Great efforts, Hoda, and unfortunately facing issues all too many face.
Have you attended your local Bf Coalition? I find them a fabulous resource. Folks there may save you a lot of duplicated effort.
I'd encourage you to develop a relationship with 1 or 2 docs. You may find that your local WIC office has already done so. Possibly there could be some coordinated effort to send an interested physician for further training. I've heard of that happening in some areas.
Do you send reports to the physician? That may be part of the process of developing the relationship. I've also asked for permission to accompany parents to the appointment. Once I went prepared to advocate and found the physician fully supportive (such a pleasant surprise).
Wish I could answer your other questions better. For some reason I was under the impression that Medi-Cal covered the Purely Yours.
Mary L. Wagner-Davis, MS, MFT, IBCLC, LLLL
Roseville, CA
---------------------------------------------------------------------------------------
Date: Fri, 21 Nov 2014 22:50:30 -0800
From: Hoda Shawky <[log in to unmask]>
Subject: Lactation for the underserved
Hello everyone,
I'm a new IBCLC, and for the past 5 months, I have been
working in a
community clinic on a pilot project to offer lactation
services in
California. I have quickly taken note to the differences in
providing BF
care for clinic versus private practice patients. Here are
the challenges
I'm facing...
1. For one, I'm having a lot of trouble finding an ENT
doctor who accepts
MediCal who will do frenotomies for posterior tongue ties or
lip ties. They
all state that they do them, but when I refer the patients,
they don't do
the procedure (with one baby, who wasn't gaining weight,
feeds for a very
long time, and has already chewed into the mother's nipples)
the parents
were told the baby didn't need it). Similar things have
happened to other
patients, and I truly only refer the ones who have
significant problems
that are not corrected with adjustments in positioning, and
whatever else
we can teach them in the clinic.
2. Does nipple confusion sometimes mimic a posterior tongue
tie when you
feel the peristaltic motion of the tongue? In both cases, I
feel the same
thing; the posterior portion of the tongue compresses the
finger up against
the palate, and the motion is often disorganized. Many of
the babies who I
felt had tongue ties did better with my "pseudo suck
training" (for those
whose parents understood and were committed enough to do
it). What I teach
them is more a gentle stroke to relax the tongue rather than
true training.
This has seemed to work with some who I knew will not get
the frenotomy. Am
I on the right track with this? Do you use similar
techniques to help with
babies who are symptomatic like this?
3. MediCal and our county's subsidized insurance programs
cover 1 type of
pump that we know of- the Evenflo single electric pump.
Based on pt.
feedback, they break easily and don't do very well pumping.
Does anyone
know of alternative pumps that insurances for the
underserved are willing
to cover?
4. Now I just need to vent on my frustrations. While I feel
so blessed to
be able to encourage more exclusive breastfeeding in an area
that has very
little support, it's also very saddening how even something
so natural as
exclusive breastfeeding ends up being a luxury due to the
lack of resources
for the poor.
5. Anyone know where a pediatric NP can be trained in
performing
frenotomies??!!!
I'm trying to make the best of my limited resources, but I
wanted to see
what suggestions or wisdom you may have to offer so
that I may be more
effective.
Thank you!
Peace and blessings to all,
>
> Hoda Shawky, RN, MSN, CPNP, IBCLC
> *Owner, Baby's First Nurse*
> (424) 26-BABY-7 OR 262-2297
> www.BabysFirstNurse.com
> [log in to unmask]
>
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