Maybe you’ve weighed out the benefits of social-distancing, maybe your area doesn’t have a lactation consulting resource close to you, maybe a video-consult seems less overwhelming, maybe you need quicker answers?

Whatever your reason for seeking virtual health-support, we want to make sure you make the best of your time with your providers. While this is a breastfeeding-specific blog, these tips may help you also think thru how to make the best of your time with other birth-providers.

TIPS

1. If the consult will involve your child or baby, see if you can have an extra set of hands for videoing. For virtual lactation consults, for example, it’s enormously helpful to have a “camera-person” to help free up your hands and give us better angles when we need them. Plus an extra (supportive) person involved the consult is always helpful.

2. Use a device that can easily be moved, like a phone or tablet, since so much of what we assess requires zooming-in (to observe latch) and zooming-out (to assess positioning), and because making your way to your desktop’s camera to show us a cracked nipple can be challenging when holding a little one!

3. Make sure to have good lighting. Natural bright light behind the camera works best but isn’t required. Consider having a flashlight or another device with a flashlight available in case we need to look closer at your anatomy, inside babies mouth or into pump flanges in action.

4. If you want your lactation consultant to observe a feed and help you troubleshoot latch, make sure to have your baby ready (partially fed and changed) before the beginning of the consult. Feed your sweetpea partially (not fully) about half an hour before the consult time or pick a time for the appointment when baby will not be ravenously hungry. Also, change the baby’s diaper prior to starting. Clearly, there’s flexibility in stopping to change a baby’s diaper, but having them ready to go helps us make better use of your investment and our time together.

5. If your consult will involve pumping, bottlefeeding, or possible suck-training, make sure to have pump parts, bottles and pacifiers washed and ready to go to cut down on time of stopping to organize equipment.

6. Have realistic expectations of Internet connectivity and signals, and have additional secure communication platforms downloaded if needed (we’ll send links to you prior to our consult for alternative platforms).

7. At the time of scheduling, be realistic about how much time you will need for your consult. We want to troubleshoot permanently all of your breastfeeding issues, instead of just stabilizing a few of them. While we always allow for an extra half hour of time in case it’s needed (see homepage for rates when consults go longer) we see families back-to-back and for scheduling reasons, we appreciate knowing beforehand how long our consults will be.

8. Likely the most important tip for preparing for your virtual consult: Complete the e-intake forms in the client portal we will email you access to once we accept your appointment reservation. Completing these forms well before our appointment time helps sooooo much in making sure we use our time together wisely.

BONUS TIP: Jot down your questions!

​•••

Whether you schedule with us or another virtual lactation consultant, we hope these tips for preparing for your virtual consult help you have a wonderfully productive session!

By Dawna Mangrum, IBCLC, RLC
​

I was recently asked “what’s your favorite thing about being an International Board Certified Lactation Consultant ”. I have to admit, I was initially thrown off by the question.

My immediate thought...

All of it, duh!

But...a singular favorite thing? Hmmm….well…..

I do talk about tongue ties and oral restrictions a lot due to personal experiences. In fact, those experiences are largely what inspired me to become an #IBCLC.

I’m also passionate about the disparities in care and ways to increase access to comprehensive lactation support.

And there's the fact that I fiercely believe there needs to be better education and support starting way before the baby is even born so families can make well-informed decisions.

But I can’t say any of those are my favorite things about being an IBCLC-and just as I was musing this over, I glanced down at my forearm and saw the tattoo that I got to represent my own breastfeeding journey:

Moonflowers done in rainbow watercolors.

And that’s when it hit me! My favorite thing about being an IBCLC is something that doesn't quite have a name.

It's that amazing moment when a breastfeeding/chestfeeding parent hits the empowered realization that “I can do this!”

And this is that moment:.

You see, when my own milky baby, Charley, was born, breastfeeding was extremely challenging….and painful! In addition to recovering from a traumatic birth experience, I had to deal with cracked and bleeding nipples. Turns out my daughter had extreme oral restrictions and I had very little access to the comprehensive care and clinical breastfeeding support that only an IBCLC can offer. This meant I was left to my own devices as a single mom struggling with baby blues (and later PPD/PPA). My own intuition had to drive me through excruciating nursing with a baby that seemed to want the boob 23/7. I truly thought everyone had lied to me when they said breastfeeding wasn't painful. I told myself I would suffer through the pain of exclusive breastfeeding for 6 weeks before I threw in the towel.

Meanwhile....

I researched extensively.

I tried different latch techniques (#flipple latch ftw).

I nursed in modified positions.

And I celebrated each "milestone", like the time my nipple came out shaped like a tube of lipstick instead of flattened like a pancake.

I saw what few providers were available to me, with no improvement, and lamented my lack of options.

But.....at 5 weeks postpartum, I finally found someone who listened. I went to a #facebookmommytribe and trusted my gut to get to the root of our problems: her lip and tongue tie were truly problematic. After lots of self-advocating, I found a pediatric dentist who helped us change the course of our breastfeeding. My daughter's #frenectomy was the turning point and by my 6 weeks deadline we were latching pain free.

We would have never gotten there if it weren't for my persistence and intuition. For me, my breastfeeding relationship and how I navigated the issues to be successful defined who I was to be as a mother.

I felt empowered!

I didn't give in when the pediatrician dismissed my concerns.

I managed to hold off when I remembered the formula in the cabinet I had received as marketing (a different topic for another time).

I was able to stay the course when my own self doubts infiltrated my thoughts.

This isn't the reality for everyone though!

Truthfully, much of my resilience was not motivated by what was best for my baby. It was obviously a factor, but not my driving force. My motivation came from a sense of self-protection and a need to prove myself. Because I was already feeling a sense of loss from not having my perfect birth experience, I couldn't "fail" at breastfeeding too. My own internal pressure to breastfeed pushed me to succeed and gave me the wisdom to listen to my inner voice.

Now, I would never recommend that anyone navigate breastfeeding landmines the way I did, without a great IBCLC to support them. My path was unique and was leading me to a calling. The reality is, I would still have found this path to becoming an IBCLC had I had professional breastfeeding support...only without those 5 weeks of trauma. That "AHA!" moment of our first pain-free latch opened a whole new world for me. But I was succinctly aware that many families never reach that moment of empowerment, often leading to resentment and regret. This is where comprehensive lactation support comes into play. For many, the clinical support offered by an IBCLC can make all the difference in troubleshooting breastfeeding issues.

​ As IBCLCs, we're not superheroes. The parents are the superheroes with their babies as their sidekick. We're more like Batman's Lucius Fox: we can provide some of the tools to unlock their superpowers! This puts us in an amazing position where we can be present, and impactful, when families first realize they are empowered. And that moment of empowerment is amazing to witness. The relief that comes over a breastfeeding parent’s face when they ease the grimace they were preparing for, watching a baby’s shoulders relax into milk-drunkness after their first effective latch, these are the moments I love about my work.

...but instead of casting a net, or bumbling around on business-matchmaking-sites, I put out a request that the same #BreastfeedingProvidence that helped me create this neat resource, would also make it exceptionally clear when my prayers were answered.

And these were my prayers:

First, that I would be given complete peace about co-parenting my business-baby.

And the next prayer had to do with who they would be (I mean, maybe a little like me?):

In order to keep the same “essence” of urgency that BH was founded on, whoever was brought to me needed to be intensely driven.

Overcoming adversity would need to be in their code.

Changing our community would need to be their ultimate determination.

And strangely, it would be nice if they felt the same stings I did—the type that stung enough for me to want to do something.

And...my dream business partner would have had to navigate past the unique mirages found in today’s professional lactation world, having come out thirsty-and grateful.

I very specifically asked that this person be of a lactation lineage like mine...of honed outpatient counseling skills gathered from #thebestprogramever (shout out to TexasWIC) as a breastfeeding peer counselor, and that they learn the hospital-setting just for a long-enough season to give them the feels, but not long enough to feel impotent.

I wanted a humble lineage...yet a lineage that was able to see opportunities for healing communities, instead of seeing themselves as the cure.

And somewhere into the second year of praying for this, someone like her made herself seen.

While I was worried about running out of emotional fuel for all of my babies, #BreastfeedingProvidence was lighting a fire under someone pretty amazing.

This chica knew her strengths. She positioned herself vulnerably in the same places I did. She saw (and felt) the cracks and peered through them to learn, with the resolve to heal and to fill them. She was driven, assertive, oblivious and wise. She was a walking #breastfeedinglifehack...a question-asker, an observer of moves and a taker of lessons...all with the end of supporting families in the same love and the same tone the I had been praying for...

As I got to know her, I saw that supporting parents in their journey wasn’t an impulse for her. It was a lifestyle- like it was for me.

I see in her who I was 10 years ago, and I see in me who she will be 10 years from now (the wisdom, not the grey-hair).

Sooooooooo....

After having her on my radar for some time, I made my approach exactly one a year ago this week...

Except...

...it wasn’t the right time.

I mean, it was a kinda flimsy approach-I just planted a seed during a time she was leaving in to “go see the world” (aka, move permanently to Laredo to become a hospital-lactation consultant). I could’ve done more to keep her here, but she had growing to do...and I still had life to sort out.

Meh.

If she was “mine”, she’d come back. If not-it wasn’t meant to be.

Plus, I mean, we needed a friendship. Her growing, my sorting and trust would need to somehow fall into gear—and I learned never to rush #BreastfeedingProvidence...especially because I depended on it to get her back here without me being who influenced her choice to return...

But, its interesting...how when you ask for things to happen in Perfect time the details just kinda just fall into place. 🧐🤔

Like during that one time we talked this last November. I vented to her about how busy things were in work and life, and she vented to me about a frustration I knew all too well: “I just don’t feel as impactful as I know I could be in the hospital setting.” she said.

And that’s when it dawned on me.

She had reached the last thing on my wish list:
that exact level of “hospital-wisdom“ that I wanted in a BH co-parent.

It was a realization that took me personally about 6 mo to arrive at; a humbling of sorts from feeling that you can change the whole world in numbers a little, but that you can changed the whole world for a family a lot when you can build a relationship with them.

And preserving breastfeeding relationships is what Breastfeeding Housecalls does best.

Maybe my sage-advice should’ve been “Hang in there and suck it up.” but instead it was a silent and possibly inviting “You know, Dawna...?” (💡)

And that, folks, is how #BreastfeedingProvidence plays itself out.

Both of us just had to be ready...

Beginning in February 2020, Dawna Mangrum, IBCLC, RLC, will begin investing her time and talents in the growth and eventual co-ownership of Breastfeeding Housecalls, LLC.

Please join me in welcoming her via hug, hand-shake, fist-bump or smile into San Antonio’s professional breastfeeding support community as a private-practice IBCLC and co-owner-in-training of
Breastfeeding Housecalls, LLC.

​•••

BUT FIRST:
​
This article is based on my professional experience working with new parents in the communities which I lovingly serve (San Antonio, Texas USA and its surrounding rural areas). ​ It's possible that other parts of the US or other countries have different models of healthcare than the relationships represented in this article (pediatricians, midwives, general practice doctors and lactation consultants).

​The thoughts shared below are based on my experiences with the referral of mothers and babies to their healthcare professionals when clinical scenarios present to me during lactation consultations. In order to prevent bias toward any genre of providers, no physician, midwife or other lactation consultant was directly involved in the writing or review of this article,.
​
​My hope is that the following thoughts are insightful to parents seeking to build life-long relationships with providers who support them and their babies.

​-Laura

​Choose a Doctor Who Supports Your Family's Health Goals
​
One of the most important things that expectant parents can do is choose their baby's doctor well before their sweet baby arrives, even when planning on birthing with a midwife (more on this below). Many parents don't realize that they don't have to wait until their insurance company, hospital or midwife provides them with a list of pediatricians (a list not usually given to parents until after baby is born). In fact, by doing their homework about doctors prenatally, parents will have time to think about what matters most to them and be able to make an educated choice about the providers who will support them.

Discovering Your Family's Health Values

Your pregnancy (or your baby's gestation, if you are adopting) has given you a few months to think about your growing family's future health. If you haven't already talked to your partner or other support people about health topics that are important to your family, as soon as possible is the right time. Educating yourself about health topics and defining your health values will prove very important to choosing your baby's doctor.

What are health values?
​
Your health values are those things that are important to you and your family when it comes to health and wellness, and these values are different for every family. For example, when it comes to babies some families will discuss vaccinations, circumcision, the family's diet, a mother's breastfeeding goals, and even the what-ifs of childhood (discipline/behavior or adolescent issues). Once you and your partner or support person have talked about what is most important, it will be easier to ask your friends and community for referrals to providers who will support you (much more about about how to do this in just a bit).

Valid points to ponder...

Choose your baby's providers based on their ability to support all of your family's health goals, not just one or two of your health goals.
​

1. AVOID DISAPPOINTMENT: All too often parents are disappointed upon discovering suddenly that their pediatrician isn't as like-minded as they believed (and this disappointment can go both ways since providers also want patients who are like-minded and compliant), and usually that is because the pediatrician was chosen based on only one or a few shared health values, or was chosen last-minute. For example, the pediatrician who is unconditionally supportive of one health value may not support or be knowledgable about another one. Getting to know your baby's doctor prenatally gives both you and your baby's doctor the opportunity to see if you are a good fit for each other. LAURA'S NOTE: Doctors care just as much as parents do about whether or not a family is a fit with their practice values. It's important to know that doctors are able to ask that parents with differing views on health values seek care from other providers if a family's health values request that a doctor practice outside of their practice protocols. This doesn’t mean they’re bad doctors, it just means they aren’t a fit with your family, and that’s ok because and others will be.
2. TALK ABOUT IT: Know also that just because a doctor may not share your exact health values doesn't mean that they may not be a good overall fit with your family. While it's important to choose a doctor who is easy to talk to and can make you feel like a partner in your baby's care, it’s also important that you as a brand new parent are able to trust your doctors advice during moments of overwhelment with a new baby.
3. THINK AHEAD: It's important to choose a provider who you feel your growing baby/child can eventually trust and will feel comfortable being examined by (this includes being touched by and talked to) over the course of their childhood and adolescence. Choosing a provider who may have strong future-compatibility and connection with your children and your family may outweigh slight incompatibilites with health-values during their newborn stage. Laura’s Note: Learning consent and body-autonomy starts at birth, and choosing providers who ask you and your child for consent to touch, and are able to speak directly to your child once they’re old enough to talk is a very important point to ponder.

Choosing a Doctor Who Supports Your Breastfeeding Goals

Ideally, because breastfeeding is still relatively new to our chapter in humanity, in addition to the health topics discussed above, it is wise that breastfeeding families choose a physician (or midwife for care during baby's first weeks) who has taken the time to update their practice with contemporary and evidence-based breastfeeding management skills. If your doctor or midwife is not also an International Board Certified Lactation Consultant (most are not, and that's ok) it is important that he or she have access to or knowledge about resources that offer prompt care from International Board Certified Lactation Consultants (IBCLCs) as a supplement to their medical care and guidance. IBCLCs are breastfeeding experts who help troubleshoot and improve breastfeeding and will provide information about your baby's feeds which is helpful to doctors.

Remember, you doctor or midwife doesn't have to be a breastfeeding expert, but knowing who to refer you to when a breastfeeding expert is needed is an important aspect to consider when choosing a provider for your baby.
​
Midwifery Care
Does this advice apply to me since I plan on using a midwife as my newborn's healthcare provider?

​Yes! It absolutely applies!

In the same way that parents who deliver with a midwife prepare a Plan B for birth (in case of a hospital transfer) there is a lot of wisdom in asking your midwife for referrals in selecting a doctor just in case your baby needs one during the early days. Midwives can be an excellent referral source for families seeking like-minded physicians. In fact, there are two points when families who see midwives will need to have their baby's care transferred to a doctor.

These two points during midwifery care are:

• When a baby reaches their age limit to be cared for by a midwife (in Texas, this is 6 weeks of age)
• When a baby's health goes outside of normal and healthy

Remember that selecting a doctor for your baby "just in case" won't mean that your baby won't continue seeing your midwife for their healthy and normal newborn care. It simply means that you will be prepared when your midwife is ready to transfer your baby's healthcare to a doctor. Also, rest assured that just because your baby has to see a doctor during your early weeks for medical reasons, doesn’t mean you can’t resume care with your midwife until baby is old enough to graduate out of their care.

Some important things to think about:

• Emergency Rooms: Not being registered with a doctor's practice can cause parents to be routed to a hospital emergency room for their baby's routine and non-emergency medical care--although in cases of emergencies babies should always be taken to emergency rooms for evaluation and treatment. Being registered with a doctor (yes, this could involve taking baby in at least once to the doctor's office so that there is an established patient-provider relationship) would allow parents to be able to call their doctor in cases or non-emergencies, instead of being seen at an emergency room for non-emergencies.​ Most doctors who have not yet seen baby at least once will not offer medical advice over the phone, and will refer families to emergency rooms. ​
• Other Providers: Other healthcare providers often require families to be on-record with a physician in case clinical situations arise during their care for which a report or a referral is necessary. For example, speech pathologists and lactation consultants are examples of healthcare professionals who work with babies who may require that a baby have a doctor.

Finally, here are some TIPS that can help you pick the right doctor for your baby:

• ASK AROUND: One of the best ways to choose a provider who is supportive of your wellness and breastfeeding goals is to ask friends, family members and peers who they have been supported by.
• MAKE A "SHORT LIST": Now that you have asked around and made a list of a handful of providers that may be a good fit for your family, narrow the list down to the ones you are most curious about. Calling the office to schedule a prenatal consult can give you an idea of how welcoming or helpful their office staff is, which is an important point to ponder.
• ​VISIT THEM: Many providers are very willing to meet with expectant parents (this is often free or covered by health insurance or public health coverage). These meetings serve as a "Question & Answer" session for both parents and providers.
• ASK THE RIGHT QUESTIONS: In addition to making a list of all important health topics and values that you want to discuss with your baby's doctor, make a list of what matters most to you and your partner with regard to breastfeeding. ​

Questions to Ask Your Baby's Doctor

Below are are some questions (mostly about breastfeeding, but can be insightful for all parents) to ask your baby's doctor. Having attended a breastfeeding class during your pregnancy can help your understanding of contemporary breastfeeding practices, something which will be helpful when asking your future pediatrician about their breastfeeding supportiveness. If you haven’t yet taken a breastfeeding class, now would also be a good time to register for one.

Questions about breastfeeding to ask your baby's doctor:

Remember, the only "right" answers to these questions are the answers that most closely match your family's health values.
​

• Can you tell me about your breastfeeding-supportiveness?
• How long do you support breastfeeding for?
• In what circumstance would you recommend that I stop breastfeeding my baby?
• Do you have a board-certified lactation consultant who you regularly refer to when families need expert breastfeeding support?​​
• At what age do you feel babies should begin eating solids?
• LAURA'S NOTE: I have met exceptional general practioners andfamily medicine doctors, HOWEVER, in San Antonio, where I live, these providers don't usually see newborns or babies (although a few do see them regularly). Because of this, it's always a good idea to ask how many babies the general practice or family practice provider sees regularly. This is an important question to ask, especially in urban areas where general practitioners and family medicine doctors see mostly older children and adults. If a provider doesn’t see newborns and older babies regularly, I would personally find one that does.

​
And, here are some additional points to ponder when choosing a provider:
​

• Is the doctor's office close to your home, or your child's caregiver?
• Does your baby's doctor have flexible hours?
• What hospital does your baby's doctor visit (or admit baby's/children to when needed)?
  • Not all doctors see their own patients during hospital admissions. Many private doctors use the hospitals' doctors (called "hospitalists") to assess their patients and send them reports.
• Is it important for you to be seen by the same provider at every visit? Many practices have multiple providers which can be attractive to some parents, yet overwhelm others.
• What services does your provider offer (do they do urgent care/same-day apps., do they have a lab on-site, etc)?

To conclude...

Remember that you will be seeing your baby's doctor during your baby's first days, first months, throughout their first year--and of course, every single time you have a medical question or concern about your baby (which will be frequently, trust me). Needless to say, your baby's doctor will be a very big part of your baby's life (and of yours) so taking the time to choose them wisely will be one of the most important choices you will make for your baby's future health!

If you found this advice helpful, make sure to share it with your friends! 💜
​
Helpful Links:

• La Leche League article about working with your baby's doctor
• Choosing Your A-Team by Best for Babes
• The American Academy of Pediatrics link on choosing your pediatrician

Sharing is caring! Please share or print this article for educational purposes, but please do not copy/paste or take any parts of it as your own.

I usually do an intro to blogs, but this one doesn’t need an into-unless you missed this week’s NYT article about Trump’s administration’s opposition to global breastfeeding protection, preservation and support (which also stated that the US bullied other countries into opposing) in order to create fruitful ground for formula companies. If you missed it, take a moment to read it and weap, and then come back here to learn what you can do ASAP.
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Whether it’s starting your community’s first breastfeeding coalition or support group, to joining efforts in existing ones, to learning what you can do with national efforts and international efforts will put you on the right side of preserving, promoting and supporting breastfeeding.

Since there are too many to list completely, please link your local resources and the cities they serve in the comments, as well as listing national and international advocacy groups.

Lets cummulatively do for our babies what our government won’t!

💜,
​laura

Having been born on an island (Puerto Rico) there's a higher-than-most likelihood that a mass emergency would be a part of my story, and it is. One of the reasons my family ended up in Texas was the result of flooding from a major tropical storm in 1980. Despite me being barely two years old, I remember the flood, and remember being carried to my grandparent's home, in a trash bag. This early experience with adrenaline and near-total loss I'm sure in some part contributed to me generally being calm under pressure, and being a need-meeter, instead of a need-creator. And interestingly, while growing up I joined the Police Explorers in high school knowing I wanted to eventually enter into the mass-emergency world, then later in my mid 20s decided to live this out by changing my school major to Emergency Management...and I did that exactly two months before Hurricanes Rita and Katrina hit.

But what does all of that background have to do with me being a lactation consultant now? How did I go from working for FEMA as a disaster reservist to helping moms with breastfeeding?

Because nothing feels more like a disaster or emergency than a mother desperate to breastfeed her child...

Helping moms troubleshoot their breastfeeding scratched the same exact itch that helping families recover from major disasters scratched: I was able to help someone overcome.

Now that I'm on the breastfeeding side of it, one can see where meeting the needs of families with babies during emergencies would be high on my list of passions.

Because of that, being available to support the needs of evacuating-families with infants and making sure they have the resources they need is important to me. Families evacuating to SA and needing assistance with technical or logistical help with finding pump-parts, etc. will be able to count on Breastfeeding Housecalls.