Originally written May 29, 2012 and updated July 2, 2020

Many of you know me as a Birth Doula, Bradley Childbirth Instructor, and an IBCLC (now retired from my Doula work but still teaching childbirth education and of course as an IBCLC). I want to focus on the IBCLC right now because tonight on a Facebook Group I was asked what an IBCLC is. IBCLC stands for International Board Certified Lactation Consultant.

There are many people who like to give breastfeeding advice. I see it every day on Facebook and other online forums. I understand the great desire of many to share what they have learned in their own breastfeeding journey. I would like to stress to all the well-meaning folks out there….every breast is different and every situation is unique. Just because shooting pains towards the back were thrush for you, doesn’t mean that it is thrush for someone else. Honestly, it is rarely ever thrush. 

​My path to becoming an IBCLC was a long one. I started working with breastfeeding mothers as a La Leche League Leader in 1999. I had been breastfeeding my first child since he was born in 1996. I met all of the training requirements and started to lead a Group in Austin in addition to answering phone calls and online help questions. I led meetings in Killeen, San Antonio and Corpus Christi before coming back to San Antonio three years ago (now 11 years ago) and leading meetings here again. In that time, I have helped thousands of women in person, over the phone, and online with breastfeeding issues. I have taken phone calls on Christmas Day and New Year’s Eve as well as in the middle of the night. I love working with breastfeeding/chestfeeding families. I had the pleasure and privilege of staying home with my children for 12 years and so my early breastfeeding work was all volunteer time. I didn’t want to sit for the exam even though I was active in my local Breastfeeding Coalitions, organized the Texas State Conference for La Leche League and have always been a proud Activist. When I ventured back into the workforce, I was working an office job. I really hated it. It wasn’t my passion. I decided then to start working towards a job in a field that I love. I found a Mentor in an amazing woman by the name of Linda Worzer. I asked her tons of questions and started on my path as she had years before. I took my DONA training towards becoming a Doula. I flew to California to take training in the Bradley Method of Childbirth Education. The final step was towards becoming an IBCLC. I set my goal and started to gather my hours. Although I already had all of the hands-on hours I needed, I chose to shadow a local IBCLC in the NICU and asked for any insight she and others had to offer. I took in-person and online classes and started studying hard with my good friend Ginger Chun.  We studied for months almost every day and finally we took the exam and PASSED!

(All new content) I have had the pleasure of serving families in San Antonio for many years now. I am honored to be able to support families in their breastfeeding/chestfeeding journey. I am asked often about the process of becoming an IBCLC. I am ALWAYS happy to help answer those questions for you. I know that the websites and online information are confusing. Here is a link to the first place to look https://iblce.org/step-1-prepare-for-ibclc-certification/ . Once you have looked there, if you still have questions, please feel free to contact me via facebook, email, etc. 

I hope that everyone who is interested in pursuing their IBCLC, finds the kind of great support and mentoring that I found. 

Every Wednesday for the last couple of years the IBCLCs of The MILC Group have opened their doors from 10am to Noon for drop in Weight Checks and Lactation Chats. We decided we should write a short blog post letting people know what to expect during Weight Check Wednesday (WCW).

• Weight Check Wednesday is a "drop in" event meaning we do not require appointments.
• Since WCW is a "drop-in" event you will not have privacy while chatting with us.
• Some days we will see one breastfeeding family and others we may see five. We do our very best to give individual attention and to move people in and out in an organized manner.
• We ask that families fill in a very short form for us to be able to keep a track of who attends and also to track the baby's weight gains each week.
• Babies will be weighed before feeding and after feeding in order to get an idea of intake during that feeding. 
• The Lactation Consultants of The MILC Group will sit and observe the baby nursing in order to assess external latch and to listen for any indicators that there may be a latch issue. 
• The IBCLCs will answer any basic breastfeeding questions that families have during the Weight Check.
• Recommendations will be given if a full lactation consult seems to be needed.
• The baby's weight will be recorded for future reference and will be written down for you to take with you. 

Weight Check Wednesday is an excellent way to get accurate information from an International Board Certified Lactation Consultant for a minimal fee and in a short amount of time! It does not substitute for a consult.

The fee for Weight Check Wednesdays with The MILC Group is just $20. Come in and see us this Wednesday!

The MILC Group offices are located inside of Go Baby Go, 6104 Broadway, #C-4, San Antonio, TX 78209. Contact us online at www.TheMILCGroup.com or by phone at 210-960-MILC/210-960-6452.

A week ago I put my home on the market. If you have ever sold a home you know how hard it is to keep it picked up and looking show worthy every day. Today I had to leave my house with my dog in order for the house to be shown. When I returned the folks who had been here were still standing across the street talking to their realtor. It made me wonder....what do people think of my house? 

On the surface I think that my house looks very "normal." It is a simple three bedroom house. The color palate is neutral. I love all things "natural" looking. You can tell I have two daughters that live at home. There are lots of pictures of my children on the walls and in frames scattered around. Then there are the "extras" that probably set my home apart as that of a birth worker/IBCLC/hippie....
​

• Mixed among the art on my living room wall is a gorgeous collage of prints that were given to me by a client. They all depict breastfeeding. I think they are pretty subtle. 
• My Peace corner serves to keep me calm. I love all the little tidbits that have been added to it by friends and family. Underneath are two beautiful books. One was a client gift from The 4th Trimester Bodies Project  and the other is a cookbook my son and his girlfriend gave to me titled Share: The Cookbook that Celebrates our Common Humanity. 
• My bookshelves are filled with birth and breastfeeding books that I have gathered over the years. 
• In my bedroom I keep a bag filled with the things I use when teaching my childbirth classes. On top is the doll that I use for demonstrations. There she lies in her tie dyed baby t-shirt. 
• On my dresser are the remnants of the recent United States Lactation Consultant Association Conference. Just some boob friendly items including some nipple shield samples. 
• My stove hood is home to some boob magnets that I made for some events.
• My water bottle is hanging around my kitchen with the "Boobs The Original Organic Food" sticker.

I wonder if people notice these things? I wonder if they have an image of me? Hopefully it makes them smile. Maybe they will be my clients one day. Just my random thoughts for today. 

Families in the San Antonio area have a good number of choices for their breastfeeding support needs. We wanted to compile a list of reasons that you should choose The MILC Group. 
​

1. Ginger and Tina have a combined 25 plus years of experience working with breastfeeding families! That's a lot of experience.
2. Ginger and Tina both started their careers as La Leche League Leaders. Why does this matter? La Leche League is the largest non-profit breastfeeding organization in the world. As La Leche League Leaders both Ginger and Tina have had the privilege of working with families from birth into the toddler years which creates a wide range of knowledge. They also show an obvious passion for this work since they continue to volunteer their time to La Leche League instead of only doing paid lactation work. 
3. Giving to their community is of the utmost important to The MILC Group. Both Ginger and Tina still are active with La Leche League leading monthly meetings and attend many outreach events in our area to give as much to our community as possible. 
4. Education is the foundation of what Ginger and Tina do. They both attend in person and online conferences regularly to keep their skills up-to-date. 
5. Both of the MILC ladies have sought out additional hands-on training in the evaluation of tongue and lip ties as well as other structural issues. Other IBCLCs may have taken online trainings or sat through talks, but hands-on training is so valuable to this profession. 
6. Integrity is of the utmost importance to both Ginger and Tina. We are who we say we are. 
7. Relationships with other care providers is also so important and so we work to develop these relationships to benefit our clients. 
8. Developing relationships with our clients matters to us. We strive to continue to support the families that see us for as long as they need. The MILC Group offers weekly Support Groups and Weight Check opportunities to help families keep on track with their breastfeeding goals without breaking the bank. 
9. Last but not least....we are awesome! We work daily to be the best International Board Certified Lactation Consultants that we can be :) 
10. I feel like I should make one more to create an even number.....how about the fact that we are amazing parents and our kids love us. That's pretty darned important!

Your baby has arrived and you are having problems breastfeeding. What should you do? Some of your knowledgeable friends suggest that you should see an IBCLC (International Board Certified Lactation Consultant). That sounds okay, but you want to know what to expect during a meeting with one. Here is what to expect if you choose to meet with an IBCLC from The MILC Group.

• The Lactation Consult  lasts about 1.5 - 2 hours whether in our office or in your home. 
• ​We make every effort to arrive on time and call or text you if we are running behind.
• We bring a high quality baby scale which we use to weigh your little one. 
• If we make a housecall,  we set up our scale on a flat surface (kitchen counter tops work great), otherwise we always have a scale in our office.
• We wash our hands thoroughly before we touch you or your baby and we also use non-latex gloves during our exam.
• We  ask you to fill in a brief intake sheet which can be found ahead of time on our website, but we always have them available to fill out in person.
• If baby is hungry, we skip ahead and weigh the baby so you can start to feed them. If baby is sleeping, we complete the paperwork before waking the baby to feed.
• We take a health history, talk about your birth and your breastfeeding experience so far and we ask some possibly odd seeming questions (we will always explain their purpose). We get a lot of insight into issues during this part of the meeting.
• We weigh your baby in a diaper only. We always ask you to put a clean diaper on your baby before the weight which stays the entire time for the most exact pre and post feed weight possible.
• The MILC Group IBCLC performs an examination of the baby including an oral assessment. We explain what we are doing as we do it so that you feel completely comfortable as well as to point out what we observe along the way.
• Getting you comfortable before nursing is important so we in your home we set up in whichever space you feel most at ease and in our office, you choose your spot and which pillows you want to use (or not use).
• We assist your baby in latching as needed and watch and listen as your baby feeds at the breast. We correct positioning as needed during the nursing session and make any other adjustments. 
• After the nursing session, we again weigh the baby to get an idea of how much baby has transferred at the breast. 
• All of this information will go into our assessment of what issues you may be having and we will write up a care plan for you to refer back to and to share with your care providers. 
• The MILC Group provides you with a Superbill for your insurance company to be reimbursed for our services.
• We take payment at the time that services are rendered. We accept cash, checks or credit cards. 
• It is extremely important to The MILC Group IBCLCs that all of your questions and concerns are addressed so we do not rush you through the appointment and we make sure along the way that you have time to ask questions. Feel free to have a list ready for our appointment :) 

We hope that this answered your questions about what to expect if you schedule a Lactation Consultation with The MILC Group. We look forward to meeting with you and your family!

​We can be reached by phone at 210-960-MILC/210-960-6452.

Low milk supply seems to be a main concern for today's breastfeeding mother.  I do remember mothers asking, "how will I know that my baby is getting enough?" and, "how much milk does my baby need?" back when my first child was born (19 long years ago).  The difference I suppose was that we were satisfied with the answers we were given and we never pumped to see how much our body was presumably making.  We relied on observing our baby. Today's mother seems to want more answers and to know exactly how much milk she is making.  Here is a brief overview of Low Milk Supply. 

When should we be concerned that our milk supply might be low?  

• Insufficient Weight Gain
  
• Babies are expected to gain approximately one (1) ounce per day for the first two months and then half an (.5) ounce per day until around six months of age.  Remember however that all growth charts are just guidelines to follow.  They were developed to help monitor the growth and development of a large amount of babies especially in poor areas to watch for anything going wrong.  Now we utilize them for every baby but often we put too much stock into those numbers instead of looking at the whole child.
  
• Lack of  bowel movements
  
• The first several days of life a baby's bowel movements are what we call meconium.  Usually by day four, the baby is transitioning to bowel movements that are lighter in color and moving towards yellow or brown and mustardy.  If baby is still having meconium bowel movements at day five, you should contact your health care provider.  During the first few weeks of life, a baby should have frequent bowel movements.  If a newborn baby goes more than 24 hours without a bowel movement, you should contact your health care provider.  After three weeks of age, the bowel movements may space out more.  As long as baby is happy and healthy there is no cause for concern. 
  
• Lethargic Baby
  
• Some babies are very relaxed.  Relaxed and lethargic are quite different.  We want to see a baby being "active and alert" at the breast when feeding.  Your baby should be moving actively, looking around, making noises, etc.  If your baby seems inactive or overly sleepy you may wish to contact your health care provider.
  

What can cause a low milk supply?
Maternal Concerns
*Note that the majority of maternal issues would be present from the onset of the breastfeeding relationship.

• Breast Surgery
  
• Breast reductions and augmentations would be the top of this list however biopsies, injuries and surgeries of other types fall into this category.  If you have had any of the above at any time you should consult with your OB/GYN and an International Board Certified Lactation Consultant (IBCLC) to discuss how these may effect breastfeeding for you and what you can do to improve your chances of being able to provide a full or partial milk supply to your baby.
  
• Insufficient Glandular Tissue (IGT)
  
• These breasts have less milk making tissue and so mothers who have IGT may need to supplement.
  
• Thyroid Problems
  
• Can cause issues with milk release.
  
• Diabetes
  
• Milk production can be affected if insulin requirements are not well managed.  Mothers who are diabetic can reduce their child's risk of developing both type 1 and type 2 diabetes in adulthood by breastfeeding.
  
• Polycystic Ovary Syndrome & Other Fertility Issues
  
• If a mother had issues preventing her from becoming pregnant without assistance these issues may also affect lactation.  
  
• Retained Placental Fragments
  
• Can occur even after cesarean birth. 
  
• Breastfeeding Mismanagement
• Most often IBCLCs find that milk supply has been reduced due to what we call breastfeeding mismanagement.  This can mean that either baby was not being put to the breast often enough (early scheduling or sleep training) or baby was at the breast but with poor positioning and thus unable to nurse effectively.

Infant Concerns

• Prematurity
  
• Premature babies may be smaller or have weaker jaws and may need assistance transferring milk in the beginning.  Usually these babies will become more efficient as they grow.
  
• Oral Concerns
  
• Tongue Tie and/or Lip Tie are the most common however there are other oral irregularities that can affect breastfeeding. Congenital malformations such as Cleft Palate and/or Cleft Lip can also make breastfeeding challenging and cause mom's supply to drop if baby is unable to nurse effectively.
  
• Muscle and Neurological Issues
  
• As with prematurity these babies may need help until they are able to develop their oral muscles more or may need continued assistance but can transfer a portion of their food at the breast.  Remember that breastfeeding is more than food.  The closeness and comfort for many babies will help them to grow and develop and provide comfort to both mom and baby.
  
• Chromosomal Disorders
  
• Down's Syndrome is among the most common.  Many Down's Syndrome children are able to breastfeed with little assistance but perseverance from their amazing mothers. 
  
• Heart Conditions or other illness
  
• These babies may be too weak to transfer milk effectively.  
  

What can we do?
With any of these concerns the first step would be to work with an experienced Health Care Provider (HCP).  This can be your OB/GYN, Pediatrician and/or an International Board Certified Lactation Consultant (IBCLC).  Who you work with depends on which issue you are dealing with.  While seeking out a professional who can assist you and working on a care plan you will want to:

1. Make sure baby is being fed.
   
2. Make sure you are protecting your milk supply by pumping and/or hand expressing in addition to breastfeeding.

Ways to Increase Milk Supply

• Increasing Milk Removal
  
• Breastfeeding more frequently, pumping more frequently and in general increasing the removal of milk from the breast.  Breast compressions may also assist with this.
  
• Assist Baby in Gaining Oral Strength/Developing Orally
  
• Working with an IBCLC you can develop a care plan to work with Pediatric Dentists, Pediatric Ear, Nose and Throat Doctors, Speech Therapists, Occupational or Physical Therapists, Chiropractors and/or Cranio Sacral Therapists to aid baby in gaining oral strength and function.  By doing this you will find baby is able to stimulate your breasts to make more milk.
  
• Bring Mother's Health into Balance
  
• Your OB/GYN or other HCP can work with you to check maternal hormone levels, thyroid function, etc. to bring mother's health into balance to assist her body in being able to produce more breastmilk.  This includes checking for retained placental fragments which must be removed.
  
• Utilizing Galactagogues
  
• Galactagogues are any substance that increases milk production.  These include herbs, foods and prescription medications.  A list of common galactagogues is below.   
  

Common Galactagogues

• Goat's Rue - Often used for IGT and Breast Surgery situations
  
• Shatavari - Often used for hormonal support
  
• Fennel - Often used for milk release problems
  
• Alfalfa
  
• Fenugreek
  
• Barley
  
• Brown Rice
  
• Oatmeal
  
• Domperidone (Motilium) - Often used to increase Prolactin
  
• Metoclopramide (Reglan, Maxeran) - Often used to increase Prolactin
  
• Metformin (Glucophage) - Often used to stabilize blood sugar
  

There are many great Low Milk Supply Resources.  Following is a list of just a few:
http://www.mobimotherhood.org/
http://www.lowmilksupply.org/
http://kellymom.com/hot-topics/low-supply/
http://www.llli.org/nb/nbmilksupplyissues.html

If you have questions or concerns about your milk supply we will be happy to meet and discuss those concerns with you either prenatally or after baby arrives.  www.TheMILCGroup.com  210-960-MILC/210-960-6452

Last summer Ginger and I had the pleasure of attending a wonderful workshop at the Texas La Leche League Conference.  We attended the daytime session led by Jaye Simpson, IBCLC and thoroughly enjoyed hearing in-depth information on "Structure and Function" as it relates to the anatomy of the infant and what could be contributing to breastfeeding difficulty.  That evening we attended a hands-on clinical session where we observed techniques and put them to work evaluating an infant.  We attended many other wonderful sessions in lactation education; however, the sessions taught by Jaye had the most impact on our work.  I would say that this information was so empowering and helped us to become even more confident in our evaluations of infants during our lactation consultations.  

This knowledge coupled with our years of additional training and experience would lead me to say that here in San Antonio we may be the lactation consultants doing the most thorough examinations of babies and catching oral and physical issues that other practitioners miss. This may be because they are either rushed through visits (often not by choice when the practitioner works in a hospital with limited time resources) or because they lack the extensive training that we have received.  Ginger and I continue to seek out courses that further our education and we are excited to team up with other lactation professionals in Central Texas to educate ourselves more fully on how different practitioners working together can get a baby nursing more effectively, gaining weight better and nipping (no pun intended) oral or physical issues in the bud before they effect a baby's later development.  

On our website www.TheMILCGroup.com we have compiled a short list of wonderful resources for parents who are seeking information regarding a possible tongue tie, lip tie or other oral issue in their baby.  We include practitioners who our clients have found helpful as we want all of our clients to have the best possible experiences.  We do suggest that parents seek out the guidance of a lactation professional to help them to decide what kind of practitioner will best serve their needs.  

If you suspect that your baby has an oral issue and would like to meet with us for a full evaluation you can contact us by phone at 210-960-MILC/210-960-6452.

For those parents not located in San Antonio, South Texas or the surrounding areas, we suggest that you seek out the support of your local La Leche League Leader or IBCLC to find resources to assist you with your breastfeeding issues.  We are always happy to support families who are not located near to us in finding the support that they need.

Human milk sharing has been around most likely since the beginning of time.  When women died in childbirth another woman would step in to breastfeed her child.  When one woman was away from her child another would breastfeed that baby in a sort of informal shared parenting agreement.  There were no bottles or breastpumps.  Other cultures still share breastmilk with each other as a way to survive.  Even here in the United States situations can arise where mothers are unable to provide breastmilk to their baby themselves but wish for their baby to receive the nutrition of breastmilk and so they enter into some sort of human milk sharing.

There are two basic types of human milk sharing.  Those are formal and informal milk sharing.  

• Formal milk sharing is done by utilizing milk obtained from a Milk Bank.  Milk Banks are facilities that collect human milk donations, batch process the milk and pasteurize it before sending it to families in need.
  
• Informal milk sharing is the sharing of breastmilk from one mother to another.  There are websites set up for milk sharing but often it is done via word of mouth or local area mothering groups.

Here at The MILC Group we as International Board Certified Lactation Consultants (IBCLCs) uphold very strict health standards.  We promote breastfeeding and support mothers in reaching their breastfeeding goals.  We provide information and resources. However, we do not facilitate milk sharing or act as a go between for mothers. There are risks to milk sharing. A great discussion of these risks can be found in this article, Milk sharing and formula feeding: Infant feeding risks in comparative perspective? by Karleen D. Gribble and Bernice L. Hausman.