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. 

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How does Telehealth Work? 

  1. 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. 
  2. 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.
  3. 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. 
  4. When it is time for our meeting, click on the link in your calendar for our appointment. 
  5. Enable both the video and microphone so I can see and hear you! 

Some Tips on Telehealth

  1. 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. 
  2. A well lit room is better than a dark one, but I will work with where ever you feel comfortable. 
  3. 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.
  4. 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!
  5. 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. 
  6. 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.

 

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.

 

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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.

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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.

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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.

 

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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.

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.

The Eight Stages of Breastfeeding

Lots of moms seem to go through the same stages of breastfeeding in the early days following their baby’s birth. These range slightly from situation to situation, but mostly follow the same patterns.

 

Stage One: Prenatal Bliss

12407_10150143443275585_1733879_nYou are pregnant, in the home stretch, maybe only one to two months to go. You have read a few books, gone to that breastfeeding class your hospital or birth center offered, and every woman with a snot nosed toddler and a sassy five year old in tow has told you their horror story. Still, you figure, that won’t be me, breastfeeding is NATURAL. Besides, they don’t want it as much as I do. At this point, you also probably have a lot of feelings about babies sleeping alone, toys staying out of your personal space, and still going on date nights once a week.

Stage Two: Post-partum (The Hospital)

babyhospitalCongratulations! You have a healthy baby! (or you don’t) and they latch right on after birth! (or they don’t) In the next 24 hours, your baby is bathed, washing away the scent of you, and making it hard for them to find you again. Then they are vaccinated, poked for a blood draw. This is followed by prodding, weighing, measuring, photographing, wrapping, and eye goo smearing.  Finally, after all that, handed back to you…1-3 hours later.  This is if everything goes right and you don’t opt for unnecessary surgeries!

Stage Three: Bliss Bubble

You are floating in  a bliss bubble, and so is everyone else you know. They are all crowded around, asking to hold the baby. If the baby latches, you may not even notice it is bad, or that it hurts (my first born literally gave me hickies on 80% of my breast) until the nurses start bothering you.  Everything is measured: weight, blood sugar levels, jaundice levels, body temperature, how often/how much you are nursing, and poop and pee output.  By the way, their answer for all of this, is supplementation.

Meanwhile, it is really hard to nurse on demand when everyone you have ever known is in your postpartum room, holding your new baby. That is when the nurses and doctors aren’t doing their rounds.

319969_10152734486005585_941556193_nThis is about half of my IMMEDIATE family. I know what I am talking about.

 

Stage Four: Hospital Help

lactation-consultantAt this point you may see the hospital’s Lactation Consultant. Or, you may see a nurse who once sat through a two hour course online, who calls herself the Lactation Consultant. If you are lucky, she will help you with latch and she will give you great tips on how to better position the baby. If you are extremely lucky, and the hospital is empty, she will look at the baby’s oral anatomy as well as yours and make sure everything is working properly. If you catch her on a good day, she will treat you like a human. Often, none of this actually happens.

Stage Five: Things Change

postpartum-depression-130806You arrive home, finally. Perhaps you are already are supplementing or using a nipple shield just to get out of the hospital. Maybe this was for good reason, or maybe this was a band-aid that was put on a problem that was ignored. You are tired. You are grateful to be home. You are ready to start enjoying your baby. His latch is great! Everything is going so well!

And then, The Milk Fairy arrives! Suddenly, your breasts have swollen to the size of bowling balls and the baby won’t latch. Or, your milk isn’t coming in and the baby cries all day. Your nipples may be sore, cracked, even bleeding. You are worried the baby isn’t latching correctly, or that you just don’t know how to do this. You saw a Lactation Consultant in the hospital, do you really need a home visit from one now?! You call the hospital. You realize you can not talk to the kind and wonderful LC you talked to when you were there anymore. That is against the rules.

Stage Six: Home Help

You find the number for a International Board Certified Lactation Consultant (IBCLC) in private practice. You make an appointment. She will come to your home, spend as long as it takes with you and your baby making sure everything is working properly, and give you a care plan. She will communicate to your healthcare providers. She will empower you to make good decisions based on your goals and your baby’s needs. Best yet, your insurance is required to reimburse you for her services, just like they covered that shiny new pump you received a few weeks ago.

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Stage Seven: Healing and Learning 

1916682_1391808597875_697479_nLactation Consultants can’t make everything all better with just one visit. They can, however, empower you to do so. The first weeks out of the hospital are difficult. You don’t have to go it alone. There is still going to be a learning process and a period of really getting to know your baby, their likes and dislikes and quirks.  There is also a getting to know yourself as a mother period, so be kind to your body, to your soul, this all takes time, this is not a skill you just know how to do. And you are NOT alone.

Stage Eight: Breastfeeding Boss

You are pain free! You can now cook while you tuck Junior under one arm, latched the whole time. You no longer fear public places, or feeding time, or returning to work. You are a pro! Your baby is growing, and thriving, and starting to smile at you while he nurses. You might even be thinking, you could do this all over again in a few years…

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Myth Monday: Daddy Bonding pt. 2

daddybabySo, this meany IBCLC doesn’t want daddies to feed their babies? How small minded and unfeminist of me! Don’t you realize that lots of women work?!

Whoa. Let me assure you, I am a big fan of bottles when breasts aren’t available! Rule number one of parenting is this: FEED THE BABY. Bottles can be helpful for a parent who is returning to work, and should be introduced at some point  between 4-6 weeks by someone other than the mother, but that isn’t what we are talking about today.

The problem with the whole, “pump so daddy can feed” thing, is:

  1. If you aren’t removing milk from your breast at every feed you are decreasing your supply. Period. So if you plan on sleeping through that feeding the daddy is taking over, don’t, you best get up and pump! And if you are up anyway, why not just feed the baby and save your sweetie all those dishes to wash?
  2. Pumping is a lot less fun than holding a cute, cuddly, big eyed, sweetly smelling baby.
  3. When you get in a cycle of pumping and bottle feeding, you breastfeed less and less, which ultimately decreases your supply and YOUR ability to bond with the baby.
  4. You will most likely, want to slap the bottle out of your dear loved one’s hands. Hormones make us protective of our little ones and of our milk supply. It is why our breasts let down when we hear a kitten meow sometimes, we want to feed the WORLD! This doesn’t go away just because you pledged your life to this guy with the bottle, your gut will rebel against someone else feeding your baby.
  5. Pumps just aren’t as efficient as babies, and sometimes, you won’t be able to pump at all. This has NOTHING to do with your supply, simply with the intelligence of your breasts. They know this droid is not the baby they are looking for! However, the sight of two bottles with drips of milk in the bottom after 30 minutes of not bonding with your baby can be really disheartening.

Enjoy your only job for the next few weeks being to feed and enjoy your baby!

5 Reasons to Hire an IBCLC

How do you know when to throw up your hands and call a professional to help you with breastfeeding?

1. The pain of breastfeeding makes you wish for the days of leather straps and a strong shot of whiskey.
Breastfeeding should not make you dread every feeding. It should not make your toes curl. It should not make you cry. Sometimes, yes, it can be mildly uncomfortable for the first couple of sucks, but it should not make your nipples bleed, bruise, or bevel. That is not normal, and you should seek help from an International Board Certified Lactation Consultant (IBCLC) before help from a plastic surgeon is needed.

2.  Your baby isn’t gaining weight
Don’t reach for that handy dandy bottle of formula that came in the mail just because you signed up for a baby registry! Instead, pick up the phone and call for help. If a baby hasn’t gained their birth weight back by 2 weeks, it doesn’t mean your milk isn’t good, or there isn’t enough. It could mean that they aren’t able to transfer enough because of latch or perhaps because they would rather sleep! Simple tweaks to breastfeeding management might be all they need to get them gaining again.

3. The baby won’t latch
Sometimes, due to extenuating circumstances, babies develop a preference for the bottle, and prefer not to nurse at the breast. If this happens, you aren’t alone, you don’t have to give up, and breastfeeding CAN be regained!

4. You would like to have your boobs back but you don’t know where to start…to stop.
IBCLCs have knowledge to help you from pregnancy all the way to helping you come up with a weaning plan. Weaning gently is one of the hardest things to do emotionally, don’t go it alone.

4. Something went wrong the first time
If this is your second (or third, or fourth) and you have struggled with breastfeeding in the past, set yourself up for success, and get a prenatal consult. Talking with a professional with what went wrong before can help you work out how to avoid the pit falls and “boobie traps” that are so common in the first weeks of parenthood.

5. Any other reason that you feel like you can’t do it alone
If you want to punch the next person that tells you how “natural” breastfeeding is, it might be time to call in an expert. If it is a quick question, call me, I do free help over the phone. If it is a problem big enough to warrant a home visit, then we will take those steps, but questions are normal.

Ultimately, the early days of parenthood is rough enough without trying to take it all on alone. Peeing is also natural, but if it burned every time, and you started seeing blood, you would go to a doctor, right!? Don’t feel like you must go this alone. Historically, we used to have our aunties, mothers, cousins, friends, sisters, all who breastfed openly and around us, to be our lactation consultants. We have ALWAYS needed help learning this skill, we just don’t have the support systems and knowledge we once did (thanks Similac!).