The purpose: Gather tips and techniques from an IBCLC that I can put to use when I start seeing patients again.

The mission: Spend a morning shadowing Elysia, owner of Mason Lactation and Wellness during an in-home lactation appointment.

The results: Welcoming us into their beautiful country home was a sweet 4 month old with a quick, easy smile and his Mama. While I took a seat out of the way, Elysia began her 60-90 minute follow up appointment.

When there is no ‘magic bullet’ to fix the problem

Here is something I noticed that really hit home for me. Now, I’ve been in this field long enough to know that there is not a simple fix, magic-bullet, for all (or let’s face it, for many) dyads. When I first started in the field, I would feel like a failure if I could not give very specific, actionable steps that yielded very clear results. Over the years, as I gained more experience, I learned some different strategies to address these challenges. Elysia handled this situation beautifully. The primary concern of the visit was bottle refusal, this was a follow up appointment and the basics had been reviewed at the first visit: try a different bottle nipple (consider Dr. Browns), let the baby play with the bottle, have someone other than Mom offer the bottle, try rocking and swaying while offering the bottle, etc. Well, the 4 month old still was not interested in the bottle and Mom was concerned. After doing an oral assessment and observing an attempted bottle feed, Elysia gave some tangible next steps for the parents to try: some very gentle stretching of the labial frenulum, cheek support, etc. And yet, there was no simple fix today, baby did not take a bottle while we were there. The real magic came in the second half of the visit: Elysia dug deeper to address the underlying concern. WHY was mom so worried about baby taking a bottle? The answer happened to be two fold:

1. Mom would be returning to work when baby was 8 months old and wanted him to take a bottle while she was away. Elysia addressed this directly, explaining to mom that if he won’t take a bottle at that time, he can always take breastmilk through a sippy cup. So, it will be okay if he is not taking a bottle at 8 months, he will still be fed while she is at work.
2. Mom was feeling very anxious about leaving her baby for a couple hours for something as simple as dinner out with her husband. Elysia dove deep into this topic and had a full conversation with Mom, uncovering her fears, talking through her emotions, and then discussing ways to help her overcome this even if baby is not taking a bottle.

So, while we did not have a simple fix for the bottle solution, there were quite a few actionable next steps to try. And, equally -if not more- important, they addressed mom’s fears and the reason WHY she was so concerned about her baby not taking the bottle. This was a really good reminder for me to dig deep to the WHY behind the concern, especially when it is not a simple fix.

Putting parents – and baby – at ease while assessing baby

One thing I noticed as she was assessing baby- the whole entire time- she was talking to the little one. That baby was smiling and cooing and just loving the interaction. As an onlooker, I can only imagine, that this puts mom in a place of calmness and trust. When I was a new lactation consultant, I very vividly remember being very focused while I was assessing baby, very much in my head, thinking about all the things. And that’s okay. I’ve been to many doctor offices with my littles where the nurse or provider is quietly assessing my little one. And, there is a totally different feeling in the room, a totally different vibe from the provider, when they are cooing and engaging and smiling with my baby. It takes that level of professionalism and adds a level of comfort and trust. This is one small, simple action that I can practice when I assess babies in the future. When I asked Elysia about this later she shared that the narration is primarily for baby, to ensure the baby is comfortable with her and to get permission from baby for things like the oral assessment. Now I think it is really important to be aware of sincerity. If you’re faking this interaction, the parent is going to pick up on that. Instead, make a conscious effort to engage with the baby in your own way. In my opinion, this will up-level the relationship with the parents and give baby another level of comfort and respect.

Verbiage from Website

Here is something that I very much appreciate and never expected to be writing about: verbiage on a website. MasonLactationandWellnessLLC.com has certain phrases that, as a mom myself, I truly appreciate. Here are a few things found on Elysia’s website that, I’m sure, really resonate with parents:

• Under her Insurance section she talks about how she can provide a super bill, but the real magic is found under the heading “Will My Insurance Reimburse Me?” Of course, she recommends calling your insurance company; but, the beautiful addition is that she gives you the exact questions to ask your insurance company when you call:
  • “Do you reimburse for out-of-network lactation consultations provided by an IBCLC?”
  • “Are there any restrictions on who can provide these services or how they are delivered (e.g., home visits, virtual visits)?”
  • “What documentation do you require for reimbursement?”

Giving the patient the exact questions to ask their insurance company, and listing the prices on the website, the patient should go into this visit knowing what it is going to cost them and what their insurance will reimburse. For the parents concerned about finances – most of them – this should give them clarity and peace of mind knowing what to expect. As a mom, myself, who is currently two months postpartum, I am getting hit with medical bills from every which way. Unfortunately, I did not know how much many of the bills would come to, so simply knowing ahead of time what to expect gives you an edge over most medical practices.

In other verbiage, I truly appreciate this wording right here, found in the FAQ section under the heading What happens during an in-home visit?

• “Provide hands-on (or off!) guidance for positioning and latch techniques tailored to your unique needs.“

I love that she stresses the (or off!). I picture a new mother, three or four days postpartum at 2:00 am worried about her baby, dreading the next feeding because her nipples hurt, wanting help with breastfeeding and hating the thought of some stranger touching her – maybe she has a history of sexual abuse. She stumbles upon this website while she scours the internet for help, she reads the ‘my story’ section on the main page and tears up because she feels like she is not alone. She looks a bit closer at the website because she’s at the end of her rope with feeding and she knows she needs help if she is going to keep breastfeeding. And, she just dreads the thought of some stranger touching her. Then, she sees that Elysia can offer hands-off guidance and she breathes a small, imperceptible sigh of relief and decides to reach out for help.

This leads to the other part of her website that I personally adore:

• ‘my story’. Found on her main page. I think it is so beautifully written and truly captures the experience and the feelings that I saw time and again while working with parents during that season of caring for a brand new baby. I get chills when I read it.

Let’s talk charting.

Elysia prefers good ole pen and paper, and so she does paper charting that she then scans into her electronic records and gives to the patient. She has beautiful hand writing, so she can pull it off. I’m a keyboard typer through and through, so I won’t be borrowing this technique from her – but if you like paper charting, she has a very nice set up that may interest you.

She has a multiple page template that she brings to every appointment. The template has orderly, clear sections defined by a few blank lines between sections and a beautiful blue heading above each. It appears very professional and simple to read with a pleasing aesthetic. Under each section are prompts for her charting, some spaces are lines for free writing, others are check boxes for quick and simple notations. Once she has finished her charting, she scans it into her computer and sends her patients a copy. Her patients can then share it with any of their providers, peds, OBGYN, etc. She does this to encourage communication with their pediatrician or other provider, so that the Doctor can quickly and easily see how the visit with the lactation consultant went. If you’re going to hand chart, it sounds to me like this is the way to do it.

If you incorporate any of these techniques into your practice, let us know how it goes in the comments.