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​Check out recent blogs!​
  • Breastfeeding: What's Normal, What Isn't, and When to Seek Help
  • ​What Exactly Happens During a Lactation Consultation?
  • 6 Reasons Why Private-Practice Lactation Consultants Are Worth Their Weight in Liquid Gold​​
  • 5 Myths About Tongue Tie​
  • How do I choose the right doctor for my baby?
Read this before scheduling please!
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Supporting Autistic Women in Birth & Mothering

1/3/2021

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But first:
Imagine that we are having 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, talented and ambitious Autistic daughter (whose permission and encouragement I have to share this). As such, I disclaim my selfishness, and admit that my motivation to write this stems from our experiences as neurodiverse people navigating health issues in realms in which our chattiness, silence, pauses, and lack of adherence to conventional communication standards and information processing uniqueness have often been misunderstood and mistreated.

Because the pregnancy, birth, and infant-care season involves augmented sensory experiences, has increased communication requirements, and involves both short-term (ie answering questions during consults) and long-term processing (ie birth outcomes) my hope by writing this is that birth and infant-care professionals will update their practices to accommodate the needs of Autistic people.


Also:
This article was reviewed by Autistic and Allistic mothers and birth professionals prior to publishing.


***The suggestions in this article are best understood and implemented by those who have updated their understanding about Autism relative to girls, women, and female identifying or perceived. Please visit that link first (it will direct you to this one.***

Autistic women and girls, like neurotypicals, 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 that still operates at biased baselines set for non-Autistics. In fact, with schools assessing and accommodating Autistic students earlier in life, more Autistic and neurodiverse people are entering adulthood with more information and acceptance about their difference 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, who pride ourselves in education and prevention, we must update our approaches to be inclusive to the emerging generations of adults who know more about how they learn than than anyone else.

​And who are they? For the sake of this article, they are Autistic and neurodiverse women and female-identifying/perceived, a demographic of Autistics who have been underrepresented in conversations about Autism until recently.

Why are accommodations for Autistic birthing parents important?

Note: These accommodations can help any Autistic new parent, whether the birth parent or not.

Sensory Support

In our educational link about Autism, you learned that Autistics have heightened sensory perception that could make sound, sights and touch especially overwhelming. While distracting and overwhelming scenarios are often faced by Autistics in many life situations, the birth and infant-care season presents a unique opportunity for supporters to help Autistic parents avoid trauma and anxiety with their birth and babies.


During action-filled interactions surrounding birth and infant care, particularly when time sensitive “performance” is expected, one can imagine the stress a person with sensory-processing challenges may experience. For instance, being in a birthing room, half-dressed, with lights that are too bright or too dark, with multiple providers coming in and out asking questions, touching personal areas, family giving opinions, etc.. To any person this would be overwhelming no matter how prepared, but to a person who struggles to process information, a birth space (even calm ones, and even those that have “good” birth outcomes) could be remembered as traumatic for a lifetime. Add to that situations which have high trauma-perception for any parent, like being transferred to from a home-birth setting, having an unplanned surgical birth, having a NICU team whisk a baby away, all without transparent communication, and the likelihood of added trauma increases exponentially for anyone, and for an Autistic or neurodiverse parent, situations like these could present significant sensory challenges that are hard to process, both emotionally and technically.

Sensory-Supportive
Provider Interactions


From prenatal appointments, to infant-feeding consultations, all new parents seemingly experience more questions and teaching than they might during other times in their lives. While the pace of these interactions may seem like a lot even to Allistic (non-Autistic) parents, to an Autistic parent who organizes thoughts better in silence, or who may need extra time to express their thoughts and questions, the pressures surrounding basic appointments can be very overwhelming. While not all Autistics shut down or enter into a “mental block” when overwhelmed many do—but preventing this can be as simple as a provider slowing down their pace, recapping what’s been shared, or stopping frequently to give opportunities for questions.

Accounting for a processing vulnerability does not mean providing less information or less complex concepts (unless intellectually applicable) it simply means slowing down, and presenting ideas in ways that can be retained and used when needed.

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. In fact, once implemented, you may find that they improve experiences for all of your clients. 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 shared here are intended as a starting place yet know that the best way to learn how to serve anyone, and especially an Autistic or neurodiverse person 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 then 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 (to them) of encouraging masking in Autistic females/identifying...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.

Consider adding opportunities to your intake forms for self-identification (without expecting disclosure).

​Examples of intake questions:

“Are you a neurodiverse thinker (have ADHD, are Autistic, etc)? If so (and if you’re comfortable sharing) please tell us what we can do to make your experience with us more valuable.”

”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 right away:

• Provide anticipatory guidance in a layered approach: provide verbal, written material as well as videos of concepts you have or will teach. Having multiple venues to reinforce teaching is great for everyone, and very good for Autustics.

• Watch your expressions of frustrations and be mindful of any patronizing or cutesy tone that could cause a person to feel inferior. Autistics may be stereotyped as having issues expressing their feelings via gestures or facial expressions, but most are seasoned observers and can be more perceptive to expressions than words.

• Check your use of analogies, sarcasm, and terms not easily understood by literal thinkers (i.e. in lactation, these would be terms like “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!)

• Don’t automatically interpret disinterest from an Autistic person 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 (i.e. low gaze, fast pace talking, high-anxiety, mentally-stuck, etc.) and that insisting that sensory issues are trauma when they are actually not, can 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 experienced neuropsychologist.

***

My hope is that this article and it’s resource page have not only given seeds of acceptance and understanding to providers, but that those who learned from it sow these seeds in themselves and them in those they mentor.

​-Laura
​🪴
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8 tips for making the best of your virtual lactation consultation

7/12/2020

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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!
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Video-Consults VS. In-Person Consults: What type of lactation consult is best?

7/12/2020

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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 9 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 objectively look at the differences and benefits of both video-consults, and in-person consults.


VIDEO-CONSULT

  • RELATIONSHIP: Provides relationship-based consulting

  • MASKS NOT REQUIRED: Face-masks are not worn, providing ability for clients and provider to see non-verbal expressions, which are necessary in trust-building and communication

  • ASSESSMENT: Near-identical visual assessment and guidance of latch, parent/baby anatomy, positioning, pumping, supply management, proper bottle feeding techniques. Experienced LCs can provide assessments of baby’s structure and function based on observation of features, feeding mechanics, client’s reporting of issues, and guided-by-LC oral assessment by parent

  • RISK: Zero health-risk of vulnerability to family and provider’s networks and daily activities

  • AVAILABILITY: Often near-immediate availability and solutions

  • REFERRALS: Provides near identical referrals (when needed) while reducing family’s general exposure by at least one provider

  • CONNECTIVITY: Requires a reliable internet connection, and patience when connections are spotty; many options for accessing HIPAA-compliant care can be used during consult when connections are unreliable

  • SECURITY: Because we perform our consults on secure-platforms, know that no part of the consult will be accessed by others, nor is any part of the consult recorded or saved

  • PHYSICAL ACCESS: LCs do not have physical access to parent and baby, which foments a stronger parent-baby bond while receiving coaching and teaching*

  • ​EQUIPMENT: Seasoned breastfeeding experts are able to assess (and teach parents how to assess) adequate milk transfer, satiation and growth without equipment. Still, for our most delicate cases, BH provides 2-7 day rental and loaner scales for local-to-San Antonio families on a case-by-case basis.

  • OUTCOMES: Successful outcomes are most common


IN-PERSON CONSULT:

  • RISK: 1-2-hr sustained contact (while wearing masks and practicing hand-hygiene, and as much social-distancing as possible); vulnerability to respective in-person encounters with other people and their daily activities; if consult is in-office, logistics of travel, facilty-type, etc. should be considered

  • AVAILABILITY: Possible wait for appointment since in-person consults may be are scarce during social-distancing seasons

  • NON-VERBAL COMMUNICATION: Limited ability to see necessary non-verbal expression due to necessary face-mask-use; non-verbal communication is necessary in trust-building and communication with both parents and baby

  • RELATIONSHIP: Provides relationship-based consulting

  • ASSESSMENT: Assessment and guidance of latch, parent/baby anatomy, positioning, pumping, supply management, proper bottle feeding techniques; experienced lactation consultant can provide structural/functional assessments of baby based on observation of features, feeding mechanics, parent’s reporting, and digital suck assessment
​
  • REFERRALS: May provide referrals to other in-person providers

  • CONNECTIVITY: Reliability or security of internet and care-platforms are not a concern

  • SECURITY: Unless parents have security cameras actively filming in their home (for home-based consults), there is zero concern that a lactation consult will be recorded or accessed

  • CONTACT: Lactation consultant and parents have increased opportunities for physical contact*

  • EQUIPMENT: Most in-person lactation consults have a scale available during the consult to check overall weight gain and to measure milk transfer. Most reliably, however, parents should be taught how to measure milk-transfer and thriving without a dependency on scales
    ​
  • OUTCOMES: Successful outcomes are most common

*”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.
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Breastfeeding “Aha! moments”, as illustrated by Lucius Fox, moonflowers, and Dawna Mangrum, IBCLC

1/27/2020

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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.
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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.
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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.
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BH Doubles it’s Trouble...shooting Capacity to Support More Breastfeeding Babies!!!

1/10/2020

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​
​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
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When you give a private-practice IBCLC 2 hours...

11/19/2019

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​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

🤱🏻💜
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A Lactation Consultant’s Wisdom On Choosing the Right Doctor for Your Baby (regardless of where or how you plan on birthing)

1/13/2019

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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.
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  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.
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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.
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  • 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:
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  • 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.
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8 Ways to Promote, Preserve and Protect Breastfeeding When Your Government Won’t

7/11/2018

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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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​1. Educate yourself on the history of formula company and government loyalties

Read Gabrielle Palmer’s The Politics of Breastfeeding or Kimberly Seals-Allers’ The Big Letdown. These books will help you understand how formula companies are as predatory as tobacco companies, how breastfeeding was stolen from humanity by pharmaceuticals and the dairy industry, and give you every reason on earth to fight to renormalize human milk for human babies.
​

2. Read the WHO Code of Marketing of Breastmilk Substitutes

This will give you a toolbox of how not to market your business and services in ways that perpetuate artificial infant feeding as norm. Read it and pledge to follow it in all of your personal and business dealings.
​

  1. 3. Encourage expectant parents to ask their birth professionals about their affiliations with companies that make artificial baby milk before hiring them

If a birth profesional has loyalties or gets royalties from formula companies or formula company reps, they will likely not be the birth professionals that will help families reach breastfeeding goals.
​

  1. 4. Stop sharing formula company propaganda

Sharing mushy-gushy formula company internet commercials about “sisterhoods” makes you complicit in predatory practices and distract you from the main issue . Formula companies prey on vulnerabilities of new families by attaching feel-good sentiments and “permissions to surrender” to their commercials, seeming to diffuse (yet perpetuate) controversial topics, such as “mommy wars”. While these commercials seem to be advocating for inclusion, know that they are actually ploys to ensure and grow a market. Without mommy-wars or mommy-guilt formula companies’ market share would be much smaller. Sharing these feel-good videos adds fuel to a fire, not water.
​

5. Stop amplifying the “Fed is Best” movement that encourages complacency in infant feeding and early breastfeeding cessation

Instead of shrugging your shoulders and simply agreeing with “Fed is Best”, ask “Fed WHAT is best?”, and then ask yourselves:

Was everything done to fix breastfeeding before replacing it? If the answer is no, then make all efforts to fix breastfeeding (like reaching out to a breastfeeding professional, or another mom who has experience in overcoming breastfeeding issues). If the issue still couldn’t be fixed, the next option to preserve a baby’s right to have breastmilk is to receive a mother’s own hand-expressed of pumped milk- and if that can’t be had, then seeking donor human milk/wet-nurse is the last step to exhaust before choosing PROPERLY PREPARED infant formula, made with clean water in hygienic conditions.

Asking these questions before dismissing a baby’s right to human milk by easily accepting the FIB mentality will keep you from amplifying the FIB hidden message that formula-fed is best.
​

6. Ironically, stop demonizing infant formula

When properly prepared, formula can lead to the survival of babies whose caregivers don’t have access to human milk. Artificial baby milk DOES have a place in the infant-feeding realm (but it doesn’t have first place, or even second or third place, as mentioned above) and demonizing it under all conditions just feeds in to the mommy-war and guilt rhetoric, and gives the formula industry more reason to invest their wealth in making families feel less of the guilt we place on them by snubbing their feeding method.
​

7. Realize that formula can be dangerous here in the US, too

Yes, #6 asked you to stop demonizing formula, yet #7 is telling you it can be dangerous? Yep.

Before going on a soapbox that improperly prepared infant formula doesn’t exist in developed countries, let me go on mine:

Improper formula preparation is not an issue exclusive to underdeveloped countries. Framing it as a third-world issue separates us from our domenstic reality. Something as easy to do as overdiluting formula to “make it last” or to “add calories” or to “hydrate a constipated baby” (all excuses I’ve heard) can very much harm or kill a baby. Add those common issues to the likely more common issue of formula that’s been handled unhygienically, left unrefrigerated too long, or prepared with tap water (which is soooooo often done in household of all “levels” here in the US) and you have many US families preparing formula incorrectly.

Needless to say, if these are issues in a country whose water supplies we deem “safe”, and literacy rates considered higher than underdeveloped countries, then think about parts of the world with less than perfect sanitation conditions, language barriers to preparation instructions when “well-meaning” corporate donations from the US land somewhere where families can’t read (or can’t read the formula label’s language).


​

8. Understand your local, national and global breast feeding support landscape

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

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Introducing Breastfeeding Housecalls' TEAM of breastfeeding experts!

10/24/2017

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​​ "Can I take you home with me?"

​When I worked as a hospital bedside lactation consultant, "Can I take you home with me?!" is something that I heard over and over again from new families. This plea from mothers is what inspired me to take my lactation consulting out of the hospitals and into my community. Breastfeeding Housecalls & Lactation Clinic, LLC (BH) was born precisely because I was shown an unmet need and felt called to meet it.

To make BH a long-term and sustainable resource for San Antonio families, I always knew it would take more than me. For seven years I have worked super. crazy. hard. taking steps backwards, making leaps forward, putting on blinders, and remaining hyper-focused on laying the foundation for what would become a better resource for my city.

But it wasn't as simple as hiring a handful of lactation consultants...

The truth is that outpatient clinical lactation skill-sets are hard to find-even in a robust community of IBCLCS...and as is my typical mode of operandi, I made things even harder by wanting the outpatient clinical lactation skill-set in a particular type of lactation consultant, the kind who meets the same "Can I take you home with me?" criteria of kindness and relatabilty. To do this, I have been listening closely for years to the desires of contemporary families, learning from parents about who in my professional community had the gentlest of hearts at the bedside so when the time came to put a cadre of responsive IBCLCs together-the members of the BH Team were who I thought of. What I wanted were hearts with enough space in them to download BH's care model and promise of providing expert, objective and loving support while being God's hands and heart in the lives of new families.


I hired each of these sweet and knowledgeable women for their passion to support mothers and babies, to embrace new families, to remain curious, and to bring strengths and interests in to the practice.

So with that...

I present to you Breastfeeding Housecalls' very awesome home-visiting team! I pray that San Antonio families and providers will receive them the same open arms with which I have been received for the past seven years.

Thank you to those who believed in and have encouraged BH always.

Love,
laura maría gruber, IBCLC, RLC
​owner

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Feeding Your Baby During Mass-Emergencies: Tips for Evacuating-Families, & Practical Area-Specific Resources to Help Guest-Families in San Antonio

8/25/2017

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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.


Here's are some resources of what to do to ensure that babies remain fed safely during times of mass-emergency:

• For those who care for babies during emergencies:
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225303/

• For shelter-operators:
http://www.ennonline.net/motherbabycornershonduras

• For Moms:
http://kellymom.com/bf/concerns/bf-emergencies/
https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html

• Breastmilk Storage in Emergency Situations:
http://kellymom.com/hot-topics/frozen-milk-power-outage/

• Keeping food and water safe during disasters: https://www.cdc.gov/disasters/foodwater/

• Tips for finding resources (like pump parts) in San Antonio
​:

Plug into the mothering community of the area you're sheltering in. This may mean joining online support groups and messaging the admins to let them know the reason you're asking to join their local group. Mother's in online mothering can be exceptional resources in locating things like pump parts, breastfeeding supportive local healthcare providers, provide references of medical services, participate in milk donation conversations, and even be a resource for feeding items like forgotten pump parts, battery packs, etc. Here's a list of local to San Antonio online support groups: San Antonio Breastfeeding Suppprt Groups.

North Central Baptist, North East Baptist & St Luke's Baptist Hospitals' sell Medela tubing in their gift shops, or you can call any hospitals post-partum unit and ask to speak with their lactation consultants, who often stash extra pump parts to have available for emergencies. Target, Walgreens, HEB and Babies R Us sell manual-pumps, or again, learn to manually express here: https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html

• Local to San Antonio professional breastfeeding resources:
sabctx.org/local-resources


• Safe Formula Preparation:
http://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

If you are an evacuating-guest in our city and need support preserving your breastfeeding during your time away from home, please know that Breastfeeding Housecalls is available for phone or in-person support this weekend.

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Breastfeeding Housecalls & Lactation Clinic, LLC
(210) 209-1002
San Antonio, TX

The services offered by Breastfeeding Housecalls do not replace medical advice;
please consult your healthcare provider if you suspect you or your child are not well.


As does every healthcare provider, Breastfeeding Housecalls has a legal obligation to report unsafe conditions.



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Breastfeeding Housecalls adheres firmly to the World Health Organization's Code of Marketing of Breastmilk Substitutes and only participates in activities or conducts business with organizations who are free of ties from manufacturers of artificial baby milk (infant formula).

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