Sharon Knorr wrote:
>Are you an IBCLC, LLLL, ??? This mom needs to be seen by a competent IBCLC.
>
No I'm not, and I don't pretend to be. In the long run, I would like to
become an IBCLC, but that is many years down the road. I'm curently a
lactation educator, and the majority of what I do is pre-natal
breastfeeding classes. For 3 years I was also the person responsible
for workplace lactation support at my full time (non-healthcare
realated) job. So I have worked with quite a few moms over the past 3
years, in addition to being a nursing mom myself for the past 4.5
years. When a problem is more complicated than what I can easily provide
support on, I always refer women to an IBCLC. This mom has seen an
IBCLC who was not very helpful and is not eager to pay for another
consult. Since she is unwilling/unable at the moment (for financial
reasons), I am trying to give her some ideas. She has also been
attending LLL meetings, but the only ideas that she has been given there
are related to diet. She has tried to eliminate common allergens,
however, since the baby is content to take her pumped milk from a
bottle, she does not think that allergies are the issue.
>it is never normal for babies to be coughing and struggling at the breast - and certainly an 8 wk. old baby is way past the learning how to breastfeed stage, so I don't know what this LC she did see was thinking.
>
This was my thought also, however I did not express this to the mother
since I did not want to undermine the IBCLC that she saw. Also, the
coughing has stopped even though the fussing has not.
>What was happening for the first 6 wks?
>
She says that the first 6 weeks went fine.
> How is the weight gain?
>
The baby is gaining well and is healthy, just not happy at the breast.
>Have you actually ever seen this dyad? This is not a slam against you, Trish. I don't know how much experience you have or what else has gone on with this case. However, when people post with case histories, it is difficult to give any suggestions when so much basic info is missing. Also, in many cases it is really going to be close to impossible to help a mom and baby unless someone who knows what they are doing sees them and does a thorough examination and evaluation.
>
No, I have not seen them in person. If a problem is so severe that an
in person consult is necessary I refer women to an IBCLC, I don't do in
person consults. This mother was sent to me by a mutual friend and
since she is unwilling/unable to pay for another IBCLC at this time, I'm
trying my best to support her.
>I've done counseling by email, but I don't like it much unless it is a simple question or problem. Otherwise, if I can't see them, I don't feel that I can ethically try to help. Same thing with stuff over the phone. Supporting a new mom with a pat on the back and basic breastfeeding stuff is one thing. Once a problem has gone on for a while or if baby is not thriving, then someone has to see them or in most cases, there will not be a resolution, except for weaning. I'm not saying that long-distance counseling can never work, but it's very difficult and leaves most LC's feeling very uneasy as the process continues and the LC is never really sure if what she is hearing described is what she would actually be seeing if she were there. It's better than nothing, but it's not a great solution in a complicated case.
>
I understand all of this, and agree, but at the moment "better than
nothing" is the best that I can do for this mom. I will continue to
suggest that she seek out another IBCLC, but in the mean time, I want to
give her what support I can.
>Baby could have reflux.
>
Reflux has been ruled out by her pediatrician, including a trial course
of zantac which did not provide any relief
>There are no easy answers here. Keep us posted on how things go. Good luck.
>
Thanks for all of your thoughts. I hope that she will re-consider
seeing another IBCLC, but if not then I hope that I will be able to
offer some suggestions that will help her. Or at least encourage her to
hang on until she is willing/able to see someone else. I will let you
know what happens.
Trish
--
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