What can you expect from a consult?

Ever wonder why a breastfeeding consult take so long? Often times people expect it to just be 15 or 20 minutes. Check a latch and make some corrections, right? Maybe get a weight?  Wrong. The more I learnt the lengthier my visits needed to become.

So what can you expect in the two or so hours we might spend together?

First, I do an overall physical assessment of mom and baby(ies). This is an exam of mothers breasts, positions, posture, birth injuries, physical restrictions, etc. Anything that might affect mothers comfort or ability to produce milk I will note and take in to consideration. 

I do a physical exam of baby looking for things like torticollis, structure alignment, tone, and an oral assessment. Baby is an equal participant in breastfeeding and so we need to ensure s/he can be her/his best self when feeding.

We will do a collective assessment of mom & baby were we look at history from birth to where we are today. Babies birth and early days can have a big impact on breastfeeding, from birth position to hospital treatments. "Small" things can have "big" impact. 

I observe positioning and latch & baby feeding without interference as to observe what is currently

happening. Then I give feedback about what I observe and give pointers and help make changes that may improve the situation.

I provide a written Immediate Lactation Care Plan after this. I provide a Comprehensive Lactation Care plan which follows via email. Mother receives a couple follow up phone calls/e-mails if needed. Any referrals and reports that need to be made/sent are made and sent.

I can provide much the same care via distance. Pictures, videos and written history or a skype/phone conversation works also. It might add a few more "hurdles" but overall it can work very well...better than no support, right? 

Lessons and Blessings and the Journey of Learning What I Did Not Know I Did Not Know

I am often found reflecting at wee hours of the day about the families I am working with or have worked with. You see, we do not know what we do not know. I do not know what I do not know and what I will learn next. I only know that I will continue to learn. I am committed to learn from each family I meet, from each class I can take, from each professional I collaborate with.

 

Often in my journey of learning, especially this year, I have found myself holding an emotional space with the thoughts of past families in this space with me, with the intention of sending an apology. These apologies are for not knowing "something" when they needed me to know it and I discovered one of those things I did not know that I did not know.  

 

Book learning only affords one so much. Clinical training with 99% "normal" does a really good job of teaching normal. It does not prep one really well for "abnormal". So, as I work with families that have fallen off normal sometimes I am sent turning over stones I have never turned over before, and sometimes that means families did not make it to where we all would have liked and we are left wondering why what I did know to be "true' did not work. After those moments I still continue to turn stones so that i can find that piece of information we needed. Sometimes I find it and know I found it and other times it comes to me unknowing in another class or article and a moment of reflection on a past scenario comes into light.  I hold that piece with the memory of the previous family as I move forward to another family. That might mean it is "too late" for someone and that someone previously felt let down but it also means because that someone taught me something it is not "too late" for the next family.

 

Encounters are lessons or blessings and sometimes we need lessons before we can give the blessings. To all the families *I* have been blessed to work with who have taught *me* my lessons, I will carry forth blessings to other families as I continue my work. I apologize to you for not knowing what I did not know and not having what I needed for you when you reached out to me but I can assure you that the experiences we shared are not wasted experiences.

 

I want my families to be aware that I hold on to you, your stories, your experiences, much much longer that you probably would have ever imagined.

Holiday Nursing

The holiday season is exciting and magical and might even be more so for new parents.  It can also be an overwhelming time of the year, again, maybe more so for the new parents. If you have made the commitment to breastfeed, that can add in yet another element. 

Getting ready for the holidays can take up so much time. Feeding also can occupy a large amount of time. How can we manage to get it all done?

With all the action going on moms of breastfeeding babies may notice that baby’s typical patterning is off. Keeping this in mind ensure you are spending the time needed to meet your baby’s needs. Not feeding baby often enough can result in plugged ducts, mastitis and a decrease in supply, not to mention decreased nourishment of baby. Why not use the baby as an excuse to lie day, relax and excuse yourself from some of the bustle?

Often, well-meaning people want to feed the baby solid foods. It is common for us to celebrate with food, so naturally people wanting to include baby, may want to share these foods with baby. You know your baby best and if s/he is not ready yet, stick to breastfeeding. Even if baby appears ready the holidays, especially if away from home, may not be the ideal time to start solids. You just never know how baby is going to react. That is why we call it an “introduction” and expect it to be a slower process. Let’s keep in mind the people who think they are doing you a favor if they offer to feed the baby a bottle for you at this time, too. A simple, “Thank you, but we are ok” is all you need!

Again, discussing our sharing in food as well celebrate, we have the supper table. But is it Ok to latch baby at the table? Of course, if you are comfortable with it the baby should be able to celebrate in the same meal time as mom. You might need an extra set of hands to help cut your food or serve you a plate. Having said that, if you feel the need to escape or are more comfortable in a quiet room to nurse than by all means this is just fine. You and your baby will decide this together.

Just as you and your baby will decide what environment is best to nurse in, you will also decide to what is best for your baby to nurse til. Some people have never seen an older baby nursing. They may make remarks or have an odd glance. There is no need to explain anything to anyone. This is a personal decision and it only matters that you know that you and your baby are benefiting from breastfeeding.

If you dress comfortably with clothes that make breastfeeding easier to manage this will help the above situations flow well. Having a simple shirt and a good nursing bra is a good place to start. For more formal gatherings, I suggest a two piece (a skirt or pants and a top), or a zippered or buttoned front dress, with maybe a scarf. Layering with a nursing camisole is also a great option.



Photo Credits to Rhonda Young-Pilon



As with food, adults often celebrate with alcohol. “Whether or not to use alcohol is a choice that all breastfeeding mothers must make. The use of alcohol by breastfeeding mothers is widespread and is even considered ‘usually compatible’ with breastfeeding”. For more information about breastfeeding and alcohol visit http://www.infantrisk.com/content/alcohol-and-breastfeeding  You may be shocked to find that you might be able to enjoy a drink or two this season.

Be prepared by knowing where to get help with breastfeeding if you are pregnant and expecting a new baby during the holidays. Some options are to connect online with a parenting forum, especially if travelling or house bound. Ideally, it is wise to get in touch with a lactation consultant before you deliver to ensure you know availability if need be and even give her the heads up you might be looking for extra support during the holidays. If you have access to a La Leche League meeting or prenatal breastfeeding class this will help give you come confidence about how to latch on your baby. You may also learn about how to avoid other common concerns or difficulties, which may help in case you cannot get support immediately during the holidays.

Lastly, keep in mind, the holidays will come again next year so if you need to step back this year, you can a redo next year. Babies are only babies once.

Breastfeeding and the Weather

When we think of Saskatchewan, we don't think about breastfeeding and "natural disasters", but as I sit in my house looking out the window today, I do think about the advantages of breastfeeding in this province when Mother Nature presents herself like she did yesterday and today.

After a couple days of above 0 temps we have had melting snow and ice, which is usually a treat. But add to that freezing rain for a few hours and then fresh fluffy snow overnight and all morning and temps that dropped drastically and we have a dangerous recipe for travel.

In a news report, I saw that there were 28 reportable accidents in 24 hours in our city. How many were not reported or reportable? Yikes, that makes 1 or more an hour that needed assistance.

Wow, am I glad to be able to stay inside safe with my children, one who is a young breastfeeding infant.

But, what if he was not breastfeed? What if I ran out of an alternative to feed him, which for the vast majority of non-breastfeed babies in our province, would be formula? Forced into heading out onto these roads to shop for infant formula would be awful.

Add to that, what if I was out travelling on the roads, and got into an accident, either with or without that baby with me. Now, I have a hungry baby whom I cannot get food for, that I may or may not be with, and an even bigger delay in getting him feed. That sounds stressful to me and would be stressful to that baby.

As a breastfeeding mom, an accident delay if we did happen to be travelling, at least maintains a food source for the infant. So long as mom and baby can remain together, baby has a food source. Of course, accidents are the extreme, but what if we were to have gotten stuck in some snowy/icy roads. In conditions like this it can take hours for help to come. Babies cannot wait hours to be feed. I did get stuck in some snow while travelling with a baby a few years ago and it did take hours for help to come. I was so grateful that I was able to just nurse that baby while we waited.

So, while we do live in a province that is free of hurricane's and earthquakes that can create major havoc for days on end, loss of electricity, food shortages, etc and we can easily think of why breastfeeding is so important in times like that, Saskatchewan mothers are not immune for the effects of Mother Natures extremes and how they can impact infant care and well-being.

Take care in this crazy weather Saskatchewan families and happy safe, cozy, warm breastfeeding.

Labor/Birth Doula

 

Also called a childbirth or labor assistant, a labor/birth doula is a trained woman who will stay with you throughout labor and birth. The word "doula" is a Greek word meaning "woman caregiver".
Labor/birth doula's attend to the emotional and physical comfort needs of laboring women to smooth the labor process. A labor/birth doula gives you information about what is happening to you, facilitates communication between you and medical staff and supports your decisions. She makes suggestions on how you can best cope with labor and what will help labor progress smoothly.
As a labor/birth doula we will have 2 or more visits before the birth so that I can get to know you, and learn about your preferences, priorities and concerns. I can assist in writing your birth plan or preferences.
At the time in your labor that you need me I will join you and stay with you throughout your labor and birth of your baby and for about 2 hours after the birth. We will have at least one visit after the birth to review the experience. In addition, I am available by phone or email both before and after the birth for help, nonmedical advice, referrals or just to listen.
Doulas don't participate in any of the medical aspects of your care. Cost for doula services with breastfeeding support is $700

Professional Enhancement & Continuing Education

I wanted to share feedback from a workshop I facilitated last weekend. It was a two day "Breastfeeding and the Birth Professional" with a focus on the Professional Doula.

Recently I was a participant in Kim Smith's Breastfeeding Workshop for Doulas. I am a Registered Nurse and a CAPPA trained doula. My reason for taking the course was to add to my helping skills in the breastfeeding realm, as I primarily volunteer in the area of c-section and VBAC support, as well as talking to moms after they have experienced birth trauma and may have had breastfeeding difficulties as a consequence. I am also a babywearing educator, and often times mothers will turn to babywearing as a tool to breastfeed and have normalized activity. I thought that the workshop was very comprehensive and raised many key issues. Kim addressed a wide variety of topics, and reinforced what is normal to see and what key tools a doula can use to assist her client. It also covered elements, like the WHO code of breastmilk and breastmilk substitutes, BFI, and societal issues which affect our clients. We had lots of opportunity for discussion, videos which were informative and relevant, and Kim did a great job keeping us on task and facilitating the workshop. She came prepared with technology but it was very well balanced and well used to teach the workshop. My feedback to Kim was that every birth professional should review this information. Even though I am a registered nurse and have a degree, I found that the information Kim provided was cutting edge, evidence based, and would absolutely apply to any professional working with lactation. As a labour doula, I have seen the benefit to having additional breastfeeding support on board with my own clients. Not all clients are able to access feeding advice, and it has been inconsistent. I think Kim's workshop would absolutely apply to our professional development as nurses and definitely to doulas, midwives, and anyone else working with mother and child.

I thoroughly enjoyed the worshop.

If you are interested in having me speak with a group of professionals, please contact me.

Being an IBCLC is more than passing an exam, for me

Certainly, the defining markers of an IBCLC are that she has fulfilled the learning requirements, put in the hours observing and assisting, and ultimately passed the IBCLC exam. Passing that exam is important, make no mistake, but the journey does not end with a passing mark.

Frankly, I have learned much more since passing the exam than I had preparing for it. I thought I knew it all when I decided I was ready to write. OK not all; I had some refining to do, but I knew a lot. So, I refined. I felt ready to kick exam butt, with just the right amount of stress and worry to to indicate that I am human.

But one does not know what they don’t know, now do they? I soon learned that I knew a lot but that I had much, much more to learn. My “standard” theoretical answers were not the practical answers, or at least they did not get to the root of the issues I was seeing. Granted, I helped those moms and babies get by and meet goals, but I felt that there must be a better way. In my heart of hearts, even when moms and babies were happier, making it, doing well, I could feel that their breastfeeding relationships were not as peaceful or fulfilling as they could be.

With each new family and obstacle I learned more, and this continues to be true.

Each time I can get to an education event, I go.

Each opportunity I have to listen to a webinar, I listen.

But, most importantly, I listen to moms. How I interact with moms in my practice is unique. Not unique to me specifically, but it is not the normal practice of the other health care workers that those mothers will interact with.

I don't give moms 15 minutes of my time and walk out the door. I usually have 2 hours. This quality time is so important.

I follow up with my moms. I see the outcome of our work and time together. Is what I suggested working for them? Has it worked for others in the past? Why not this time? How is this mom and baby different from another seemingly similar situation?

I generally do not stop providing care until they are happy and content with their individual situations.

This is their relationship. I am an invited visitor, and one who is honoured to be so.

From a personal standpoint, my livelihood depends on the outcomes and happiness of my clients. If my clients are not happy, it is a lose-lose situation. They lose out on a contented breastfeeding relationship, I lose out on their word-of-mouth recommendations, and my family loses out on my income. This is not a 'side gig'. There is no job with benefits awaiting me if I fail. There is no paycheck for just showing up and seeing who I might be able to help that day. I must create the best me for my myself, for my clients, and for my family.