You aren’t home, your husband answers a call from a breastfeeding mom and knows what breastpump to recommend to her.

…Your son’s teacher tells him she wants to talk to me about breastfeeding but HIS translation is “Miss McGillicuddy needs help with her nipples.”

…You could hand express anything that has milk in it.

…You find yourself obsessing over the creation of the perfect, crocheted demo breast.

…You perform reverse pressure softening on yourself while describing it to a desperate mom over the phone.

…Your doctor’s nurse, while there for your annual check-up, asks you to palpate a lump in her nipple and give your opinion on what it might be.

…Your jaw doesn’t drop when you see nickel-sized nipples attached to watermelon-sized breasts on a mom with a 6 pound baby because you know nipples and breasts come in all shapes and sizes.

…You can keep a professional face when a client tells you her pediatrician’s nurse, or better yet, her pediatrician tells her that her six week old baby only needs to nurse 6 times a day and should be sleeping through the night.

…You are no longer uncomfortable with your children overhearing your telephone conversations about sore nipples and engorgement. You figure someday when they are parents they will need the info too!

 …Though you’re not a man, you make “eye” contact with every woman’s breasts before her eyes as you contemplate her breastfeeding experience or her plans to breastfeed.

…You can somehow relate every life moment back to breasts and breastfeeding.

…You learn something from every mom you meet!

…You can’t sleep or “wind” down after a consult….on a lactation high for hours!!

…You are not afraid to join a mom having a good post-partum cry.

…You have been know to literally do the “happy dance” through your house when you get a message from a mom who just days before was in tears and desperate for help but today is enjoying breastfeeding and in no pain!!

...And you are not afraid to celebrate with a mom as she reaches personal milestones along her breastfeeding journey.

No Perfect Houses Allowed: Preparing For Your Lactation Consultation

9 Apr

*Don’t clean! As lactation consultants,  our focus is on mom and baby.  We won’t be looking at the piles of laundry or dishes in the sink.  Leave the tidying up for the in-laws and even then wait at least a month…..

*Dress For Comfort Not Style.  PJs are totally ok!  Just wear a top with easy access so you won’t have to worry about it getting in the way of your breastfeeding efforts.

*Tuck Your Pets Away.  Or ask us before the visit if we mind the pets being out.  Sometimes dogs and cats are so friendly they want to be in middle of the consult.  Although Rover and Mr. Whiskers are cute, they can be a distraction for momma, and we want you to feel relaxed throughout the consult and not concerned about the pets sniffing out the new visitors and their strange bags. 🙂

*Expect to Breastfeed.  But don’t hold off a feeding if your baby is hungry before we arrive.  They are usually always willing to eat again.  It’s helpful if you can text us when you expect the baby to feed next, and we may be able to adjust our schedule around the feeding!

*Pick a location.  Decide where you will be most comfortable breastfeeding…couch, recliner, bed…and have pillows, burp cloth, receiving blanket and a bottle of water within reach.

*Write Down Your Questions.  Don’t try to remember them…your new mom brain won’t let you.  Take a couple of minutes the day of the consult to make a list of questions and concerns you may have.  We won’t leave until we know that you have had all of your questions addressed. 

*Plan payment.  Feel free to ask ahead of time the specifics about fees and payment methods so it’s not a source of worry and surprise for you at the conclusion of the visit.  You or preferably your partner may also want to contact your insurance company to see if any of our services are reimbursable to you or can be applied to a flex spending account.

*Get Your Pump Out.  If you are using a pump at the time of the consult, have it available for us to look at so we can make sure the fit is good for you and provide you tips for getting the most out of your pumping sessions.

*Talk With Your Support Person.  And ask them if they might be available to listen in on the consult and watch techniques.  Having another set of eyes and ears present ensures that when we leave you will feel confident in their ability to give you gentle reminders of the techniques and tips you learned during the consult

*Get Baby in Skin to Skin.  Plan to have your baby dressed in just a clean diaper and spend a few minutes with her on your chest, heart to heart, before our arrival. Babies who are held in skin to skin just prior to feeding go through a specific set of feeding behaviors which generally enables them to latch and breastfeed more efficiently.

*Relax.  And give yourself a pat on the back for seeking help.  While we can’t always provide an immediate fix (sometimes those magic lactation wands just don’t work), our goal is to leave you with a plan, feeling empowered and more confident to take charge of your breastfeeding journey.

The Science Behind It…Primer Guide to Research

26 Nov

In our field of practice, IBCLCs continually strive to gain respect from the community and other health care professionals. We seek to accomplish this by allowing the research to guide our practice.  This is called evidence-based practice (EBP).  As we care for mother/baby dyads, we develop plans by integrating clinical experience (ours and that of other respected IBCLCs), the values of the mother, and the best current external evidence (research) we can find.*

A great deal of time goes into reading a study, analyzing it, and applying it to practice.  There are several elements we look for to determine if the research is truly going to benefit mothers and babies.  This is called generalization…can we take the results from a study that uses a cross- section of breastfeeding mothers and apply it to all breastfeeding mothers?

Some questions we ask to determine the “health” of a study are:

  • How many participants were there?  Was it enough?
  • Did the researches design the study correctly?
  • Were the proper tools used?
  • Was the outcome of the study related to the bias of the researchers? (for example, were the researchers “obligated” to find a certain result due to funding?)  Or was the outcome achieved without any bias?
  • And will this work in the general population?

It is exciting to see more and more research being done in the field of lactation; however, more is needed as IBCLC’s continue to establish themselves as respected members of the healthcare team.  Will you be the next study participant?  Maybe….

At the Children’s Nutrition Research Center…

Lactation Study: Production of Milk Sugars & Triglycerides

Are you 18 to 35 years old, healthy, and exclusively breastfeeding? Is your baby LESS THAN 10 WEEKS OLD? If so, you are needed for a study investigating factors that affect breast milk production. The study includes a 24 hour stay at Texas Children’s Hospital with your baby. Financial compensation provided.  Click here for more information: http://www.bcm.edu/cnrc/studies

*Evidence-Based Lactation Management, Texas Department of State Health Services, February 2011.

Meet the BABE IBCLCs…Misti Ryan

22 Nov

For as long as I can remember (early childhood), I have been fascinated with mommas and babies.  My earliest memory of this fascination is when I was about 4 years old after I must have seen a mom breastfeed…I tucked myself in a little corner of our living room with a blanket and my baby doll and proceeded to nurse my doll!

These early experiences fostered a desire to help mommas and babies in my adult years as I attended nursing school and specialized in obstetrics after I graduated.  My career was my passion.  Once I had my foot in the door, though, I plunged head long into my primary goal in life: getting married and having a family of my own!

My wonderful husband and I were married in 1999…baby number one was born the summer of 2001.  My sweet little daughter was born at home with the assistance of my now life long friend and midwife, Jackie Griggs.  She nursed right away.  I was in mommy heaven!  Then, day #3 hit…the challenges!  Nothing was going to keep me from nursing my baby, so I persisted through, and by 6 weeks we were nursing comfortably, and it was pure bliss!

As a labor and delivery nurse, I knew that after my own personal breastfeeding experience I was in a unique position to help moms avoid the problems I had in the beginning of my breastfeeding journey.  I took the childbirth educator position when it became available and added a breastfeeding class to the repertoire soon after.  My job evolved, and I gradually began counseling inpatient breastfeeding moms as an educator.  I made it my personal mission to educate myself on all things breastfeeding and the dream of becoming a lactation consultant was born.

La Leche League played a big role in my breastfeeding success as well as my dream.  I became a leader shortly after the birth of my 2nd daughter in 2004 and have been co-leading the Pasadena group since then.

My family grew rapidly, a son in 2003, another daughter in 2004, third daughter in 2006, and a surprise daughter in 2009…all natural births and all breastfed.  Needless to say, I stayed busy, and each year that passed I patiently postponed making the commitment to apply for the IBCLC exam.  Then, in the fall of 2010 I met Leah Jolly while working on our La Leche League groups’ treasuries.  The rest is history, and here I sit…my dream realized.

I believe mommas are strong.  I believe babies are smart.   I believe birth is a dance.   I believe breastfeeding is natural.  And I am so excited to be a part.  Let the adventure begin!

Meet the BABE IBCLCs…Leah Jolly

22 Nov

My journey towards Lactation consultant work started with my love for science. I grew up thrilled with anything science and nature. I explored my world with the eyes of a scientist. I was so interested in the natural course of life and as I moved through my school aged years my interest grew and I was drawn into science as a career path in college.  I began college sure I wanted to work with animals but after a year of veterinary nursing school I was not so sure, I found my self more drawn to human life and sciences. So I transferred to University of Houston Clear-Lake and acquired a degree in Biology.

In my last year of college I met and married my husband. We started our family a year later. My first breastfeeding experience came when my first son arrived and due to his oral motor hypotonia, we struggled a great deal and with a lack of support to continue through the struggles, we only had 4 weeks of breastfeeding. I was devastated and determined to have a different experience the next time. When my second arrive, in 2003, after a very traumatic birth, breastfeeding started on another difficult path. Determined to not give up, I sought the support of my local La Leche League group and this is where it all began.  Even though we still had a very difficult time breastfeeding, the support and encouragement made it all so much easier! After a year with the group, I began my work to become a leader.

We had two more children, in 2005 and 2009 and with each one my breastfeeding experiences became more and more positive and less difficult.  I continued my work with La Leche League and loved helping moms achieve their breastfeeding goals. I was so reward to give back what was given to me! In the fall of 2010 I decided I want to be able to help moms even more and made plans to sit for the 2011 IBCLC exam.  I met Misti through our La Leche League work and we decided to become study partners…..well the rest is history!! My dreams have come true beyond measure! I absolutely love working as an IBCLC. I love empowering moms to listen to their own voice and their baby. It is a joy to be part of such a special part of the mothering journey! Daily, I am amazed at the strength and perseverance of mothers. I look forward to many years of working with moms and babies!

When to call a Lactation Consultant (IBCLC)

22 Nov

Breastfeeding should be an enjoyable experience for both mom and baby! Although breastfeeding is natural many factors play into the ease to which mom and baby learn and adapt to these new skills. Lactation Consultants are trained medical professionals who can evaluate the source of your breastfeeding challenges and offer ways to improve the outcome for both you and your baby.  Below is a list of common issues lactation consultants can assist with:

A mom who:

v Has Sore nipples

v Has Mastitis or plugged ducts

v Is Engorged

v Has flat or inverted nipples

v Is Ill or needs surgery

v Has a low milk supply

v Wishes to breastfeed an adopted baby

v Needs to take a medication while breastfeeding

v Plans to return to work

v Experiencing stress about breastfeeding

Or a baby who:

v Refuses to latch on

v Is jaundice

v Is not gaining weight well

v Is fussy at the breast or between feedings

v Is premature or is a late preterm

v Spits up frequently

v Has physical challenges that impair breastfeeding

Or anytime you feel breastfeeding is not going well!