Wednesday, February 27, 2013

HSV-1 Transmission from Toddler to Mother

Yesterday I had a very unusual call from one of our moms. She said that the doctor had just diagnosed her 13 month old daughter with Herpes Simplex cold sores (HSV-1). She had asked him if it were possible to get sores on her nipples as a result of breastfeeding.  He replied, "Of course." When she asked what she would do then, he said "Wean very quickly,"  - even though she already has HSV-1. Something about that advice just didn't sound right to her, so she called me.

I did a quick search of the literature readily available and found quite a bit of information about HSV-1 transmission from mother to infant. Basically, if the mother of a newborn has an open herpes lesion on her breast she MUST avoid breastfeeding on that side because herpes is extremely dangerous for a newborn. However, there was very little available information about the transmission of herpes from baby to mother. I was able to find one instance where a 15 month old who was infected by his 5 year old sibling did, in fact, infect his mother. The mother in this situation did not previously have herpes simplex virus present in her system.

So I decided to check with some experts. I contacted Dr. Jack Newman, a Canadian pediatrician who is renowned for his work with breastfeeding mothers. I specifically asked him if the advice to wean was necessary or if the mother could perhaps nurse with a nipple shield. Here is his response:
Indeed, it is very unusual for a baby to get an “adult” type of cold sore on his lip.

Do you think a baby of 13 months of age would accept a nipple shield?  In any case, if the baby has a herpes simplex cold sore, then it’s way past the time to prevent transmission to the mother’s nipples.  That happened many days ago.  She should continue breastfeeding.  If she gets a feeling she is getting a herpes infection of the nipple(s), she should start acyclovir orally and continue breastfeeding.
I was truly grateful that he took the time to respond with such terrific advice. Needless to say I didn't suggest the nipple shield to the mother! In the meantime, I had also called my friend, Rebecca Saenz, MD, IBCLC, FABM - the only Breastfeeding Medicine physician specialist anywhere near us! Dr. Saenz was sweet enough to call me back and suggested that the mother ask the pediatrician for  Zovirax, a cream form of Acyclovar, for the baby's cold sores. She said the mother could also use the cream if she developed any lesions, but that there is absolutely no need for this mother to wean.

What a blessing it is to have such terrific resources at hand. I am extremely thankful for both Dr. Newman and Dr. Saenz and the wisdom they bring to the practice of lactation consulting!

Friday, February 22, 2013

NoseFrida Saves the Night!

A couple of nights ago my nine-month old grandson spent the night. Normally he sleeps through the night, but he is having some problems with allergies, and apparently our kitty cats don't help matters. (That's another story...know anybody who wants a sweet cat or two?)

Sweet, peaceful sleep at last!
Thank you NoseFrida!!
He woke up once around 11:30, then again at 1:00. When he woke up the second time, he didn't want a bottle, he just wanted to be held. So I brought him in to our bed where his grandpa and I snuggled him. He fell asleep on my chest, but when I tried to put him back in his bed, he woke right back up. So we decided the only way we were going to get any sleep was to bring him in with us. (I certainly understand why we have our babies when we're younger - at 50+ I don't have nearly the stamina I did at 30!)

He sounded like a lawnmower on a summer Saturday morning.

When her bulb syringe broke open,
Mitzi was appalled!
He fell asleep again on my chest, but he was so congested that he sounded sort of like a lawnmower on a summer Saturday morning - no way you can sleep through that! So I jumped up and fished the NoseFrida out of his diaper bag.

A couple of sucks on the snot sucker, and we had a different baby! He fell into a quiet sleep and did well until about six in the morning! I honestly don't know what we would have done if we hadn't had the NoseFrida. It made the difference between sleep and no sleep in our household that night.

After seeing this picture of a bulb syringe posted by Mitzi Johnson, I was so thankful we had a safer way to clear out N's little nose. Mitzi was about to use this syringe on her son when it broke in two. She says, "I nearly had a heart attack! I'm thankful that it broke! I immediately threw it in the trash after I snapped the photo."

Baby M likes to do it herself!
The wonderful thing about being a grandparent is that you get to love your grandkids, snuggle them, spoil them a little and send them back to mommy.  But you better believe that I will be absolutely certain that the next time N spends the night here, I'll have a NoseFrida handy.

Recently my friend Amanda sent me a picture of her little girl using the NoseFrida. I don't think I've ever seen a child try to suction her own nose with a bulb syringe, but baby M knows that the NoseFrida will make her feel all better!

Would you like to win a NoseFrida? Leave a comment below, and we will be picking a winner on Feb. 28. If you have a NoseFrida story, we'd love to hear it. Be sure to put your email in your comment so we can contact you if you win!

Friday, February 15, 2013

Why Should I Pay for a Doula?

Doula Jeanne Stolaas
I occasionally have a mother ask me this question. She thinks a doula is a great idea, but her sister's friend in Timbuktu had a doula provided in the hospital and she didn't pay a penny! What her sister's friend didn't realize is that the doula WAS being paid...she was a hospital employee. Unfortunately in Huntsville, AL, we don't have any hospitals hiring doulas yet.

So just what is it that makes a doula such an important part of the birth process? After all, Dad is there, and maybe Grandma is there, so who needs one more person crowding the room? That's a good question. Let's look at just what a doula does.

The Doula's Role

  • She is there exclusively to focus on the mother and to use her extensive training to help the mother achieve the birth she wants.
  • She is better equipped than Dad or Grandma to advocate for the mom with the hospital staff.
  • Because she's not emotionally involved, she can make more level-headed decisions.
  • She is able to provide one-on-one training prior to the birth so that Mom and Dad will both know what to expect and will feel comfortable and confident with her presence.
  • She is just a phone call away any time Mom has a question during the pregnancy.
Doula Brittany Berghammer
So does having a doula really make a difference? Research has found that women who have one-on-one professional labor support tend to have shorter labors, fewer complications and healthier newborns, according to Jeanne Stolaas of Doula Birthing Assistant Care. The theory behind this statistical outcome is that mothers who have professional labor support produce lower levels of stress hormones than women left alone or attended by inexperienced coaches.  

The Doula's Fee

Not all doulas are certified. Sometimes a doula will actually accept clients for free when she is seeking her certification. There are three major certifying organizations for doulas, all of which certify internationally: DONA, CBI and CAPPA.  Each of these organizations requires prospective doulas to complete a program of training that includes reading, training in doula skills, understanding of the doula mentality, adherance to the doula scope of practice, attending births and testing. None of these certifications is cheap! However, the women who are passionate enough about helping other mothers during birth view the cost as an investment. As doula Brittany Berghammer says, "I see so many women who are left to labor alone and scared. I want to empower the mother, to support her and let her know she can give birth naturally without much routine interventions if any at all!" 

Doula Wendy Robertson explains the economics of a doula's fee quite well. Once you understand the commitment required of a doula, it is a little easier to understand why doulas charge what they do. 

Finding a Doula

The best way to find a doula is word of mouth. Ask your friends who have used a doula or ask your doctor for a recommendation. You'll find a list of Alabama doulas here.  Always ask for a preliminary meeting with your doula to see if you are a match personality-wise. Once you find the right doula, you'll know it!!

Friday, February 8, 2013

Breastfeeding, Insurance and FSA's

The Medela Symphony is covered by insurance
or you can pay with your FSA card.
Over the last couple of weeks, we've fielded many calls asking about insurance coverage for breastfeeding needs. The Affordable Health Care Act does offer some specific benefits for women.  At A Nurturing Moment we can help you file for an insurance pump through Blue Cross, Blue Shield, Tricare, Aetna, United Health Care and Cigna. If you need to rent a pump, we will give you the paperwork you need to file it as a FSA expense and you can pay with your FSA card here.

Many employers offer a FSA (Flexible Spending Account) as part of their benefit package. When you buy a covered item from A Nurturing Moment, you can just whip out your FSA card and use it to pay since we are now accredited to accept FSA cards!

So just what breastfeeding and maternity-related items are covered by insurance or FSA? While this may vary slightly from company to company, the following list is based on items that are considered tax deductible medical expenses in 2013.
Need an SNS? Use
your FSA card to
pay for it!

  • Rental or purchase of a breast pump and accessories 
  • Products that assist lactation (Supplemental Nursing System, transport bag, cooling elements)
  • Lactation consultant visits
  • Nutritional or herbal supplements ONLY if they are recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician. (if you want to submit your galactagogue for reimbursement or use your FSA card, you need to have a prescription or a note from a doctor recommending you take it)
  • Chiropractic care (including Webster maneuver to help a breech baby turn)
  • Acupuncture (sometimes used to treat infertility and to help induce labor)
  • Childbirth classes -  Class time instruction specifically related to childbirth (including breathing and relaxation techniques, stages and phases of labor, labor and delivery procedures, birthing positions, movies depicting childbirth) is a qualified medical expense. You must document the portion of class time spent on these areas and prorate it. 
  • Cord Blood - when deemed medically necessary by a health care professional, the cost of harvesting and storing cord blood is a covered expense. You must submit evidence of medical necessity for this to be covered.
  • Licensed midwife
  • Yeast infection medication (must be prescribed by a physician)
Now let's take a look at what isn't covered:
  • Nursing bras
  • Bottles and infant feeding supplies
  • Breastfeeding pillow
  • Diapers - UNLESS they are necessary to relieve the effects of a particular disease
  • Doulas
  • Breastfeeding Class
Be sure to talk with your insurance company to ascertain exactly what coverage you have. If you have an FSA card, you should have a guide that gives you specifics for your plan. Some items do have actual insurance codes; any time you need a  receipt for insurance or taxes, we'll be happy to provide it!