Getting ready. It is always good to be prepared and I find that women have the hardest time in the first 1-2 weeks after they give birth. It is a very difficult task to try to figure out how to take care of a new infant and keep them fed and satisfied at the same time. The goal is to be prepared for when your new bundle of joy arrives to help you feel less overwhelmed and to establish contact in case you need to reach out to someone during this difficult time

Immediately after birth

This is when most moms reach out for support. Everyone’s story and difficulties are different and depend on many different factors.

Understanding biology of breastfeeding. We talk about the biology of breastfeeding and what you should be expecting.

Nipple care: large nipples, flat nipples, cracked nipples, pain
Proper latch. Discussing of factors that could be influencing latch (ex: size and shape of nipple, prematurity)
Positioning. Different positions work for different people and depending on the anatomy of mother’s body and age/anatomy of the baby, we try to figure out the best positioning for the mommy and baby
Milk supply. There are many factors that influence milk supply. Anatomy, frequency of feeding, efficient emptying of the breast, as well as many other factors could be contributing to this issue. We use out time efficiently to come up with a long term plan to ensure a lasting milk supply
Engorgement. This is a painful and difficult issue but the positive is that the milk supply has been established and we will work on figuring out the best way to transfer the milk from breast to baby
Tongue tie. This is occasionally an issue that I encounter when evaluating babies. Tongue time prevents babies from having the appropriate tongue motion to create enough sucktion to empty the breast efficiently and causes blisring and cracking of the nipples. We will evaluate the baby and fix the issue if needed
Twins. Twice the joy but also twice the breastfeeding difficulties. The goal hear would be to come up with a plan that works for you to help with successful feeding but also to work with your schedule
Using available tools. We go over when nipple shields are appropriate and their sizing. If you are interested in using the pump we make sure that you feel comfortable using your equipment and that it is the right fit for you. We also discuss hand expression if mom is interested

At few months of life

Milk supply issues. As the baby becomes older and starts sleeping through the night, we sometimes encouter issues with milk supply. The goal is to come up with a plan to help keep up the milk supply to the duration of the feeding desired by mommy and baby
Going back to work. In our modern day society, women usually go back to work at few months of life. The goal here is to discuss proper milk storage, when to start saving milk, how to keep up the needs of the baby, evaluate if the pump fits appropriately, and to come up with a plan that would work with your job to achieve long term breastfeeding success
Food intolerances. This is a rare issues but deserves discussiong. Working together with the baby’s primary care provider, we will come up with a plan to continue breastfeeding while evaluating possible allergens

At 6 months of age

Starting solids. This particular time deserves special attention because the baby will be starting solids around this time. We discuss ways to intriduce solids but also to keep up breastfeeding and milk supply. This is a specially difficult time because the infant become more aware of surroundings and the distractions which can create new challenges

At 12 months of age and beyond

Thinking about weaning. There is no “right time” to wean the baby but after 12 months, if desired, we can discuss how to transition from breastmilk to regular milk and diet.
Nursing while pregnant. If another baby is on the way, we can discuss the changes that are going on in the body and how it will influence the feeding child and growing infant.
Tandem nursing. Goal is to establish a plan to nurse the newborn baby while satisfying the cravings of the older child

Two types of visits:

Initial

During the initial consultation we will address your main concerns and hopefully have a successful feeding.

The visit starts with some background information. The reason we collect this information is to give us a clue about what possible issues could be occurring and how to fix them. For example, premature babies are sleepy at the breast and knowing that information is an important tool to get to the solution. Here is the basic information that we usually gather:

At how many weeks gestation was the baby born?
How old is the baby now?
Were there any complications during pregnancy or delivery?
Was it a c-section or vaginal delivery? Was it planned or unplanned?
Does the mom have any medical problems?
Are there any concerns about the baby’s health?
How much did the baby weigh at birth? How much does the baby weigh now?
Is this your first baby?
If not, did you breastfeed your other child/children?
Has the mother had breast surgery?

After gathering the information, we will examine the baby to assess for tongue tie, low tone and other potential issues.

Then, we usually try to put the baby to the breast and get a good latch. Usually, we will try different positions to encourage the baby.

If we are not able to latch the baby, we go through other creative ways to improve the breastfeeding experience including nipple shields and supplementation devices.

At the end, we will review what we talked about during the visit and talk about what to expect in the upcoming weeks and months. We also go over other topics that may be of interest to the mom, such as milk storage and going back to work.

Follow-up

If feeding is still a concern or if new issues arise, we will have a follow up visit. During this visit we will mainly focus on the concerns at hand.
If the baby is still having trouble latching, we will spend most of the time trying to latch the baby to the breast.
If milk supply is a concern, we discuss ways to improve and maintain supply. These visits are more problem focused but questions are always welcome and encouraged.

Prior to birth

Immediately after birth

This is when most moms reach out for support. Everyone’s story and difficulties are different and depend on many different factors.

Understanding biology of breastfeeding. We talk about the biology of breastfeeding and what you should be expecting.

Nipple care: large nipples, flat nipples, cracked nipples, pain

Proper latch. Discussing of factors that could be influencing latch (ex: size and shape of nipple, prematurity)

Positioning. Different positions work for different people and depending on the anatomy of mother’s body and age/anatomy of the baby, we try to figure out the best positioning for the mommy and baby

Milk supply. There are many factors that influence milk supply. Anatomy, frequency of feeding, efficient emptying of the breast, as well as many other factors could be contributing to this issue. We use out time efficiently to come up with a long term plan to ensure a lasting milk supply

Engorgement. This is a painful and difficult issue but the positive is that the milk supply has been established and we will work on figuring out the best way to transfer the milk from breast to baby

Twins. Twice the joy but also twice the breastfeeding difficulties. The goal hear would be to come up with a plan that works for you to help with successful feeding but also to work with your schedule

Using available tools. We go over when nipple shields are appropriate and their sizing. If you are interested in using the pump we make sure that you feel comfortable using your equipment and that it is the right fit for you. We also discuss hand expression if mom is interested

At few months of life

Milk supply issues. As the baby becomes older and starts sleeping through the night, we sometimes encouter issues with milk supply. The goal is to come up with a plan to help keep up the milk supply to the duration of the feeding desired by mommy and baby

Food intolerances. This is a rare issues but deserves discussiong. Working together with the baby’s primary care provider, we will come up with a plan to continue breastfeeding while evaluating possible allergens

At 6 months of age

At 12 months of age and beyond

Two types of visits:

Initial

Follow-up

If feeding is still a concern or if new issues arise, we will have a follow up visit. During this visit we will mainly focus on the concerns at hand.

If the baby is still having trouble latching, we will spend most of the time trying to latch the baby to the breast.

If milk supply is a concern, we discuss ways to improve and maintain supply. These visits are more problem focused but questions are always welcome and encouraged.