Choosing Your Health Care Provider: Lactation Consultants
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KIMBERLY MURPHY: You’re planning to breastfeed your baby once she’s here. You may or may not have taken breastfeeding preparation classes but you think you may need additional support for breastfeeding when the time comes. I’m Kimberly Murphy, Internationally Board Certified Lactation consultant and today we’re discussing how to choose an LC. This is Preggie Pals.
STEPHANIE GLOVER: Welcome to Preggie Pals, broadcasting from the birth education center of San Diego. Preggie Pals is you’re online on the go support group for expecting parents and those hoping to become pregnant. I’m your host Stephanie Glover. Thanks to all of our loyal listeners who’ve joined the Preggie Pals club. Our members get special episodes and bonus content after each new show plus special giveaways and discounts. See our website for more information. Another way you can stay connected is by downloading our free Preggie Pals app, available in the Android, iTunes and Windows marketplace. Sunny, our producer is now going to give us some information about our virtual panellist program
SUNNY GAULT: Okay. So, first of all thank you guys for being with us today. If you’re not here in our San Diego studio, we would still love for you to participate in the conversation. So I am going to be checking our Facebook and Twitter accounts as we are recording today. And perhaps posting some pictures and also just kind of telling you guys what we’re talking about here in the studio. So, if you want to participate, feel free to comment on anything you see on Facebook. If you’re on Twitter, you can follow the #preggiepalsvp. The VP stands for virtual panellist and who knows we may read one of your comments on the show. And if you want some more information about our virtual panellist program you can visit our website at www.newmommymedia.com
STEPHANIE GLOVER: Great. Thank you Sunny. So we’re going to go around the studio here and have the panellist introduce themselves. So I’ll start with Kristen, won’t you go ahead
KIRSTEN PAYVON: Hi, I’m Kristen Payvon. I am thirty three years old. My current job title is full time stay at home mom. I am not currently pregnant. I have two children, my daughter Zoe turned three last week and my son Brady is ten and a half months old. I had both children at [inaudible] hospital. Both were inductions and both were vaginal deliveries.
STEPHANIE GLOVER: Thanks
MICHELLE ASHLEY: My name is Michelle Ashley. I am thirty four and I am an insurance agent. I am due actually with my second on December thirty first, another boy. I have an eighteen month old son at home. Delivered both at the hospital, regular vaginal birth
KIRSTEN STRATON: My name is Kristen Straton. I am a birth and postpartum doula and since we’re talking about breastfeeding today, I breastfed all three of my children ages four, two and a half and fifteen months
SUNNY GAULT: And I’m Sunny. I’m producing again. And so I’ve got four kids. I have a four year old, a two year old, both of those are boys. And then I have identical twin girls that are ten months old. Breastfeeding my twins
STEPHANIE GLOVER: Great. Thanks for joining us
SUNNY GAULT: Okay so before we get started today, we’re going to do an app review. And we kind of hold our panelists today to see what apps they like. And so, our token pregnant momma in the room, Michelle, has an app on her phone and it’s called Pregnancy Companion. So, Michelle, tell us a little bit about the app
MICHELLE ASHLEY: Well I’m using the free version of the app. It has a lot of options, everything from a, you want to know like a medication is safe. It will tell you if you should call your doctor, check your list. Right now, I’m using it as a kick counter and I like it that it actually I can save and record my weighing’s throughout my pregnancy. And, has a nice little status bubble that tells me how many weeks and days. How many I have left and I totally like. So I like it for its simplicity but also because it has so much variety of yoga moves and recipes which I haven’t really used. But the only real criticism is, it told me last week I was in my third trimester and I think I have a couple of more weeks to go. But otherwise, it’s you know, the second time around I’m finding it a little more practical
SUNNY GAULT: I’m shocked at how much information is on it for being a free app
STEPHANIE GLOVER: Yeah. I mean acupressure? That’s so, I don’t know, alternative, you know and like. I mean at that, you know because there I think our standard features in pregnancy apps like that charting your weight or kick counts contraction counters, that kind of thing. So I thought that, that was a really neat feature
MICHELLE ASHLEY: It also has a hydration checklist too. So, if you’re having a hard time keeping up on your water intake you can tap down as you go throughout the day
SUNNY GAULT: There’s a drug safety checker as well along with that hydration counter. And there are also 3D videos if you want to see your baby’s development. I don’t know, sometimes they look a little weird, I don’t know. Did you get the chance to look at that Michelle, are there kind of weird images on there? Sometimes, it depends on the app but sometimes
MICHELLE ASHLEY: I may not have it on my version
SUNNY GAULT: Okay, yeah. I’m looking at the website now and how it kind of breaks down. So it is an iPhone app but it’s also on Google play so for all you Android users out there, you can learn a little bit more about it. Any other thoughts on this? I like the color scheme
STEPHANIE GLOVER: Well and the presentation. It’s very organized and yeah
SUNNY GAULT: Yeah again I was surprised it was a free app. So, check it out. Thumbs up!
STEPHANIE GLOVER: Today on Preggie Pals we’re continuing our series about hiring your care providers. We’ll be discussing how to choose a lactation consultant that’s right for you. Joining us today is Kimberly Murphy, an International Board Certified Lactation Consultant. Welcome to Preggie Pals Kimberly, thanks for joining us
KIMBERLY MURPHY: Thank you for having me
STEPHANIE GLOVER: So let’s learn some basics about lactation consultants to better understand their scope of work. What is a lactation consultant or LC as they’re referred to?
KIMBERLY MURPHY: Well, first of all, were part of the health care team sometimes people forget that. An LC is someone who’s had extensive training and mentorship. And then when we sit for the boards and become board certified, internationally board-certified lactation consultants.
We’re required to do continuing education and we sit for the exam at the tenure mark just to make sure that we’re current and up on things. This also dictates the standard of care, little story here, when I first be, first of all it was my third baby was premature that got me started in the, in the business.
And then when I told my husband I was going to become a lactation consultant, his first comment was “What could you possibly have to know about breastfeeding?” He does not ask that anymore. He probably knows more now than many too more than what he wants to. Sometimes he says I could do a consult over the phone. But now, we’ve been in existence for long enough where we’re considered to be an evidence-based practice which means we have research and is no longer lip service, no pun intended.
STEPHANIE GLOVER: That’s true
KIMBERLY MURPHY: Our main goal is to promote support and protect the breastfeeding community. In other words, our milk for our babies
STEPHANIE GLOVER: And what does a lactation consultant help with, with a new mom. What would you help a new mom?
KIMBERLY MURPHY: Okay first of all there is help. I always tell my moms, you haven’t missed your window of opportunity; this is all very fixable because a lot of times they’re coming in crisis and they’re going “oh this isn’t working” and again, support because mom wants to throw in the towel. I will tell you, having been in the business for many years, ninety percent of your successful breastfeeding is your support system. And then also guidance, dispelling myths, as you guys know, there’s so many myths out there and even still as long as lactation consultants have been around there’s still a lot out there that’s just bunk
STEPHANIE GLOVER: Are there benefits to selecting the lactation consultant prior to giving birth?
KIMBERLY MURPHY: Definitely. We call that a prenatal consult and most importantly what we do is we get a history of mom. We do a breast exam and then a course on because there are some situations where and I will tell you I’ve seen a bazillion different nipples and even if we lift our shirts up here, all our nipples are going to be totally different. Yes, and all of our breasts are going to be totally different. Different amounts of glandular tissue, that type of thing so we definitely want to examine the mom. And I will tell you sometimes in practice, I’ll get a mom that’s been discharged and baby has lost you know more weight than what we’re wanting to and she lifts up her shirt and then immediately I’m going “okay, how come no one told this mom that she had insufficient glandular tissue” and she was like totally crushed because she thinks she’s starving her baby. And this wasn’t identified. So, definitely, the prenatal that helps you identify those types of situations then we go over newborn parameters, expectations. I feel like, mom has more information than she’s more up to be that baby’s advocate and feel empowered by having that information
STEPHANIE GLOVER: And I know that if I could interject to Kristen here, used a lactation consultant prior to the birth of her second, if you could maybe chime in on what your experiences or why you, you decided to get a consult ahead of time
KIRSTEN PAYVON: Sure, this is Kristen Payvon. With my first child, my daughter, I had difficulty breastfeeding. And so, at the two-month mark, I decided to exclusively pump and so, because I had the supply thankfully. So, I exclusively pump and bottle-fed for eight months and then got tired of the pump. And switched her to formula after that which was fine, that worked for us and that was the solution that was needed at the time. But the second time around, I wanted to, to really try breastfeeding in an old-fashioned way and save myself a little bit of time throughout the day knowing I have a toddler running around. And so, it was recommended to Robin Kaplan, who everybody knows from The Boob Group and did her prenatal consult. Because I was a second time mom, but really a first time breastfeeding mom and I had to let go of a lot of the issues that I had the first time around of feeling like a failure and feeling like I couldn’t make it work and the trauma of my baby losing weight and not, you know, all of that. And so, Robin met with me for probably ninety minutes a few weeks before I had the baby just to encourage me and support me and put together a plan of action. And I went in feeling confident and feeling empowered and it was I now recommend that to all my friends who had difficulty with the first baby
KIMBERLY MURPHY: Oh good for you girl, good for you
STEPHANIE GLOVER: And actually going off of her experience with her first child and ending up supplementing on that second half of her year, I’m wondering Kimberly if mothers who plan to pump occasionally supplement with formula, can they still reap the benefits of a lactation consultant?
KIMBERLY MURPHY: Definitely. And of course, our philosophy is any bit of breast milk that the baby gets is positive and it does not have to be an all or none situation
MICHELLE ASHLEY: And I was going to say on the pumping part, I actually utilized a lactation consultant a lot for what to expect and what I was doing right and wrong with the pump because I had more challenges using the pump. And there was a lot of good advice on that
STEPHANIE GLOVER: Yeah and it’s something that you might not even really think of the “oh I can also have support with this, you know, device” and kind of get some back up there. And are there differences between the hospital-based lactation consultant and an independent lactation consultant?
KIMBERLY MURPHY: Well we’re all board-certified, but obviously the hospital situation is a little bit different because the newborn has different expectations and parameters that we’re trying to reach. And it’s not really until you get discharged from the hospital that all these other things seemed to appear and different challenges that type of thing. And of course, I will tell you, San Diego is absolutely wonderful as far as pro-breastfeeding. Your hospitals here are pro-breastfeeding. And of course, I’m fortunate to be in a baby-friendly one which means that we, all of the breastfeeding moms are seen at least once every twenty-four hours by the lactation consultant, of course, that’s covered by your hospital stay. Whereas out in the community obviously if you’re soliciting a lactation consultant it is, you know, whether it’s in your home or going to their office or whatever it’s for a fee
STEPHANIE GLOVER: Okay, and did, Kristen, did you utilize a lactation consultant?
KIRSTEN STRATON: I did. I used one with all three of my pregnancies and surprised when my third time, I thought “oh, you know, this should be a breeze” and that actually turned out to be my most difficult breastfeeding relationship. We battled thresh, we battled mastitis, we had clogged ducts, we had a upper lip tie. So it was a big challenge and without support, I don’t think I would have made it to fifteen months of breastfeeding
STEPHANIE GLOVER: Right. And so, I assume, so you had the hospital birth. Did you have a lactation consultant in the hospital and then did you continue consulting outside
KIRSTEN STRATON: I did, I did both. I had my initial consult in the hospital before being discharged. And then I sought care afterwards to help us on this other issues that came out throughout the relationship
STEPHANIE GLOVER: Boy I love pushing that nurse button, you know, because you get the LC too if that’s what you ask for and that was so nice as a new mom too to just have those questions being able to like answered and issues addressed just with a click of the button which takes a little bit more work once you get home unfortunately. Yeah I remember one came in and she looked at me and just like she said with the breast exam she said “you have challenged nipples” and I went “I do?” what does this mean? And so I was a nipple shield user, you know, after that. Never heard of one, never saw one, no one had ever talked about them. And you have these conversations with other moms and realize you’re not alone.
But thankfully she was there to just help me right away and we never really had to struggle beyond that which was such a blessing. So I’m glad that they’re available in hospitals
KIMBERLY MURPHY: And again, you now, these are pieces of equipment, the hospital grade breast pump, the regular breast pumps, the nipple shield. But they’re not to be meant to be your enemies. In other words, if this gets baby doing what they’re supposed to be doing and it gets breast milk in our little loves, yes
MICHELLE ASHLEY: Pumping is very complicated too. I never realized how important it was to have the right flange size and make sure you’re membranes are in good condition that the two Venus so, kudos to moms who do that exclusively because that’s a lot of work
STEPHANIE GLOVER: Definitely
KIMBERLY MURPHY: A lot of people don’t know that with the affordable health care act that you are entitled to breast pumps now. So you want to solicit that in different insurance, you have to check with your insurance company to see what our protocol is as far as getting, but these are good pumps. We consider the hospital-grade breast pump to be the kind the like the big guns. The other ones at the insurance companies are given or kind of like the beauvics, meant to be used watch your milk supplies as well as established. But these are free girls, yes, we’re talking two hundred, three hundred dollars’ worth of equipment that’s coming to you free.
MICHELLE ASHLEY: Yeah. Yeah, they are expensive, it does add up. Which again I had no idea
KIMBERLY MURPHY: So it should be insurance solicit those pumps
STEPHANIE GLOVER: When we come back we’ll discuss how to find a lactation consultant and questions to ask your potential LC. We’ll be right back
STEPHANIE GLOVER: Welcome back, today we’re discussing how to choose a lactation consultant that’s right for you. Kimberly Murphy is our expert. Now, what are some common breastfeeding issues or conditions that women may mention and seek help with form a lactation consultant?
KIMBERLY MURPHY: I think the biggest one is mommy’s complaint of sore nipples which means the latch is probably not proper. So the latch is swell and then a few days later engorgement occurs and we’re going okay it’s like trying to latch on to a wall, okay. And then sometimes too with that delay of milk transitioning, we see a decrease in the weight loss of the baby.
Ten percent being normal but if it goes more than ten percent then we get a little flag going up and we’re going okay what’s happening here that this baby has lost more than ten percent. And then also some moms don’t produce a full milk supply so that might be some reason why we see.
Also, mastitis, reflux, gourd, plugged ducts like what you were saying earlier and the [inaudible] for what can happen. Every single line [inaudible]. And tongue tie, you said lip tie - there is the lip tie as well and then there’s the tongue tie as well. All of these things can impact what’s happening premise. Babies that come early, they’re not meant to be here before their time and it’s a very structured care plan to get them to their due date. Once they reach their due date, things fall together much more quickly, multiples
SUNNY GAULT: I had both, so I had multiples that were premise, you’re speaking my language
KIMBERLY MURPHY: Going back to work okay, and yes the last reluctant bottle feeder. I know we’re talking about breastfeeding here but yes, reluctant bottle feeder. We used do consults on that as well
STEPHANIE GLOVER: And how would one find a lactation consultant? Are there certain websites to go to or local resources?
KIMBERLY MURPHY: First of all, number one, probably, I want to say eight-five and ninety percent of our referral base comes from the pediatricians. Some pediatricians will have lactation consultants in their office and again that’s kind of a win, win situation because then it gets covered with the insurance.
But they also have their list of favorite lactation consultants that they like to refer to out in the community. So I would say number one would be your pediatrician and then, of course, all you savvy techy guys, you know, of course, you’re going to Google breastfeeding support, lactations consultants, that type of thing. And San Diego breastfeeding coalition is a good resource as well.
Mostly your hospitals, when you get, in your discharge packet you get your list of lactation consultants that are in the community
STEPHANIE GLOVER: Is certification important when choosing a lactation consultant? You mentioned that you’re International Board Certified, so is that certification important?
KIMBERLY MURPHY: I would say, yes, yes and yes.
STEPHANIE GLOVER: And why is that?
KIMBERLY MURPHY: Because it dictates the standard of care. And then also it also holds the lactation consultant to a higher standard. So I would definitely say yes, yes
SUNNY GAULT: Can I ask a question?
KIMBERLY MURPHY: Yes?
SUNNY GAULT: What’s the difference between a lactation educator and a lactation consultant?
KIMBERLY MURPHY: Well a lot of the training is the same but they haven’t actually been board certified. We are, it’s almost like you have to give your firstborn up in order to sit for the board for lactation, yeah. And again the reserved five year mark is by continuing education and then at the ten-year mark it’s sitting for the exam again.
SUNNY GAULT: Okay
KIMBERLY MURPHY: So we are definitely, held to a higher standard
SUNNY GAULT: Got it
KIMBERLY MURPHY: Yeah. And that’s not to say that they’re not good. I’m not saying that
SUNNY GAULT: Yeah
KIMBERLY MURPHY: But there is a difference
STEPHANIE GLOVER: There’s a different kind of modes of care that you can provide too correct? I mean in terms of even like being touched by someone or you know like I’ve heard different things about that. And then what are some important questions that you’d want to ask a potential lactation consultant when you’re trying to find one?
KIMBERLY MURPHY: I would be kind of very clear as far what your breastfeeding goals are and then when you’re interviewing your lactation consultant seeing that her philosophy and her, her sort of fits in with what you perceive your goals to be yeah
STEPHANIE GLOVER: Kristen how did you decide on Robin as your lactation consultant?
KIRSTEN PAYVON: So a friend of mine on Facebook had just recently had her second son and was commenting on how breastfeeding was so difficult with the first child and thank goodness for Robin Kaplan who saved her life with the second baby and she’s having successful breastfeeding. And it was like she was speaking directly to me.
Because I was, you know, I wasn’t in my third trimester and kind of had this weight on my shoulders wanting to breastfeed but nervous about it because of my previous experience. And so, I just messaged her. I said: who did you work with? Tell me. And she said, you have to call Robin, here’s her website, and that day I called her and set up that, that prenatal appointment.
And I actually, Robin has a package, we can do the prenatal appointment and then you also sign up for the postnatal appointment which actually comes to your house the day after you get home form the hospital. And that was the day that the baby was trying to latch to the wall when I was engorged and looked, you know, uhm yes – I don’t know – looked very full and you know because the first couple of days have been going well and I was all excited and then the milk came in and then he wasn’t latching and he was screaming a lot.
And Robin said “oh use a nipple shield for a few days and she saved my life. But she came to my house, spend a lot of time with me, helped calm me down, talked me through it. And then I, I’m still breastfeeding exclusively at ten months and I still am using her, calling her, texting her. And I go to her breastfeeding support group as much as I can on Wednesdays at Baby garden at South Park. That’s my lifesaver also.
KIMBERLY MURPHY: Oh cool. And I would underlie that word of mouth is probably the best advertisement, yeah
KIRSTEN STRATON: As a doula that’s probably the number one referral I give to my mom’s postpartum is a lactation consultant. That’s probably the number one reason why either get a call to come and visit. And then they usually have to refer out because they just are so wonderful, and so skilled and they really do make a difference in that relationship
STEPHANIE GLOVER: Right. And, so great for you because you’re often doing a postpartum visit for your mommas and so very natural for them to come out
KIRSTEN STRATON: Yes absolutely, I mean and especially moms who have had either a difficult birth or cesarean birth, breastfeeding could be really healing for them because they can still connect with their child in the way that maybe they didn’t get to connect with them during the birth. I can speak for myself as having had a cesarean and then having had the successful breastfeeding relationship afterwards. It was really healing and really helped facilitate bonding that I didn’t get during birth. So, that’s really important aspect of it too
STEPHANIE GLOVER: And Michelle, did you use a lactation consultant outside of the hospital?
MICHELLE ASHLEY: I did more of a group setting. At first I called my, actually my medical group and they were able to tell me about some group sessions that were coming up so I could see, I could kind of meet the lactation consultant in a more of a group setting first. And then later ended up at the Baby Garden from word of mouth through the San Diego breastfeeding coalition as well.
And my only regret was that I didn’t go sooner. I waited till about five weeks. And we had tongue tie, nipple shield, all sorts of fun things to work through and this time around I’m definitely going to be, it seems like can get out of the house. That’s, but I kind of like the idea of having somebody come to me, so. Didn’t we all?
KIMBERLY MURPHY: And I will tell you, I love
STEPHANIE GLOVER: Two kids too
KIMBERLY MURPHY: Yeah, I absolutely love doing home visits because you’re in their environment, you’re working with their things that they have worked with. And [inaudible 00:22:58] the time limit on it. And I’m there usually at least two hours, at least. Yeah. And then phone follow up is endless after that. Once your client, phone follow up is endless
STEPHANIE GLOVER: How nice. Well thank you so much for joining us today Kimberly. For more information about Kimberly, as well as information about any of our panelists, you can visit the episode page on our, episode page on our website. This conversation continues for members of our Preggie Pals club. After the show, Kimberly is going to be discussing breastfeeding support groups. To join our club, visit our website www.newmommymedia.com
ANNIE LAIRD: Hi Preggie Pals, we have a question for one of our experts. Lizy in Redlands California writes: I’m planning breastfeeding when I go back to work. Kind about twelve weeks postpartum, what kind of arrangements should I be making with the facility manager at my work for a pumping room? I work in an open cubicle farm so pumping at my desk is impossible
ROBIN KAPLAN: Well hi this is Robin from The Boob Group in the San Diego breastfeeding center and Lacey thank you so much for your question. This is such an important question to figure out. How do you talk with your boss about arrangements for your pumping room? So, if you work for a business that has more than fifty employees, your boss is required by law to give you break time to pump.
If your business is less than fifty people then they are not required by law. However, common courtesy is usually to offer moms time to pump while she is at work. So, it’s definitely important to meet with your HR person or your boss before you go back to work after you’ve had your baby.
So, during that kind of maternity leave time to discuss certain things with that person. So, as for your specific question, arrangements for your pumping room, the things that most moms prefer to have and are often required by law if you have over fifty people is having a private space preferably with a lock that you can go to, to pump. You might also make sure that there’s a comfy chair in there, a table to place your pump on. And as for time, you know, giving yourself about fifteen minutes for actual pumping time.
And then a few minutes on each side, so before you pump and after you pump, they give you some extra time to walk to the room, get your pump set up and also for cleaning up at the end. As for a fridge in the room and stuff like that, that’s not something that usually is offered but remember that you can always get a cooler to bring your milk back and forth to your desk and keep it nice and cold until you get home.
We also have a ton of Boob Group episodes about going back to work and so since you mentioned that you are in a cubicle, we have a bunch of fun ideas on how to make a cubicle work for you if you have to pump there. So definitely go check out our website, look for the Boob Group episodes specifically about going back to work and you will find some amazing tips for making this work for you
STEPHANIE GLOVER: That wraps up our show for today. We appreciate you listening to Preggie Pals.
Don’t forget to check out our sister shows
• Parent Savers for parents with newborn, infants and toddlers
• Twin Talks for parents of multiples
• Our show The Boob Group for moms who breastfeed their babies
This Preggie Pals; “Your Pregnancy Your Way”
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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