Disease care model for your lifelong health?

Canadian parents need some awareness about the health and future health of their children.

It is said about 98% of mothers “initiate” breastfeeding after birth, in home and in hospital. At six months about 14% are still breastfeeding.

We are all familiar with the arguments of “But, some moms just don’t make enough”, “I will try to breastfeed but if I am one of those mothers that cannot produce than I guess I cannot breastfeed”. Correct, some moms do not produce milk, but certainly not 84% of women. When worded that way, hopefully more people say, “yes, that can’t be possible”.

Lots of women do have low supply. Low supply does not equal no supply. Low supply does not equal not having any ability to make milk. Low supply can be avoided, turned into full supply, or can be worked with supplementation. Low supply does not need to end all breastfeeding.

What is going on then? That is not an easy answer and cases are all unique and need to be assessed however, there can be underlying answers that are similar or related.  Some examples (the list could be much bigger)

·         Birth experience (trauma, separation, medications)

·         supports (hospital staff, family, friends),

·         Education (parents, grandparents, doctors, nurses, midwives)

·         back to school or work

We seem to be setting the aim for optimal starts for our babies and children but we are not often striving to reach them. If we become derailed why are we not getting back on track? Luckily, we can get back on track when we find ourselves off track. You need to know this.

We need to get serious about giving our babies the best start. Old arguments do not hold much weight anymore. “I was formula feed and I am ok (fine, survived)”. What is ok? What is fine? What is survived?

We have overcrowded health care systems. And we have normalized this situtaion. Surprising to some, breastfeeding or rather lack thereof, can be linked back to the majority of the health conditions that patients have. We need to normalize breastfeeding to reduce the strain on our health and wellbeing. We cannot rely on the system of disease care to be the system that is going to help support our babies getting off on the right foot – being exclusively breastfeed for the first 6 months and continuing to 2 years or beyond as suggested to be optimal buy the authorities of children health. (AAP, CPA, UNICEF/WHO)

It is time to take charge of our own bodies and our children’s future. It is up to us to give our kids the best start that only we can give them.

We need to move past the idea that we have free health care. We simply do not have free health care. We have access to (some) free disease care. Healthcare would be disease and illness prevention. This certainly is not free. We need to start being accountable for our own healthcare. This lack of accountability is why we have maxed out healthcare facilities and resources. If we had more accountability we would make better choices.

  

With that awareness we need to start at the very beginning of an infant’s life and choose breastfeeding as a key to lifelong health.

There are lots of old arguments. It is time to let go of those. This is not about past choices, which were based on “what we knew then”. We know more/better now and when we know better we do better.

"For the comfort of mom and baby"

Prior to 2006 there was not a universal breastfeeding symbol. The universal symbol for "infant" used in print and in public places traditionally has been a baby bottle, even for "breastfeeding" rooms.

Mothering Magazine decided to hold a contest for people to submit their ideas for the world’s first international breastfeeding symbol in August of 2006 after this realization. There were over 500 entries submitted and in November of 2006 the design of Matt Daigle was chosen as the winner.

This symbol has the potential to be very powerful. The idea is that anyone, individuals or businesses, can use this symbol to support breastfeeding and help normalize breastfeeding.

Where available, it can be used to indicate the presence of a nursing room. Now, this particular idea is where some controversy comes in. Just because an establishment has a nursing room available, should a nursing mother have to use it? If we are striving for breastfeeding to be truly normalized, why the need for a room?

Perhaps some mothers are more comfortable in private. In environments where we still have a ways to go in normalizing breastfeeding many mothers have never witnessed another mother breastfeeding and so comfort levels are going to be varied. One mother may prefer to be in a private location and the next would not want to think she had to use such as space. This is where the lines get blurred.

Some would think that having designated nursing areas however just further perpetuated the issue of breastfeeding not being normalized by making it seem as if we must use those designated spaces. Now, an establishment may have a nursing space. Do breastfeeding patrons HAVE to use that space? What happens if they do not want to? In Canada, one cannot be forced into that space but not everyone is aware of this.

If the establishment is simply being courteous to those that want to use a private space but other patrons expect breastfeeding mothers to use that space, then what? who needs to move their line of comfort? Who has to "accommodate" who in this matter? Should the mother be forced to move? Should another patron move?

Recently a local library added a nursing chair to their space. This chair was placed in a washroom. Some will be horrified by this, some will not react at all. But lets think this out for just a brief minute. If I am a nursing mother, in a children's library, I likely have a toddler/preschooler/school aged child with me. How practical is this for a mother and her children? New babies eat often and sometimes lengthy feeds. Would it not make more sense for the mother to simply feed in whatever space her and her other children are? It would be far less disruptive to her and her family. It will also be less disruptive for other patrons. Can you imagine a toddler or preschooler trapped in a bathroom in the middle of the library with all kinds of things to explore?

So, I ask, by creating this nursing space "for the comfort of moms and babies", who are we really trying to make comfortable?

Surely, this is not for the comfort of most new moms and until we start to normalize this act of simply feeding a baby, the comfort levels of everyone are not going to rise.

Please, lets stop with the nursing spaces. If you want to show support, place the International Breastfeeding symbol on the front door and leave it at that. Leave the chair in the bathroom even. If a mom really wants to feed in that chair, she will know it is there, and can use it at her discretion, without the blurred lines of if she must use it, by herself, staff  or other patrons.

My admiration for a special mom

I must first start off saying all moms are special. This we know. But every once in a while a certain mom will touch me in a unique way.

I have the pleasure of knowing a mom who society may normally be a little bit "tougher" one. But I can tell you, it seems no one challenges her harder than she challenges herself.

She is a young mom. Perhaps she may not have chosen to be a mother at the young age she did. But she embraced her pregnancy in a beautiful way. She was embraced by her family wholesomely. She embraced and rocked the birth stronger than she thought she would and I think more than anyone else there imagined she would. She feel madly in love with her baby the moment she held her. She mothers with ease, just as natural as everything else she has ever done in life, as if she has done it before. Breastfeeding was the only option to feeding this baby and low and behold, it did not get off to a good start. But the determination and desire to provide breastmilk for her child meant she accepted help, ideas and recommendations to get her and baby on the right track.

This mother also had dreams of going off to school. Many people would have assumed a young mother to set that aside. to be too overwhelmed with mothering to consider adding school to the mix. Mothering is hard work, let alone classrooms, homework, getting work placements, etc. But this mom accepts that challenge. I told you she challenges herself more than others might. She has made arrangements for childcare as well as worked out a schedule to be able to continue to breastfeed, pumping as needed but only as absolutely needed, instead trying to limit the amount of feeds away from the breast directly. And when she has extra milk, she is also donating to other moms and babies in need!

I do not think that this mom knows that she is doing anything that other moms would not do. I do not she thinks much more about it other than she is doing what needs to be done to combine her mothering with her education. But I want her to know she is doing a heck of a job. I want her to know that I often hear moms say they had to stop breastfeeding because they had to go back to school. Or they had to give up school so they could breastfeed. Or they could not breastfeed because they did not get a maternity leave and had to work. Breastfeeding can be really easy to quit. But when breastfeeding is a huge part of how you mother, it cannot just be quit.

Anyways, that is just a little ramble about a mom who touches my heart with her dedication to herself, her baby and her family. You know who you are ;)

Tongue Tie Interview

I was recently interviewed by Sheila Coles from the Morning Edition on CBC Regina. We were discussing tongue ties, laser revision and new supports coming to Regina. 

Here is a link for anyone wanting to have a listen 

http://www.cbc.ca/morningedition/episode/2013/02/14/help-for-tongue-tied-babies/

Some of what was higlighted in the six minute discussion I have summed up below plus expanded a small amount for clarity. 

The definition of (tongue or lip) tie is restricted mobility as a result of a short and/or tight frenulum. Restricted mobility impacts the function of the tongue. (And the tongue is a key player in breastfeeding).

The definition of a tie is a functional one used in conjunction with visual assessment. Using only appearance qualities to make a diagnosis causes professionals to miss some ties but could also lead to over-treatment. 

Visual assessment alone is not adequate for diagnosis and treatment decisions. The evaluation of function must take precedence over appearance so that over treatment can be avoided. Depending on symptoms will depend on who you may need to help make an assessment. (Lactation consultant, dentist, speech pathologist, chiropractor, osteopath,etc)  It can be a interdisciplinary approach from assessment to treatment. 

2-12% of the population are said to be affected by ties depending on the population under study and the definition used. There are various grades of ties identified which can impact symptoms, diagnosis and treatment. The current lack of awareness and education are often barriers to assessment & treatment. 

Like everything in medicine advancements are made. Lasers have now provided us advancement in treatment of oral restrictions with benefits over scissor releases.

Scissors bleed, can be messy, cannot always reach all ties efficiently and  have more of a one-time chance. Lasers do not bleed, user has more control, practioner can get back further to ensure a deep enough release and can assess as the procedure is being done. Lasers also have anesthetic properties as well as antibacterial properties. 

  

Symptoms can be maternal and/or baby: maternal pain, nipple damage, engorgement, mastitis, thrush, low milk supply, weight loss in baby, slow weight gain in baby, failure to thrive babies, reflux, colic, digestion issues, fatigue, slow feeds, difficulty latching, gagging, choking, coughing, breast refusal, shallow latch, chin tremors, clicking noises, fretful

Breastfeeding Impact

•          Inadequate latch that interferes with milk transfer

•          Insufficient milk intake and inefficient feeding due to inability to maintain and adequate tongue seal

•          Nipple/breast pain and damage

•          Compromised normal suck-swallow-breathe patterns

•          Long feeds

•          Possible weight gain compromise

•          Reduced milk supply

•          Early weaning

•          Need to supplement

Beyond breastfeeding

•          Bottle-fed baby can also struggle

•          Babies may have trouble with solid foods (reverse swallowing)

•          Speech may be affected

•          Orofacial development (high, narrow palate, orthodontics)

•          Dental issues

•          Increased salivation

•          Airway integrity and apnea

Feeding and milk supply concerns can be worked on with the assistance of a Lactation Consultant. There are various tools and management techniques that can be used depending on each unique situation.

Tongue mobility is the goal of laser treatment. The secondary results, such as increased milk transfer occur only when treatment restores optimal tongue placement, movement and strength.

Function restoral is generally dependent on a team approach to care including dentists, bodyworkers (osteopathy, chiropractic) and lactation consultants.

When breastfeeding is the concern the earlier the treatment the better but that is not to say later treatment is not beneficial to other symptoms that may arise.

Tongue ties are a controversial and subjective topic currently.

The team approach will be growing in Regina soon with a local dentist coming on board to help with treatment. 

But what if she cannot help?

You are considering a Lactation Consultant because you want to enjoy all that breastfeeding offers. Your desire for breastfeeding to work makes you want to believe in that fact that someone that can tell you about what is happening and how to make it better if it is not going as desired. However, you have some skepticism making you reluctant to commit to calling, making an appointment or spending the money.  

I can appreciate that. Perhaps you have had many families unsuccessfully attempt to breastfeed. Perhaps a friend had a bad experience. Maybe you have sought the help of others already and did not find the support that you needed and you think another person will have no more to offer. I want to help eliminate the fear of seeking out yet another resource and tell you I am confident we can overcome almost all obstacles that might be standing in your way. 

You have a fear of loss when considering spending money on Lactation services. Not only can be there be a loss of money, there can also be a loss of breastfeeding. I want to help reduce those fears. I can not guarantee 100% success depending on your situation and each mom and baby is unique, but I can guarantee that I will continue to work with you until you are at a place that you are content. I guarantee to continue performing services until you are satisfied with where you are at. 

As you can see when you look at my website, I have lactation packages and they give time frames. These are just rough time frames to give you an idea about how much time consults take. With all of these packages you get email/phone support, phone check ins and if needed return visits will be scheduled. Often breastfeeding concerns can be resolved quickly but sometimes they take a bit longer. You may not know what you are facing, which is why I offer these packages, so that there is no fear about the clock ticking away while we work on the issues and concerns you are having. 

I am always willing to listen to your history and give you an idea of what a lactation care plan might look like to help you decide on moving forward. 

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.