One of the most rewarding client interactions I’ve had recently as a Lactation provider has been…wait for it... on the phone. With a mom who was adopting a baby girl many states away from her.
I know. You have questions.
1) A Lactation Consultant help an adoptive mom/parent with breastfeeding?
And 2), On the phone??
A while back, I heard of the important work of Amy Twombley, of Hello, Baby Adoption Consulting Services. Amy helps create families. She helps adoptive parents navigate the process and get their baby home.
I immediately thought of the challenging, rewarding and very unique situations I’d encountered in 7 years in Lactation at a busy city hospital, with a Level 3 NICU, and how I could help.
I was reminded of The two Dad family who’d had a surrogate carry their twins, and delivered the babies very prematurely. There was need for breastmilk for these babies, and no one had considered how to navigate mother's milk from the surrogate mom.
I had the pleasure of working with several adoptive families in a hospital setting, and each situation and family plan/need was different. One family opted to have the birth mom pump milk for several weeks and cold ship the milk to them. One family decided they wanted a few days of colostrum given to their baby, and all parties agreed that breastfeeding the baby directly and hand expression of colostrum would be their plan.
Still another same sex mom couple decided to induce lactation with the non-birthing partner, and both moms breastfed their daughter on her arrival.
There are as many different plans of care as there are different families out there!
But, the one common thread I hear constantly when discussing breastmilk/chestfeeding outside of direct birth is: “I didn’t even know this was possible”.
Education and information isn't really getting out there for most families on their journey.
In discussion with Amy and Hello, Baby, we explored how to offer education to adoptive families.
We agreed that breastmilk/chest feeding isn’t the right path for all. And that's ok.
But what about the family that it IS right for? Or the family who didn’t even know these options existed? The two Dad family that might like to feed their baby breastmilk on their chests, skin to skin? Where can they find breastmilk; what options for milk banks/donor milk is out there? Who can guide them?
What about the adoptive mom who never even thought she could possibly choose to breastfeed due to medical or reproductive challenges? The Trans or nonbinary family that would like to know their breastmilk feeding options?
Those families deserve to know their choices, too.
Back to the adoptive mom at the beginning of our story...
Naomi (name used with her permission) had breastfed her other children, and was expecting to adopt a little girl. She had already begun to pump and to use medications to induce lactation again. She was knowledgeable, capable and informed.
She called me with some general questions, and I wasn’t sure initially how I could help her.
We quickly realized that despite her excellent planning for bringing in a milk supply, Naomi wasn’t prepared for how to manage at an out of state hospital, where the baby would most likely be placed in a NICU. Would they let her bring her own milk into the hospital? Would they allow her to feed the baby? Indirectly? How could we include the birth mom respectfully in this process?
It was here I knew where I could fit in and help. Because of my extensive hospital and NICU experience, I was able to coach her in communications with the baby's medical caregivers and birth mom, and plan how to keep pumping as she traveled, and while she was in hotel room while she was out of state. We discussed her plan for skin to skin, and early NICU feeding expectations. I was a sounding board for small and big things… how to get baby to latch after she’d been bottle fed, how to store the milk she’d been pumping, how to maximize her pumping routine. What pacifiers would be best? How to locate donor milk?
We coined the term, “ breastfeeding coach”, because that’s what I ended up being; coaching her, guiding her, finding those small and not so small challenges along the way, and tackling them… on the phone.
A few small challenges, and many triumphs later, Naomi is home with her sweet sunshine daughter, happily breastfeeding and living their best lives.
We’ve never met, but I feel like a tiny part of their family. And so grateful to help a new mom meet her feeding goals, because that’s really what MY goal is….to help you meet yours.
If you are planning adoption, surrogacy, are an LGBTQ family, or have a non-traditional plan for birth, please reach out for information or a discussion about how you can make breastmilk or chestfeeding part of your baby’s feeding plan. I think you’ll be surprised at your options.
Lori Atkins, RN, IBCLC
As you might know, October is pregnancy and infant loss awareness month. I've decided to tell my story (deep breath) in hopes that women can heal in a different way than I experienced.
See this gorgeous picture?^^ This is what most of my moms want. They dream of effortless, beautiful moments of intense bonding while breastfeeding; ample and bountiful milk with no pain, no fuss and years of health and well being for their babies and themselves. Ahhh. Sounds fantastic doesn't it? Lots of times it works out something like this. Something resembling their vision at least, something meaningful and totally worth the work and doubtful moments.
This is what I hear from most of my mommas. They say, "I really want to breastfeed!". After all, then why are they contacting me? A board certified lactation consultant?
Samantha ( not her real name ) contacted me before her baby was born, for a prenatal planning class. One of my favorite things to do! I happily traveled to her home, chatted with her and her supportive husband. She asked all kinds of appropriate questions, she looked engagingly at all my teaching materials. We got to one of my absolutely important discussions... " What is your goal with feeding your baby? How would you like breastfeeding to look for you and your family as you move forward?" She hesitated just slightly. I noticed her husband quietly slip out of the room.
"I'm not entirely sure about this" she said. " I really want to try and I know it's best for the baby, so I guess we'll see".
She got a bit quiet, but insisted she really wanted to try to breastfeed. She didn't really have a reason for her trepidation. I made it clear that no matter what, breastfeeding had to work for her and her alone. I made eye contact with her, and made it clear there were lots of ways to feed her baby, and I'd be there for her to make her way, whatever way that was.
"Henry" was born healthy and lovely a few weeks later. I heard via text he had a drive by through the NICU for a small respiratory problem, but that he and mom where breastfeeding beautifully, even easily. She asked for me to come to her home for a visit. Henry was a champ, nursed, slept, and gained weight. None of the issues I usually see. Nada. Couldn't be more perfect. Mom was surprised, she said, happy that things were well. No signs of breast engorgement or of post partum depression. No unhappiness; all was well. We spent some time talking and it was time to go. I touched her hand, had her look directly at me. "How are you doing? Is being a mom everything you thought it would be?" She said, "Its really ok. Thank you". I left, thinking, well, perhaps the oxytocin is doing it's thing, and we're past whatever issues momma had.
Two days later she called back. " Lori, please come. I cannot do this". She said she just didn't know why, but had been hating every moment of breastfeeding, and was wracked with guilt, but needed to wean Henry. That day. I made a mad dash to her home. She was teary but resolved... Henry needed to take a bottle. Breastfeeding felt horrible to her, and she was dreading each feeding. She wasn't at all feeling depressed, the only "bad" part about her postpartum recovery was feeding. That her husband had been supportive towards whatever plan she wanted, but was encouraging her to wean, too. Pumping her milk wasn't in the cards, either. Guilt fell down with her tears... despite his feeding so well, she just couldn't do it.
Gosh. I won't lie that it was a little hard for me. Watching this gorgeously breastfeeding baby stuffing his face while his momma cried over him. Knowing how hard this would be for them both. So very many things crowded my mind....But knowing that for this momma, at this moment, she needed me to support her and be there for her. She didn't need preaching or rehashing of our education, or facts or statistics. She needed me to show her what she needed. She needed another woman to not judge her. She was doing plenty of that herself. How this was a watershed moment in her motherhood. That how I reacted could have far reaching implications.
I took a deep breath, gave her a hug and asked where she kept her bottles. We made some formula, practiced some paced bottle feeding and ways to keep him skin to skin, and feed him in a loving, close and special way. He chewed on the bottle nipple at first, quizzically looking at mom, then happily figured it out, to her relief. I gently asked a few more questions, and she honestly couldn't reflect why she felt the way she did. There are studies about women with sexual abuse histories struggling with breastfeeding. Some moms experience a physically uncomfortable feeling with nursing, called DMER. She said this wasn't the case. She just didn't like it. I left a grateful, loving mom that had chosen to formula feed.
Of course I worried about postpartum depression, as not meeting an infant feeding goal can be a risk factor. She knew, too, and we kept in touch for a few weeks. She actually felt better, she said. She looked forward to feeding her son, and was deeply enjoying motherhood. She thanked me profusely, but my gratitude was to her. She reinforced to me how important our work is. Who else would have taught her how to respectfully bottle feed with evidenced based techniques and taken the time to screen her for postpartum depression and about her coping and recovery? She encouraged me to go forward, to educate about infant feeding and breastfeeding with science and with love...and help families make choices that work for them. She strongly reminded me how my job isn't to have a goal and a path for a mom. My goal is to help her find her own.
Our shower was on the fritz. After 20 years, I guess it was due to crash and leak.
I paid my plumber 289$ dollars for a tiny part and a half hours' work. And I was happy to do so. Well, my wallet wasn’t, but you get my drift. I looooove my shower, and I knew I had to pay someone professional to fix it. My fee covered his overhead, his parts, gas, and employees. His education, and his experience. I didn’t necessarily plan for a shower problem, but we all know that these problems don’t pop up at convenient moments, like winning-scratch-off-lottery-ticket times. They happen just…because. It IS better if you can at least plan for stuff, but we all know that is hard to do.
What does this have to do with IBCLC care? We all wish the insurance companies would comply with the Government ACA mandates, but the reality is, they aren’t making it easy. We want to help, but working for free isn’t feasible. For you, for me, for anyone.
About that plumber’s fee? Here’s a sample of what your IBCLC’s overhead looks like. Our professional education is expensive. Keeping current in lactation care is required by our certification, to the tune of many hundreds of dollars every year. We recertify every 5 years and by exam every 10 years. We don’t carry shower parts, but we have lots of other kinds of tubing! Nipple shields, syringes and hydrogel pads, advertising, written materials, insurance, gas and wear and tear on our vehicles… you get the picture.
Food=costs, for all of us. It’s life. Formula prices are outrageously high (I smell another blog post about THAT subject). And no kidding; it is a billion-dollar profit industry. You are your baby’s own grocery store and pharmacy all wrapped up into an awesome momma package! Although breastmilk is “free”, sometimes there are maintenance costs for the system that creates this awesome perfect food, food with baby-specific-super-vaccinations right in the mix! One lactation consult, or even a few, doesn’t nearly approach formula expenses, which can be thousands of dollars. Add a few extra trips to the Pediatrician for reducible health care issues for a non-breastfed infant; parents taking more time off work to get to the doctor, and whew, it’s looking like the cost outweighs the risk of NOT paying for help.
Insurance companies know what they need to do. The ACA mandates breastfeeding supplies and care to be covered. Do they WANT to? Despite the clear and overwhelming research telling them it makes sense to pay for the minimal cost of healthier moms and babies? Aetna has covered IBCLCs since 2012, recognizing we are the Gold Standard in lactation care. It’s kinda-sorta BS to me that other companies won’t do the same. So….What to do before, and when you need help?
* Health Savings Account plans cover lactation care. And lots of us have card readers to help make the payment easier.
* Baby shower gifts. Register for me! Factor in the LC care as something as needed as say, the crib, or the Boppy. Or the baby photographer. Tell your mom, grandmother, work peeps and college sisters to chip in. It's not as fun as a cutesy diaper cake (hey, I just saw one on Pinterest shaped like a motorcycle!) but it can get the “baby food” taken care of! PS; I'll even send a gift certificate in an adorable basket with some goodies to open at the shower.
* Save little bits throughout the pregnancy. If you don't need it, get a mani-pedi/massage. Pay a sitter for a night out. Or start that college savings account.
* Get a prenatal planning visit. Most insurers will cover this as a class fee. In my practice, we focus on preventing problems by learning about infant behavior and needs after birth, identifying barriers before problems occur. Hey, you might not need me at all after baby comes! I best be careful or I'll practice myself right out of practice.
* Pay a bit at a time over the pregnancy. Yes, we can work out a plan.
* After a visit, submit the superbill to your insurance company and take names, numbers and dates. Keep at it, get what you've paid for. The National Women's Center in Washington, DC is keeping track of these issues, as well as law firms considering class action suits for violation of the ACA. Every state has an insurance commissioner’s office to hear complaints. Don’t let them get away with shoddy practice over this important care.
Support IBCLC licensure in your state. Rhode Island and Georgia have gotten there, and it will help with insurance reimbursement.
A Lactation Consultant? She comes after the baby? After I've checked in with the 12 mommy groups on Facebook, right?Read Now
3am panic text. Loading up the car on an icy day, or during vacation. All of the lovely lactation support people I know will give their all to help you meet your breastfeeding goals. We drop things to go when we can, and often when it's late, or inconvenient. Am I looking for a medal? Nah, just making drama points! But many times, breastfeeding moms wait until they're exhausted many other options, and things are desperate; online, friends, a cousin, their Pediatrician ( more on that in a minute ), and more online mommy group pleading, before calling in the very person who should have been involved BEFORE the baby... Your friendly International Board Certified Lactation Consultant.
Lots of information exists out there on the interwebs. And some is appropriate, especially trained volunteer groups like Breastfeeding USA, and La Leche League. But, this information is dizzying, in its sheer overwhelming massiveness. And much of it is tough to sort out if your nipples are bleeding and your baby isn't gaining weight.
But; imagine this... Your bundle of joy arrives....and many breastfeeding difficulties are avoided, yes, AVOIDED, because you know what to expect. You don't panic over clusterfeeding ( yes, you'll even know exactly what the heck that is! ), and over some weight loss in the hospital. You know what's normal and what's not...because you have an expert in your corner, ready to go. You've already have a plan, support, and preemptive education from your secret weapon!
A word about lactation support. Well, a few words. There is a maze of credentials out there. CLC, BC, CLEC, and a slew of others. Ok. Now what? Your Pedi office says they have a lactation "specialist". Or your Pediatrician or their nurse, has attended a week long, 35 hour class, and now says he or she is a Lactation Consultant. Hmm. Since the phrase "Lactation Consultant" isn't trademarked ( except in the great state of Rhode Island, where IBCLCS are licensed ), anyone can use it. Yes, your lawn care guy can tell you he's a lactation consultant. Creepy, I know, but again for the drama! So what, right? Who cares what someone's background is, they should be able to help, shouldn't they? Yeah, I wish.
Lots of really good support exists for simple issues, and for breastfeeding that's going very well and needs some management tips. BUT... For education, care planning and problem solving, an IBCLC is the gold standard. It's OK to ask what someone's breastfeeding support experience is. Pediatricians get a couple of hours in Medical school on breastfeeding education. That's it. Your hairdresser has 1500 prep hours before they can cut your hair unsupervised, just saying. Your Pedi will be an expert at managing your babies health, but it's not inherent they'll be experts at feeding.
IBCLCs have years of preparation, college courses designed specifically in lactation, and thousands of supervised clinical lactation support. That means someone had to sign off on my thousands of hours. Oh, yes, then pass a rigorous, hours-long proctored exam given by a third party independent company. And have to recertify every 5 years, and every ten years by exam. Whew, I'm tired just remembering!
So while you're shopping for your registry with that funky wand-thingy at Babies R Us for the fourth boppy pillow ( kidding! You only need three! ), and for the multitude of stuff seemingly required for one tiny human, consider ahead of time, before problems arise and before delivery, where you'll get your lactation help and plan from. And make one. Have a prenatal consult. Even a prenatal breast discussion and exam. Take a breastfeeding class, look around, talk to friends. Check out the link at ILCA's "find a lactation consultant". Talk to your OB or Pediatrician and ask if they work with a feeding expert, and make that connection early and often. Many IBCLCS offer distance support if needed, and many will help you get your ACA-mandated care covered by your insurance company. Prepare for breastfeeding like you've prepared for the rest of your pregnancy. Have your shower attendees get you a gift certificate for a consult. Now there's something useful! And save the mommy group on Facebook for how to pick out a diaper genie.
P. S. Do they still make those?