Find Answers

Welcome to “Breastfeeding Between the Lines” at The Second 9 Months!

Nobody “taught” these two little girls how to breastfeed their babies.  No one showed them how to properly “latch.”  They didn’t call a lactation consultant for help.  It wasn’t necessary.   Breastfeeding was just another part of life for them.   They sat on my lap or played on the floor during scores of LaLeche League meetings.  They watched neighbors and friends nurse their babies.   They absorbed it and learned. So there they are, absentmindedly watching TV while they’re nursing their babies.  The most natural thing in the world.   Perfect positioning without really thinking about it.   So why do many new moms struggle so much with breastfeeding?  Why are lactation consultants necessary?  Why is this blog necessary?  Because babies were born to breastfeed and mothers are designed for breastfeeding, but we were not meant to do it alone! Our busy, independence-oriented culture creates isolation for new mothers.   In addition most of my clients have NEVER seen a baby breastfeed and many have never held a newborn other than their own.  Is it any wonder new mothers need help?

“Breastfeeding Between the Lines” is an attempt to streamline information for new parents.  To dispel myths.  To make it all simple.  Please browse the posts.  To get started, check out “It’s Not Supposed to Hurt.” Feel free to add comments.  Post an alternative viewpoint.  Tell me what you think!  I look forward hearing from you.

Renee Beebe

Frenotomy–Parent Perseverance Pays Off

reneeb : June 29, 2016 10:46 am : Breastfeeding, Frenotomy, Lactation Consultants, Mom/baby story, sore nipples, tongue tie

 

20140828_095301Breastfeeding always hurt for first- time breastfeeder, Tina. She was given a nipple shield to help with the pain. And it did help. Even so, she knew a nipple shield was not a long-term solution. She kept trying to get rid of the shield. She hated the thing! But every time baby latched without it it, it resulted in intense nipple pain and wounds—her nipple was painfully creased after feedings as well. So, understandably,  she continued to nurse with the shield.

Meanwhile, baby Carolyn wasn’t gaining weight well. At every appointment she was gaining about ½ of expected weight gain. Baby was breastfeeding frequently—over 10x/day and still not gaining appropriately. She was having infrequent bowel movements, was gassy, and uncomfortable. Tina felt that something was very wrong. more »

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Guest Post: Two Big Reasons to Skip Rice Cereal

reneeb : April 13, 2016 11:00 am : Breastfeeding, starting solids

The following is a guest post from Beth Martin. Beth is a certified Nutritional Therapy Practitioner (NTP) and the owner of Small Bites Wellness in Seattle, Washington. She is passionate about whole food nutrition for the whole family and believes that ANY change you make in the pursuit of your health, or your child’s health, is worthy. Health is a journey, not a destination. Thank you Beth, for this great information!

I recently shared the most common reasons pediatricians recommend rice cereal as a first food for infants.

IMG_1091I advocate feeding children nutrient dense whole foods that naturally contain the macronutrients, vitamins, and minerals they need to grow and develop. Rice cereal does not fit into this paradigm as a first food, and here’s why. more »

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Guest Post: Why Pediatricians Recommend Rice Cereal (and Why I don’t Agree)

reneeb : April 13, 2016 10:46 am : Breastfeeding, sore nipples, starting solids

The following is a guest post from Beth Martin. Beth is a certified Nutritional Therapy Practitioner (NTP) in Seattle, and the owner of Small Bites Wellness. She is passionate about whole food nutrition for the whole family and believes that ANY change you make in the pursuit of your health, or your child’s health, is worthy. Health is a journey, not a destination. Please contact Beth for questions about your family’s nutrition.

IMG_0117For decades, rice cereal has been the recommended first food for infants, sometimes as early as two months of age. In recent years, some doctors, nutritionists and the American Academy of Pediatrics (AAP) have begun to change their stance on rice cereal. more »

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Frenotomy Aftercare: Effective and Respectful

reneeb : February 28, 2016 7:46 pm : Breastfeeding, Frenotomy, Lactation Consultants, tongue tie

Your baby has had a frenotomy/frenectomy (frenectomy is the term for laser frenulum release and frenotomy for scissors) and the last thing you want is for it to heal incorrectly–possibly requiring a second procedure.  You probably got a handout with instructions for aftercare. It sounded simple when your IBCLC was discussing it with you.  But now that you’re home with baby, it all seems so confusing. What are all these “stretches” and “exercises” people are talking about?

Your provider might call them “stretches,” or “sweeps” or “exercises”. Whatever they are called, there is one purpose–to ensure that the frenotomy site heals as open as possible; which, in turn, will give baby more mobility (movement) of his tongue. We want that beautiful diamond that was created with the frenotomy or frenectomy to stay a beautiful diamond. Just like the one below.

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This photo was taken just a few days after a laser frenectomy. The color of the diamond is normal. It will be white or yellowish for a few days before it fades to pink.

 

 

 

 

Doing effective aftercare means you have to get your fingers in your baby’s mouth.  You’re not used to it. It feels strange. And baby likely won’t be thrilled about it either. Keep in mind, however, that there are probably a lot of things that your baby objects to, but you do it anyway, right? You change her diapers, bathe her and put clothes on her–all with some degree of protest from baby.

A few pointers to make this easier for both you and baby. Ask permission–verbally or by gently tapping on mouth with your fingers. Be matter-of-fact about the process and let baby know what you’re doing. Keep it short. Lastly, no need to be rough–you can be gentle and still be effective.

Here’s a short video of a tongue tied baby who is graciously helping to demonstrate aftercare. Most babies–including this one–really dislike anything under the tongue. She lets us know that she is not happy about the “forklift” maneuver, but she is not in any pain. Note: This is before the frenectomy so the frenulum is still present.

 

 

The photo below shows the forklift maneuver from the perspective of the parent. Note that the IBCLC in the picture is approaching from the top of the baby’s head. This is the most effective way to get complete separation of tongue and the floor of the mouth. The middle fingers are holding the chin to get separation–not merely a lift of the tongue. If you only lift the tongue, the jaw will follow and separation will not occur.

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Gloves are not required if you are the baby’s parent! But some parents do use gloves to do the aftercare because of concerns about fingernails. It’s up to you. Do whatever works for you to ensure that these “exercises” happen at least 6 times per day.

Finally, whether laser or scissors, please schedule a follow up with your IBCLC and your frenotomy/frenectomy provider about 5-7 days post procedure. You and your baby will benefit most from the procedure with timely follow up.

See also: “My Baby is Tongue Tied?”, “Twenty Things You Don’t Know about Tongue Tie”

If you suspect that your baby is tongue tied, I’m happy to help! No matter where you are around the globe, virtual consultations are available. If you’re in the Seattle area, we can meet in your home or at Docere Center for Natural Medicine.

For frenotomies in the Seattle area I highly recommend Dr. Chenelle Roberts at Docere Center for Natural Medicine in the Greenlake neighborhood.

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Virtual Lactation Consultations

reneeb : February 8, 2016 5:39 pm : Breastfeeding

Meeting with a terrific IBCLC in person can be a game-changing moment for a parent struggling with breastfeeding challenges. But what if there is no IBCLC in your area?Maybe you’ve had a less than helpful experience with your local lactation professional. Or, perhaps you’re looking for a very specialized type of expertise. In all of these situations, a video conference may be perfect for you! With the advent of video conferencing platforms similar to skype and facetime, I can now see my clients and their babies from 1000’s of miles away!

Here’s what Dani had to say after a recent remote consultation with her and her baby who was refusing the breast:

“Renee was able to help our family tremendously even through cyberspace! She was very professional and respectful, I felt very comfortable– almost like she was in the same room with us. She also had great follow-up and support with our family. We were able to start exclusively nursing again after a several month break and other barriers in just a few days!”

This parent was able to show me frenulum of baby from afar.

This parent was able to show me the baby’s frenulum from afar.

If you like the idea of a remote consultation, here’s what you need know:

  • Consultations need to be scheduled in advance. I can usually schedule w/in 24-48 hours of your request. Be sure to let me know your time zone when you request an appointment!
  • I use a HIPAA-compliant platform so you don’t have to worry about privacy. There are no recordings made during your session.
  • Once your consultation is scheduled you will receive an invitation via email. You’ll be asked to download a small file so you can use the platform and we can see each other. This process is simple and takes less than a minute.
  • You will need to have high-speed internet to participate in a virtual consultation. A laptop, tablet or phone can be used as your camera. A helper to aim the camera can make things go smoothly.
  • Good lighting is essential—especially if I need to look into the baby’s mouth. Have a flashlight handy just in case.
  • If you’d like to bill your insurance company, you will be provided with a superbill and instructions for how to complete it.
  • Consultations last about an hour. Follow ups can be scheduled as necessary.
  • Payment for your consultation is made in advance through paypal. If you don’t have a paypal account we can make other arrangements for credit card payment over the phone.
  • I will do my best to locate professionals in your area who can help support the plan we develop together.

If this sounds good to you, shoot me an email to schedule. I look forward to meeting you soon!

 

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Ten Facts You Must Know about Insurance and Breastfeeding Support

reneeb : June 1, 2015 2:57 pm : Breast Pumps, Breastfeeding, Insurance Reimbursement, Lactation Consultants, Working and Breastfeeding

My dear colleague and friend, Joy Funston, recently attended a webinar to understand the rights of the breastfeeding mother under the Affordable Care Act. (In the US) She graciously shared what she learned with her colleagues. We collaborated to write this post and bring this important information to as many mothers and mothers-to-be as possible.Thank you Joy!!

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If you are in the U.S, you have probably heard that the Affordable Care Act (ACA) mandates insurance coverage for lactation support. You are correct! Unfortunately, the details of the law are vague,and that has created loopholes for insurance companies to jump through.

For example,  the law requires that insurance companies develop a network of breastfeeding professionals. The may “say” they have a network of lactation consultants, but on closer inspection, it is found that lactation services will only be a covered expense if they are provided by a licensed medical professional such as an M.D.  As we know, the vast majority of M.D.’s do not provide lactation services.

Another important aspect of the ACA is mandated coverage for breast pumps & supplies. Unfortunately, no details are included. What type of pump?  Who decides?

The National Women’s Law Center in Washington, DC has attempted to be a resource for moms trying to access coverage and to IBCLC’s offering assistance. The following information is from a webinar that they provided. 

Know your rights! If your insurance company has denied lactation services by an IBCLC, here are the points that you can argue with your insurer:

1.The lactation portion of the ACA states that specific benefit are covered “for the duration of breastfeeding.” Insurance companies are not in compliance with the law if they have arbitrary rules for a set number of consultations or certain age of the baby. There are a couple of exceptions: “Grandfathered plans” and some private “self-insured” plans do not always have to follow the ACA.

2- IBCLC’s are ready and available as trained experts in lactation. No other credential comes close. And no other credential is needed. 

3. While not the intent, ineffective breast pumps satisfy the law. The ACA does not specify the quality of a pump.  Note from Renee: Given the law as it is now, I recommend purchasing your own pump if your insurance company will not provide the type that you need. .

4. The ACA does NOT include a requirement of return to work or school for breast pump coverage.

5. Tricare, insurance for military personal, is NOT covered by the ACA. But things are changing. Recently there was a mandate for covered benefits by the armed forces appropriation’s bill.

7. New marketplace plans ARE, in fact, covered by the ACA.

8. The law mandates “no cost sharing” for lactation support services. This means no co-pay, no deductible and no co-insurance cost. Period.

9. Each insurance company is supposed to provide in-network professional lactation support options. If there is no in-network option provided which is geographically accessible, you may go out of network for support. Keep in mind that the vast majority of insurance companies do not allow IBCLC’s to become in-network providers. The insurance company can use this to deny benefits. This is a “Catch 22” situation and needs to be reported.

10. Any complaints about insurance noncompliance should go directly to your state’s insurance commissioner.  Every time. Every mom. Every problem. Note from Renee: Washington state’s insurance commissioner is very responsive! Documentation of insurance noncompliance can also be reported to www.coverher.org.  They hope to continue to compile data & to be a resource.

And finally, part of the ambiguity in the implementation of the ACA is that the insurance companies are not acknowledging who actually is the expert breastfeeding professional. IBCLC is an international recognition– the only professional qualified to step into the role the law envisioned. But IBCLC does not come with a “license” and in the USA, Insurance companies traditionally reimburse the services of licensed professionals only. Please support state licensure of IBCLC’s when you can.

Sadly the law was not precise… But the intent was very clear. Mothers are absolutely entitled to healthcare benefits for lactation support. Consumers need to demand the coverage their premiums are mandated to provide.

Joy Funston, RN, IBCLC. RNC is in private practice in Charlottesville, VA.  She can be reached at www.joyfulstartlc.com.

 

 

 

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Tongue Tie and Social Media: Concerning and Confusing!

reneeb : December 14, 2014 4:13 pm : Breastfeeding, Lactation Consultants, Mom/baby story, tongue tie

This post was co-written by Renee Beebe and sister IBCLC Jessica Altemara. Thank you Jessica for your inspiration and professionalism! 

20140828_095301Some lactation professionals have been trying to address a lack of understanding regarding tongue ties and lip ties for many years. They wanted it better known that tethered oral tissue (term used to refer to all types of “ties”) can negatively impact breastfeeding. But now, with the advent of instant-access social media, we are seeing a trend that is a bit disturbing to these same advocates. We see mothers diagnosing their babies’ tongue ties based on images they see on a Facebook group. We see professionals saying to mothers: “That baby needs a frenotomy,” based on a picture posted to Facebook.  more »

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Breastfeeding Help from your Physician? Maybe Not.

reneeb : October 26, 2014 2:44 pm : benefits of breastfeeding, Breastfeeding, Formula, Lactation Consultants, Milk Supply, Mom/baby story

photoBreastfeeding is something that every mother and every baby has a right to do. More importantly, it is widely accepted as the preferred way to feed a baby. We can all rattle off numerous health risks to mom and baby that can result from artificial feeding. It follows, then, that our health care providers—especially those who are charged with the task (and privilege!) of supporting new mothers and vulnerable infants—would be well versed in how to support the breastfeeding dyad. Tragically, this is sometimes not the case. more »

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Nursing Your Older Baby or Toddler

reneeb : October 25, 2014 5:20 pm : benefits of breastfeeding, Breastfeeding, Teething

 

DSCN2783The word breastfeeding typically conjures up soft-focus images of mom/baby blissful, peaceful togetherness. The baby is still, looking up into mothers eyes, or perhaps drinking with eyes closed. Mother has a dreamy look on her face as she enjoys the warmth and glow of oxytocin. It is a beautiful, serene picture.

As you baby grows, things may change. You will still get those sweet, sleepy nursing times. But when awake, your older baby will want to move. She may even want to move while she is attached to the breast. She may put her foot in the air. Or on your shoulder!  She may want to nurse standing up or upside down. She will want to see the source of the noise across the room. She wants to interact with big sister without letting go of your precious breast. And often, she doesn’t seem to realize that the breast is attached to YOU! We often call this “acrobatic nursing.”

DSC_0779Some older nurslings will find it absolutely necessary to keep at least one hand busy throughout the nursing time. Your baby may want to play with your hair, your necklace or a toy. He may even want to hold the other breast. Even though all of these behaviors are perfectly normal and developmentally appropriate, I’m the first to admit they can be annoying.

Breastfeeding is a relationship between 2 people. If there is something going on during breastfeeding that is painful or you simply don’t like it, it’s perfectly ok to say so! When your newborn baby didn’t latch correctly and it hurt, you broke the latch and tried again. If your toddler is amused by pinching your belly fat while she’s nursing and you don’t like it, you can let her know it’s not ok. It’s completely appropriate for you to set limits. It’s your body! If, on the other hand, you find your nurslings acrobatics amusing and cute, by all means, enjoy!

64256_10153268688688448_8493501332460479548_nOne of the truly wonderful and often overlooked benefits of nursing toddlers is the immediate pain relief it provides. Toddlers fall—a lot. They bang into things. They get frustrated by what they can’t do yet. A quick dose of your milk will often cure whatever has made your toddler dissolve into tears. Whether it’s rage or pain, nursing is nothing short of miraculous.

Enjoy your nursling. This time is short. Soon he’ll be running around having fun with his friends and will simply be too busy to cuddle with mommy. Oh, ok.. maybe just a little!

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See also, “Breastfeeding and Biting: Tips to Avoid Those Teeth!” And “Weaning: What’s Normal?”

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Low Milk Supply: Tricky to Treat!

reneeb : August 31, 2014 11:35 am : Breastfeeding, Formula, Lactation Consultants, Latching, Milk Supply, Mom/baby story, sore nipples, tongue tie

Supplementing at breast

Supplementing at the breast.

When a mom is experiencing difficulty making enough milk for her baby, the usual suggestion from well meaning professionals is often, “Nurse your baby more —your body will rally and you will make more milk in just a few days.” This suggestion is based on the law of supply and demand. When more milk is removed from the breast, the breast will respond by making more milk. While this advice can be legitimate in some situations, many times it can result in an exhausted baby who, despite mom’s best efforts, can’t get enough milk to gain well. more »

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