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 But first: Imagine that we are at coffee, and you ask me what I do to support my neurodiverse and Autistic clients. That is the context I share the information below... The goal of this post is to help the underserved niche of women, girls and female-identifying Autistics seeking birth and healthcare support. This blog is not written to alienate other identifications, and is written with the intention to elevate acceptance of female and female-identifying Autistics. Disclaimer I am writing this blog from the perspective of a neurodiverse woman, who is the proud parent to a bright and talented Autistic daughter (whose permission I have to share this). As such, I disclaim my selfishness, and admit that my motivation to write this stems from my desire to enlighten the providers who will one day serve her in ways I was not served. Also: This article was eye-balled by other neurotypical and Autistic mothers and birth professionals prior to publishing. Coming soon as a preface to this article: Autistic women and girls, like neuerotypicals, expect their healthcare providers to understand them.
The evolution of understanding of Autistic females is helping more medical and educational professionals learn their role in helping Autistic-girls and women exist at their highest potential in a world still operating at biased baselines set for non-Autistics. In fact, with schools assessing and accommodating Autistic students earlier, more Autistic and neurodiverse people are entering adulthood with information and with agency over their learning and choice-making. Not only does this apply to academic settings, but it also applies to how Autistics experience, expect, and receive their health care and education. As health professionals, constantly engaged in education and prevention, our practices must evolve to account for not only a spectrum of learning potentials, but also to provide support to emerging generations who know more about how they learn than ever. What can you change? While my suggestions are inherently biased toward birth-care professionals, they can be applied to consulting and counseling services of all types and to all genders of Autistic people. Know that these are not all-encompassing recommendations, and that you may need to do more to accommodate the needs of all of the neurodiverse people you serve. The ideas below are intended as a starting place but know that the best way to learn how to serve someone who is isn’t neurotypical is by actually asking them what they need. How to change (for the better) Like anything, change starts within oneself, so beginning by creating an accepting environment for atypical and Autistic thinkers will start with identifying, accepting and updating aspects of your practice that need it. Whether you’re a solo-practioner or a member of a group, taking inventory of things you can improve and genuinely changing individual behaviors to be inclusive and equitable will reflect on your practice’s overall and eventual acceptance of Autism and neurodiversity. As you start planning your patient/client experience for neurodiverse and Autistic people: • Accept that the onus of need-meeting is yours, not your client’s. They came to you for help (and unless you’re a neuropsychologist, they likely didn’t come to you for help with being Autistic, they came for what you specialize in). Regardless of your personal neurotype, considering theirs in how you provide care is necessary. • Update what you previously knew about Autism by devouring every corner of this resource page and the vast resources written by Autistics online. • Understand what masking means in the context of Autism, and in particular, the nuances and dangers of encouraging masking in Autistic girls and women...and provide services that help clients unmask when with you without being judged • Know that it is ok to ask your clients/patients about their neurodiversity, processing differences and learning preferences • Add opportunities to your intake forms for self-identification (but don’t expect disclosure). Examples of intake questions: “Are you a neurodiverse thinker (have ADHD, are Autistic, etc) and if so, please share what we can do to make your experience with us more valuable to you.” ”Please help us understand how you learn best.” ”What sensory accommodations would you like us to make during your visit with us?” “Do you need a quiet space in our office?” “How comfortable are you learning with multiple people present in the consult?” • Update your use of language and terminology surrounding neurodiversity and Autism; identify and change abliest approaches (you can learn about this in our resource page). What you can start doing today: • Check your use of analogies, sarcasm, and terms not easily understood by literal thinkers (i.e. liquid gold, nose-to-nipple, nursing-nest, etc.) • Allow extra thought-processing time when asking questions • Ask for consent to hug or touch (with any person, always...duh!) • Don’t automatically interpret disinterest because eye contact or tone isn’t mirrored Note: Ask about trauma if it is suspected, but also know that some sensory issues look like trauma (ie low gaze, fast pace talking, high-anxiety, mentally-stuck, etc.) and that insisting that sensory issues that look like trauma when they are not, can actually cause client-distrust and create trauma where it did not exist. If you need help teasing out trauma-related reactions vs Autism-related behaviors, discuss your case with an Autism vs Trauma experienced neuropsychologist. And lastly, remember that while Autistics may have very basic things in common with each other, their strengths, vulnerabilities, and passions will vary vastly. If you want to know more about how to support Autistic people, the best place to start is to simply ask them!  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!  What’s best? Video-health vs in-person lactation support, in the context of a pandemic? Our best answer is: You decide. On a good day, welcoming a new baby in to the world is full of emotions...and welcoming a baby during a pandemic is full of all the same emotions a few (ok, a lot) of added questions. Because brand new parents today have more to think about than any other time in recent history, it’s important that they be provided with complete information in order to do their own “benefit vs risk” assessment about all of their options in seeking care for their little ones. ••• Because Breastfeeding Housecalls has spent the last 8 years visiting multiple families per day, we understand the undeniable value of an in-person visit. And, because we also want families to stay healthy more than anything during these unprecedented times, we have been able to adjust to meet the needs of new-patenting today. Below, we break down the most important things to consider in your choice to seek out virtual vs. in-person lactation care: VIDEO-CONSULT
IN-PERSON CONSULT:
*”Low/No-Touch” encounters are a care standard appreciated by many parents and practiced during many in-person lactation consults and in nearly all support group settings. Reduced physical contact when teaching is known to INCREASE baby’s physical contact and bonding with parent. We hope this comparison helps you arrive at the best decision for you and your family! If you decide to troubleshoot your breastfeeding virtually, read our next blog article with tips about how to prepare for and optimize your virtual lactation consult. At this time, in order to protect your family the most, Laura María Gruber is only doing video-consults seven days per week. You can schedule via this site, or If you don’t see a time that works for you, you can text her directly to ask about availability (she won’t provide text-based consults unless it’s to accommodate a disability). Laura is usually able to work families in quickly. Breastfeeding “Aha! moments”, as illustrated by Lucius Fox, moonflowers, and Dawna Mangrum, IBCLC1/27/2020 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.  I wish breastfeeding was this magical, natural moment for everyone right off the bat. That would be an ideal world and go a long way to helping prevent postpartum mood disorders. But secretly, I am thankful that families get to experience the sense of accomplishment that comes from weathering this storm. I believe most new parents have a defining moment where they go from feeling overwhelmed to empowered. This new confidence allows them to believe they are enough for their tiny human. That moment was, quite literally, life changing for me. I clearly remember the latch that changed the course of my parenting. In fact, I remember that more clearly than our first latch after she was born. There are so many lessons to be learned from the journey to get to that point. For some, it's simply learning how to ask for help. For me, it was learning to trust my instincts and advocate for myself and my daughter. But it also taught me how to turn my trauma into something beneficial, leading me to a path where I attempt to help families find that same empowerment -- that AHA! moment. When Charley was four months old, I memorialized our journey in a tattoo to serve as a daily reminder of the lessons we had learned. The moonflower is a night flower, requiring darkness to bloom. It is a symbol of growth after going through a challenging period in life. Little did I know, my favorite thing about working in lactation would be watching families bloom after their own breastfeeding challenges.  After YEARS of hustle as a single mom of a human and small business, I finally decided that parenting both babies alone was not in their respective best interest. If you know me you know I’m never getting personally-partnered again so that mostly rules out a coparent for the human child. While it’s a realization that has been years in the making, and one that I’ve tested via ruled-out approaches, I came to the conclusion that, the business-baby, Breastfeeding Housecalls needs a co-owner. Yep. A CO-OWNER... ...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. ••• Dawna, Thank you for having faith in this work, and for using your story to support other families. Alex and I are blessed beyond measure to be able to call you and Charley our friends. 🤱🏻💜, Laura   To see if you even need an IBCLC, look here: http://www.breastfeedinghousecalls.com/breastfeeding-blog/what-is-normal-with-breastfeeding-and-when-to-seek-help To read more about why private-practice IBCLCs are worth their weight in liquid gold: http://www.breastfeedinghousecalls.com/breastfeeding-blog/6-reasons-why-hiring-a-private-practice-lactation-consultant-is-worth-their-weight-in-liquid-gold And to get a feel of what happens when an IBCLC visits you, check this out: http://www.breastfeedinghousecalls.com/breastfeeding-blog/what-exactly-happens-during-a-lactation-consultation 🤱🏻💜  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.
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:
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:
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.
And, here are some additional points to ponder when choosing a provider:
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:
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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