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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? 

  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.

 

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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.

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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.

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Back to Work Breastfeeding Class!

iStock-48338332_wideWomen have always worked and breastfed. However, in our modern world it can present unique challenges.  I love to empower women to truly have it all! This class for the soon-to-be-working parent and the already-working parent who want to explore options for getting back to work while breastfeeding. This class is presented in a casual, round table format. Questions and special situations are welcome!

  •  Pumping most effectively and efficiently once you are back to work.
  • Working with your employer to create a supportive atmosphere to pump or breastfeed your baby.
  • Creating a realistic plan with your family and care providers to support your goals as a breastfeeding mom.
  • Being familiar with pump options and other supportive equipment needed for the working/breastfeeding mom.
  • Introducing your baby to a bottle
  • What to expect from your baby and you when back to work
  • Exploring the state and national laws protecting your right to breastfeed and express milk for your baby

Please bring to class your pump and bottles. Partners (and babies) are encouraged to come to learn about bottle feeding for the breast fed baby and how to provide support for the working mom. Taught by Alyssa Goss, IBCLC.

Location: Thrive Chiropractic Center 15501 Ranch Rd 620 N #1200, Austin, TX 78717
Cost: $50 per couple
Registration: Please call 512-415-8627 or email to reserve your space!