LACTATION CONSULTANT AT HOME

"Plugged" Ducts and Breast Care

9/18/2022

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I’m so excited to be able to share new evidence-based information on plugged milk ducts with you! And I’m even more excited that this knowledge has come forward and honestly has made breast care much simpler for lactating parents and clinicians alike. The Academy of Breastfeeding Medicine updated the protocol on the Mastitis spectrum this year (2022) which includes care for plugged ducts.

At some point during lactation, you may notice a discrete lump or ball in the breast. You may feel a small area that feels hard compared to the rest of the breast. This can often feel tender or painful. This can be referred to as a plugged duct. But as you will read, this name is kind of misleading.

The internet still largely contains outdated and potentially harmful information on managing breast care with plugged ducts when lactating. Some remedies that you should avoid are: applying heat, soaking your breasts in water and Epsom salt, deeply massaging the breasts, utilizing vibrational tools on the breasts, nursing more often, and pumping more often. These methods were all employed with the goal of unplugging trapped milk. Unfortunately, that isn't the problem. So they don't work. And these methods also will actively make the problem worse.

So what's really going on in your breast?

Trapped milk is not the problem. The lump or hard area you feel in the breast is mainly inflammation and not milk that is trapped. If you massage it, you will increase inflammation and worsen the symptoms. “ A breast “plug” represents a focal area of swelling in the breast and more accurately reflects lymphatic fluid congestion and dilated capillaries than a discrete “plug of milk.”” (Mitchell, 2022).

In other words, it's not milk! Your breast tissue is inflamed and there is extra fluid (not milk) collecting in breast tissue (not ducts) to deal with the problem. If we bring down the inflammation, the symptoms will resolve. Milk eventually can start to have more trouble moving around in this area if it persists. But the solution is to use ice to decrease inflammation. This allows symptom resolution and gives your milk a free path to move again.

According to the ABM (2022) “Ducts in the breast are innumerable and interlacing (Figs. 6–8) and it is not physiologically or anatomically possible for a single duct to become obstructed with a macroscopic milk ‘‘plug.’’”

Imagine spraining your ankle. It swells up and then you apply heat to it and begin vigorously and deeply massaging it. Ouch, right? It will swell more. And if we do this to our breast tissue, the inflammation will worsen. This can lead to tissue trauma.

The overall guiding principle for breast care is Be Gentle! No massage is needed! When following good breast care for a plugged duct, you should feel symptoms improving within 24hr.

Now lets get to treatment:

~Continue your normal regimen of milk removal. This means don’t pump or nurse more often due to a plug. Continue your normal routine. If you add extra stimulation to the breast that has a plug, you will increase supply and add more milk to a congested area. This will worsen the problem.

~ICE! Apply ice after nursing or pumping for 8-10 minutes (not longer than 15 minutes at a time. Do not apply ice directly to your skin. Cover it with a cloth)

~ Ask your Physician if you can take an anti-inflammatory.

~Adding a technique called Lymphatic Drainage can sometimes be called for if there is a lot of extra congestion in the breast. Please discuss this with your IBCLC.

Most of my clients who have followed these steps have reported relief within 24hr. If you have recurrent plugged ducts, work with your IBCLC to discover why and stop the cycle!

Mastitis is a blog for another day but please reach out to your IBCLC and an MD if your symptoms are not improving and you see things progressing.

Signs of mastitis are:
* Breast tenderness or warmth to the touch.
Breast swelling.
Thickening of breast tissue, or a breast lump.
Pain or a burning sensation continuously or while breastfeeding.
Skin redness, often in a wedge-shaped pattern.
Generally feeling ill.
Fever of 100.4 F (38.3 C) or greater.
Please call your MD if you have these signs and symptoms

Please remember that there are Two kinds of Mastitis: Inflammatory mastitis and Infectious mastitis. You don't always need antibiotics. Consult your IBCLC and Physician!

References:

Mitchell, K., Johnson, H., Rodrıguez, J.M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Widmer Cash, K., Berens, P., Miller, B., and The Academy of Breastfeeding Medicine. (2022) Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17 (5), 360-376. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

Mitchell, K. (2022, September 13). Mastitis and associated complications. Physician Guide to Breastfeeding. Retrieved September 18, 2022, from https://physicianguidetobreastfeeding.org/maternal-concerns/mastitis-and-associated-complications/?highlight=%22plugging%22

Cathy Walker, MA, RN, IBCLC
September 2022

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Why is breast pump flange fitting so important?

4/27/2022

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The right size pump flange can make a huge difference in your Lactation Journey! Most breast pumps come with one or two flange sizes that attach to your breast. It is unlikely that either of these sizes is going to be your best fit. It does happen sometimes. Breasts and nipples don't come in just two sizes.
We now have options to find a more custoimized fit for our pump flanges. This is a game changer for comfort, pumping efficiency and milk output.

When we are using a size that is too large, our breast and nipple is not experiencing the proper contact and stimulation to help express the most milk for our pumping session. Additionally, often the breast itself (areola) is pulled into the tunnel of the flange along with the nipple. This can result in pain and damage. This results in less output for multiple reasons. One reason is the lack of good stimulation and the other is pain. Pain can inhibit the milk letdown especially if it is chronic. Conversely a size too small can pinch and hurt the nipple and and lead to less milk output.

Some parents don't experience pain with the worng size flange but their pumping efficiency and milk output will likely still be affected.

When we are fitted for the right size, the results are much better comfort while pumping. It also can often mean larger milk sprays, more milk output overall and less time needed to pump. If you are pumping, it is always best to seek a good expert flange fitting to maximize your milk supply and ensure comfort and a good experience.

In my experience, I have worked with clients who expressed immediate improved comfort and bigger sprays of milk. This resulted in expressing more milk in a shorter period of time. Those minutes add up over your 24hr and weeks of pumping.

What to do next? See an IBCLC who is trained in flange fitting. They should try multiple sizes with you and watch the whole pumping session to determine your best fit. New knowledge in flange fitting has been presented in conferences designed for IBCLC’s. Ask if your practitioner has taken recent courses in this specialty and book a flange fitting session!

Takeaway? Flange fit Matters!

Lactation Consultation at Home can offer this service at your home, in the office and virtually!

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Why do we ask permission to choose our own path while Breastfeeding?

10/14/2021

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I sit down to write a blog when I am inspired. This usually finally happens when a theme arises in my private practice. Lately I have many parents asking “permission” to do many myriad of variations on their lactation journey: bottle feeding, adding formula, pumping less to get sleep and prioritize mental health, weaning and feeling okay about it.

I call them variations because they are not veering off the path. They are part of the many paths of breastfeeding.

This blog is not about the do’s and don’t of breastfeeding. That topic is for another day. Some of the common threads I hear:
Can I give some bottles and breastfeed? Can my partner do some feedings for me so I can rest? I know I'm not “supposed” to pump for the first 4 weeks but I really need my partner to help with feedings sooner. Can I use formula while breastfeeding? Can I decide to pump and feed my baby with a bottle? Can I stop breastfeeding?

These questions are asked in the spirit of not so much, how can I do these things, but “am I allowed to do these things?” And this is the topic of my blog. Guilt and the overarching nebulous feeling that we have to breastfeed a certain way. That breastfeeding has to look a certain way and follow a prescribed path or else we have done it wrong.

Society has pushed all these questioning thoughts on us. It's not our fault as new parents. We want to do what is best. And breastfeeding is a new thing and uncharted territory. We look to friends, family and unfortunately social media to guide our thoughts and decisions. Some of this advice is really good. And some, not so much. And then we might turn to experts in lactation. But IBCLC’s and other lactation professionals are here to Support you. Not to tell you what to do with your baby or your body.

And yes, you Can use bottles and breastfeed. You can give formula And breastmilk. Pumping can be an option for many and No one should tell you that you Should or you Have to breastfeed or when you should stop.

In other words, it’s your journey. It’s my job to support you on your desired path and provide all the best evidence based education for you to reach your goals. You don’t need anyone’s permission when settling on your special relationship with your baby. It’s yours, it's unique.

Feel confident in your decisions. Realize that you may change your mind every other day in the early weeks. Babies change really quickly and breastfeeding evolves and gets easier than that really tough first week. It’s ok to go back and do something different. You will know when you’ve made a good decision around feeding your baby when you feel relaxed and you breathe easier. Listen to your Parent intuition. You know your baby best and you know your family best. The rest of the world can just butt out.

Enjoy Your Breastfeeding Relationship!

Cathy Walker, MA, RNC, IBCLC

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Breastfeeding Can Bring You Joy

9/17/2021

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When clients sometimes ask me “how long should I breastfeed? I say, “for as long as it brings you joy.

My philosophy is that feeding your baby is a moving and powerful event and should not cause undue heartache or stress. It helps to know oneself. Understanding your goals and what allows you to enjoy your baby is important on this journey.

For some, this is turning over every stone to make breastfeeding work. For others, like myself, I persisted as long as I could mentally and physically which was less time than my original goal. But I do not regret this. I feel proud that I made those decisions for myself.

When I meet a client, I want to know “their” goal. Breastfeed exclusively? Breast and bottle feed? Breastfeed initially and add bottles at a certain interval? Exclusively pump or formula feed? Yes Lactation Consultants help with bottle skills and I don’t care what is in the bottle. I am here to support you.

One very important element that is integral to this discussion is maternal mental health. I am passionate about recognizing the signs of perinatal mood disorders and providing resources when appropriate. I also tailor my care plan to reflect the need to take care of mental health.

Self care and sleep is also important for mental health, physical health and milk supply. I will prescribe sleep instead of frequent pumping overnight with a balance to prevent plugged ducts & mastitis & not diminish milk supply as much as possible.

Sometimes parents know what they want out of breastfeeding. Sometimes parents explore their goals over time. I can help facilitate a realistic discussion and provide steps to reach each family's feeding goals.

Breastfeeding should not sacrifice our mental or physical health. It should enhance it. It should bring us joy. It takes a village to be successful at breastfeeding and raising children. An IBCLC (International Board Certified Lactation Consultant) can be a part of that essential process.

Enjoy Your Breastfeeding Relationship!

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How do I know if my baby is getting enough breast milk?

6/10/2021

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How do I know if my baby is getting enough breast milk?

I am revisiting this topic because it is the number one question I hear from every parent. And it is true that if we don’t know the answer and feel comfortable in our understanding of it, we might question breastfeeding altogether.

We actually have a solid, reliable list of signs that our babies are receiving enough breast milk. Here is the list.

Adequate weight gain
Back to birth weight by day 10 of life
Lots of wet and dirty diapers
Nursing 8-12 times every 24hr
Content between feedings
Nipples are not damaged
No pain with nursing

So let’s dive into these in some detail.

Weight gain: Babies should get back to their birth weight by day 10 of life. They should gain one ounce a day or more for the first 4 months of life. Yup they gain 2 pounds a month! This is a very accurate way to check on their progress. If you are concerned with your baby’s intake, you can ask for a weight check at your Pediatrician’s office. This is preferred to weighing your baby on your own. Home scales may or may not be accurate. User error is also common. But when you see your Pediatrician they can do an exam, counsel you and provide referrals if needed.

Diapers: What goes in, must come out! Your baby should have 6+ wet (urine) and 3-4 + poop diapers every 24hr. In order to count, a poop should be the size of a quarter. In the first week, it is helpful to use diapers that have a ‘pee’ line. It will turn from yellow to green when the baby pees. If you see less than the required number of diapers, you should call your Pediatrician.

Nursing 8-12X every 24hr and baby being content between feedings: You may have that day when your baby eats 13X or so especially if they are going through a growth spurt. But if you are struggling and feeding your baby 17X a day, every day, this is a sign to reach out for support from an IBCLC. On the other hand, if your baby is sleepy and you cannot get up to 8 feeds every 24hr, you should also reach out. In general, babies need to eat a minimum of 8+ times every 24hr to gain weight regardless of feeding methods. We also should define a feeding. There is a range of normal but if you are nursing for 60 minutes at every feeding, this is a reason to reach out for help. Some parents will say, “ I feel like I’m always feeding my baby” or “My baby is hungry right after nursing or wakes up 15 minutes later for another feeding”.

Healthy nipples and pain free nursing: That’s right! It’s not supposed to hurt. It's possible that in those first few days, your baby latched improperly for a brief period of time and caused some damage. This should heal and not recur with a deep, correct latch. Reach out for help if you are not able to attain a comfortable latch prior to leaving the hospital or birth center. Pain and nipple damage point to a shallow latch. When babies have a shallow latch, they will remove less milk than needed. Over time, this can lead to poor weight gain or weight loss. It will also lead to lowered milk supply if not corrected. The milk supply is dependent on how much milk your baby removes while breastfeeding. So if there is a challenge to this, the milk supply can decrease. You can combat this by reaching to an IBCLC to figure out the cause and by pumping to increase your supply.

You will also see that when your baby is full, their body relaxes, their little fist will become an open palm and you may see some milk on their lips. You are the expert on your baby and your experiences. Trust your gut as a parent. If you are worried about your baby’s intake, contact their doctor and an IBCLC (International Board Certified Lactation Consultant). IBCLC’s are uniquely qualified and positioned to assess breastfeeding difficulties and offer a care plan that aligns with your goals. You don’t need to measure anything to figure out if your baby is getting enough milk. You now have the knowledge to evaluate their milk intake.

Cathy Walker, MA, RNC, IBCLC

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Breastfeeding During a Pandemic

2/28/2021

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Cathy Walker, MA, RNC, IBCLC

In pre-pandemic times, having a baby is a tumultuous experience. There are many ups and downs. There is sheer exhaustion and unimaginable joy all happening at the same time. We are not meant to parent in a bubble. Breastfeeding requires support from society, family, friends, professionals and the work environment. ““It takes a village to raise a child” is an African proverb that means that an entire community of people must interact with children for those children to experience and grow in a safe and healthy environment.” (Wikipedia, 2021) In pre-pandemic times, I see this as a struggle for many families in modern US culture. Often family does not live close by and paid leave from work is very limited. Parents have to make a concentrated effort to reach out to friends, support groups, family and medical professionals for the support they need. Some parents may just feel tired and overwhelmed and this effort is a struggle or impossible.

Enter the Pandemic of 2020. Pregnant parents sometimes have to attend their prenatal appointment by themselves. No partner to share in the joy of milestones. No partner to support them if uncertain news or difficult news is delivered. Tablets and phones replace that in person presence. There was a brief time in some NYC city hospitals where partners were not allowed to be in the delivery rooms with their partner. This was reversed quickly but not before many people went through this amazing, difficult, scary, wonderful, momentous time in their lives essentially alone. Parents are together in the delivery rooms again and staying together in the rooms after birth.

Some new families stay the normal course of 2-4 days in the hospital after delivery. Some are being discharged earlier than usual. (Kuehn, 2021) That extra 24hr in the hospital allows parents to practice the latch, and take in more education on feeding and expectations over the next few weeks. Packing in 48hr of education into 24hr is hard for the staff and parents. And in the early hours after birth, a lot of information is not retained. Parents are still recovering, have adrenaline coursing through their body and are physically exhausted.

Now parents are at home with more limited resources and access to support. Many doctors allow both parents to attend early checks for their baby. But others only allow one parent. The ability of family to travel and stay with new parents can be limited due to covid restrictrictions, their own health concerns and fear of spreading this illness. That friend who normally would drop by with coffee and a boost of cheerleading and advice from their experience can’t come over. Most support groups are now being conducted online. These are so helpful and taking advantage of all online support, connection and help is critical. But human beings miss that in- person connection. There is no doubt that this is harder.

IBCLC’s (International Board Certified Lactation Consultant’s) have now pivoted to offering virtual consults. There are some who still provide Home Consultations. There are many issues and concerns that can be addressed virtually in Lactation. I have been amazed at what can be accomplished. But there are certain aspects that need an in-person evaluation.

Early on in the Pandemic, people were encouraged to stay home and not see their MD unless it was urgent, putting off well checks and follow ups for medical conditions. This has resulted in more morbidity or illness. (Rosenbaum, L., 2020) The medical profession has learned, yet again, that prevention is best. With each situation being considered individually, it is being recommended now that skipping certain check ups will be more detrimental to health overall. This is certainly true for Lactation. A virtual or in-person check up at the earliest sign of issues/concerns will help prevent further problems. Usually the earlier one reaches out, the easier it is to resolve the situation.

Some extremely positive effects have developed from this health crisis that are specific to Breastfeeding. Many hospitals are limiting visitors and keeping the babies in the rooms with parents a lot more than usual. This chance to bond, learn the babies hunger cues, feed more often on demand and have uninterrupted time to learn from nurses, doctors and lactation consultants has resulted in better breastfeeding outcomes anecdotally for many. For those utilizing the full time allotted to adjust in the hospital and ask questions and get feedback, this rooming-in without visitor interruption has a positive impact on lactation. Anecdotally it has been noted that some have experienced an earlier onset of Lactogenesis II (transitioning to mature milk with higher milk volumes). This makes sense as the babies are nursing more times in 24hr in these circumstances. Having that dedicated time to take in the teaching and ask questions is really invaluable. I have several roles in lactation. I have a private practice and I work in a hospital as a nurse and a lactation consultant. I can tell you that I don't look forward to the return of visitors. It limits our chance to provide our services. Maybe a compromise of a short window of visitation each day would be great! Those grandparents need their cuddles!!

So what can a parent do during this Covid-19 Health Crisis?

1.Take advantage of every single support you can! And you may have to reach out more than usual to get access to what you need. (Which is not fair). Ask friends for help with research to find extra support if needed. Take that off your plate.
2. Schedule Zoom calls with friends to vent about all the challenges and get those tidbits of wisdom.
3. Connect with a parent support group or breastfeeding support group that meets weekly online.
4. Take a breastfeeding class prenatally.
5. Connect prenatally with an IBCLC for a virtual visit as another option. Also just having their contact information as a backup for later is very helpful and stress reducing.
6. Reach out to an IBCLC early if you encounter difficulties. You can always start with virtual support and move to in-person if needed.
7. Make plans before birth for in-person support with family or hired help. Planning ahead will allow everyone involved to quarantine, get tested and be as safe as possible.
8. Acknowledge and take in that this is Hard and you can do it with your village!

References:
Kuehn, B., (2021, January 12) Covid-19 Precautions Hamper Breastfeeding Support. JAMA Network. https://jamanetwork.com/journals/jama/fullarticle/2774844

Rosenbaum, L., (2020, June 11) The Untold Toll-The Pandemic’s Effect on Patients without Covid-19. The New England Journal Of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMms2009984

Wikipedia, (2021, January 12) It Takes A Village. Wikipedia. https://en.wikipedia.org/wiki/It_takes_a_village

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Straight Talk on Tongue-Tie!

12/5/2020

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Hi everyone! I’m back to talk tongue-ties again. I see this problem a lot because I’m a lactation consultant. People usually call me when something isn’t going well. Lots of times it is Not a tongue-tie! Phew. But sometimes it is. I know it can be an exhausting and frustrating topic. Let’s get to the bottom of what you really need to know as a parent facing this issue.

Let’s get some myths out of the way…

MYTH: Tongue-ties are a fad

Nope. They are being recognized more often due to increased breastfeeding initiation rates in our country and better training.

MYTH: My baby can stick their tongue out of their mouth so they don’t have a tongue-tie.

Maybe. But the extension of the tongue is only one motion of the tongue that is evaluated and elevation is critical to many functions especially breastfeeding.

MYTH: My baby’s doctor said my baby does not have a tongue-tie.

Maybe. Has your doctor had extensive training in identifying a tongue-tie? What screening tools did they use to evaluate your baby’s tongue? Did they watch a whole breastfeeding session and take a full feeding history? Were their suggestions helpful in resolving your concerns? If not, seeking out an IBCLC can be key.

Now onto the good stuff. If you suspect that your baby has a tongue-tie, please consult an IBCLC (International Board Certified Lactation Consultant). We do not diagnose conditions but many of us are trained to assess for these issues and know when to refer to a trained MD. Also please find out if your IBCLC is experienced with tethered oral tissues. (TOTS)(tongue-tie, lip-tie)

Common Symptoms of Infant Tongue and Lip Tie

Poor Latch/inability to latch
Sliding off the nipple
Fatigue during feeds
>12 feeds in 24hr-endless feeding
<8 feeds in 24hr
Sleepy feeds
Poor weight gain
Clicking during a feed
Maternal nipple pain and damage(compressing, chewing, gumming, pinching, scraping the nipple)
Increased maternal nipple/breast infections
Low milk supply
Milk oversupply
Dribbling milk at the breast/bottle
Digestive issues (gassiness, ‘reflux’ due to extra air being swallowed and poor control of the milk during swallowing)
Various other feeding challenges

*Keep in mind that you can experience some of the above symptoms for other reasons as well. Your IBCLC will be able to figure out the cause with your help.

Your IBCLC is your Quarterback on this journey. An IBCLC trained in TOTS will be invaluable for you and your baby’s journey to better health. Since tongue-ties can potentially lead to challenges with other issues throughout the lifespan it is worth having this addressed even if you elect not to directly breastfeed. And yes, we help with bottle skills, pumping, and safe formula preparation too!

Imagine that you have a limp and discover that you need some surgery on your knee. You go to the orthopedist and they repair your knee. They hand you a prescription for physical therapy and say, “you must complete 20 sessions of physical therapy to ensure proper healing, maintain range of motion and return to full function”. After having undergone the procedure you dutifully report to PT and slowly improve. What would happen if you skipped PT? You might experience stiffness, difficulty walking, continued pain and it’s possible you would not improve at all or end up feeling worse.

This is similar to a tongue-tie release which is called a Frenectomy. The tongue is connected to the floor of the mouth and the muscles and fascia of the body. The tongue has not been lifting in a natural way due to the restriction. Therapy to address the overall body tension or compensations is critical to a good release and recovery afterward. Specific tongue exercises are necessary to gain the best function and results after the release.

Manual therapy is recommended in a sandwiched approach. This may be done by a chiropractor, osteopath, craniosacral therapist, or physical therapist who is specially trained in very gentle approaches for infants and newborns. It is best to do this before and after the release. The tongue exercises are directed by your IBCLC and chosen specifically for your baby to assist in their individual challenges.

Your IBCLC will have observed a feeding or several and examined your baby. They will be able to guide you on the timing of these appointments and what professionals may or may not be necessary in your specific case. IBCLC’s help you manage the breastfeeding and milk supply throughout this process, carefully adjusting your care plan as needed. We monitor you and your baby’s progress through these steps. We partner with the Doctor who performed your baby’s Frenectomy. We partner with any additional professionals you consult to ensure more informed and wraparound care.

The takeaway? There are a few needed steps for good results from a tongue tie release. This process does not need to be stressful or full of mystery. If you have an IBCLC on your team, you can focus on enjoying your baby! Isn’t that what it is all about?

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How to start off strong on your Breastfeeding Journey

10/6/2020

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Photo by Dahlak Tarekegn from Pexels

I’m going to share my favorite simple tips for a great start!

I understand that looking for straightforward answers can drag you down the ‘google’ rabbit hole. Speaking to friends and family can be dizzying with varying advice. And even professionals will sometimes offer different approaches.

I often hear, “I keep hearing different answers to my questions!”. Yup! It’s not you! There can be more than one ‘right’ answer. Finding the best answer for you requires an individualized approach. If it’s a breastfeeding question of any complexity, ask an IBCLC! Others are well meaning and may or may not have the right answer. And what worked for their baby may not be right for yours.

International Board Certified Lactation Consultants (IBCLC’s) are trained in current evidence based information in Lactation and take continuing education regularly. I happen to always be in the midst of a webinar or headed to a conference (Pre-covid). We also happen to be a tight knit group of practitioners. We pool our collective wisdom and bring it to you.

The other reality of lactating (and parenting) is that the ‘right’ answer or advice for a one day old baby is different for a three day old baby and certainly different for a one week old and so on. Then there are specific details unique to your situation that may alter these answers. When seeking your answers, an IBCLC can support you in areas of basic education and complex situations.

My personal motto is “Knowledge is Power”. (credit-Thomas Jefferson)
I have noticed that the more I know, the less I worry. I can also act sooner to prevent a real problem. This is absolutely essential in breastfeeding. Basic education on the normal expectations for the first few weeks (and beyond) helps us immensely as parents. We show more resilience during those middle of the night cluster feeding sessions when we have learned about them ahead of time. We can reach out for skilled support at the first sign of an issue. This can prevent problems from compounding and worsening and brings us to a resolution much faster. If you are familiar with some basic warning signs, you can reach out and prevent such issues as slow weight gain and low milk supply. See my blogs on “What’s all this about Tongue Tie?” and “How do I know if my baby is getting enough milk” https://www.lactationconsultantathome.com/blog/previous/2.

So how do I start off strong in my journey??

I highly recommend a breastfeeding class prenatally or a prenatal consultation with an IBCLC to prepare for birth.

Ask for help often in those early days when you may have access to help. Hit the call button and ask for the nurse or lactation consultant especially if nursing is challenging or painful. Don’t let anyone tell you that nursing is supposed to hurt in the beginning. It’s not!!

Keep your baby in your room at the hospital and at home. You will see and hear their early feeding cues and be able to respond to them faster. Breastfeeding more often will result in a higher milk supply sooner assuming other factors are normal. This strategy also results in easier latches when your baby is less frantic

Limit those visitors! You can end up ‘entertaining’ them when you are exhausted, uncomfortable and really wanting to bond and nurse your baby.

Sleep anytime you can fall asleep between feedings!

Stock your pantry with high protein, higher fat healthy snacks to munch on during nursing sessions.

Remember your baby will often need to be held by you or your partner/family between feedings. They crave closeness and this is normal! Skin to skin contact is best.

Schedule an in-person or virtual consultation with an IBCLC postpartum if you are still having challenges. IBCLC’s are specialists in Human lactation. We are trained specifically to work with the lactating parent and baby as a couplet and assess and create a care plan. If you are concerned about your journey and not getting answers from your providers, seek guidance from the experts.

Get off Google!!!! Most of the answers you will get are wrong and upsetting! Most of the time, when I do this myself, I come away thinking I’m dying of some terrible disease. Here are two reliable resources for basic information: www.kellymom.com and https://www.llli.org/

I can’t overstate how helpful a breastfeeding class is for expectant parents. I always observe that those who have taken one are more relaxed and flexible facing their nursing journey no matter what the circumstances. They feel empowered and more able to accept the truly unpredictable nature of having a new human being in their lives. A prenatal consultation with an IBCLC will cover all of these basics plus individual concerns.

Knowledge is power!!
Congratulations on your new journey!

Photo by Nicole De Khors from Burst

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When to consult with an IBCLC (International Board Certified Lactation Consultant)

5/5/2020

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What is an IBCLC?

IBCLC’s are the gold standard in Lactation Care. IBCLC’s are certified by the International Board of Lactation Consultant Examiners (IBLCE), which requires re-certification every five years. To become an IBCLC we complete 90 hours of lactation specific education, hold a degree in a health sciences field and have 1000 hours of lactation specific clinical experience. To achieve the re-certification we must take 75 hours of continuing education. IBCLC’s collaborate with health care providers.

When should you consult an IBCLC?

Endless Feedings (usually this is more than 12 feeds in 24hr repeatedly)
You are not sure if your baby is getting enough to eat
Pain while nursing
Breast or nipple pain
Nipple damage (sore, cracked, blistered or bleeding)
Low milk supply
Oversupply
Plugged ducts/ Mastitis
Overactive letdown
Baby is not latching or not able to maintain the latch
Baby is sleepy at the breast, not nursing actively
Tongue Tie/Lip Tie/Buccal Tie
Baby weight gain issues
Concerns about potential reflux
Pre-maturity
Twins/Triplets
Positioning
Pumping/Flange fit
Transition to solids
Back to work planning
Special health care needs
Breastfeeding and Lactation Education
Weaning/Milk Suppression
This list is not meant to cover every reason to consult an IBCLC

IBCLC's can help in numerous ways in common, and complex feeding issues. We are uniquely positioned to assess and create a workable care plan with your feedback that keeps your specific goals in mind.

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What is a Telehealth Lactation Consult?

3/22/2020

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Today I am writing about Telehealth Lactation Consults. You may also hear the term Virtual Consults. This method of support has been a part of many IBCLC’s (International Board-Certified Lactation Consultant’s) repertoire for years before the current health crisis. Recently many IBCLC’s have added this service and sought training on making this successful for our clients and families.

What is a Telehealth Consult?

A Telehealth or Virtual Consult is a consult that is conducted through HIPAA compliant, secure live video. This means I am still adhering to regulations to safeguard your privacy and medical information. A consult through video has limitations and does not replace an in-person consult and examination. This is also true if you have a Telemedicine visit with your MD.

What can I do to support you and your family through Telehealth?

Thorough history of parent/baby/ feeding history
Address current concerns
Visual exam of breasts/baby
Observe a feeding/latch/position/pumping/Flange Fit
Comprehensive Education
Create a Breastfeeding/Lactation Care Plan with your input with written recommendations
Provide multiple resources targeted to your needs (articles/videos/pictures)
Collaborate with your Health care provider(s)
Provide continuing follow-up per agreement

What is different in a Telehealth Consult?

I may ask you to video part of a feeding/pumping and send it to me via secure portal
I may ask you to make other brief videos to assist me in my assessment. This is all included in the consult even if it takes place later.
I can’t examine your baby or their oral structures
I can’t physically examine your breast or provide in person help with positioning and latch

How to prepare for your Telehealth Consult

Please have a person available to help position the camera/computer during the consult (For those with scheduling issues, I can arrange evening consults)

Please have sufficient lighting in the room and a separate portable light/lamp that can be directly aimed at a subject

Have your camera available to take pictures/videos for later review

Telehealth consults, due to their nature, may require more follow up messaging (this is included)

IBCLC’s are a creative group of professionals. We have always utilized videos, gesticulating with our hands and using props like dolls and knitted breasts to aid us in teaching! We have adapted to Virtual Lactation. Let us be there for you and your family during this time!

Let’s keep the milk flowing, prevent problems and keep the babies/children and parents smiling on this journey! Join us online!

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Why is breast pump flange fitting so important?

Why do we ask permission to choose our own path while Breastfeeding?

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Straight Talk on Tongue-Tie!

How to start off strong on your Breastfeeding Journey

When to consult with an IBCLC (International Board Certified Lactation Consultant)

What is a Telehealth Lactation Consult?

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