Providing Lactation Support During the COVID-19 Pandemic: Q&A With Annie Frisbie, Practicing in New York, US

New York City, New York, United States currently has more COVID-19 cases than any other place in the world—and one borough, Queens, has had more deaths than any other place in New York City.

Annie Frisbie, IBCLC, has run a private practice from her home in Queens since 2011, and she has helped hundreds of families in and around her New York City borough. In 2018, she was given the United States Lactation Consultant Association for extraordinary service to the profession, and she’s the author of several books about private lactation practice. Nothing, however, could have prepared her for the challenges her practice is facing now.

In this interview, Frisbie shares her experiences living and working at the current epicenter of the pandemic.

What is life like for you right now? 

The [New York City] hospital experiencing the greatest surge is a mile and a half from my house. It’s the hospital where, if we called 911, that’s where they would take us.

We have been staying home for quite a while now. My children are two weeks into virtual schooling. They have not really left the house except for short walks, and my husband is also only leaving the house for short walks or bike rides. 

So we’ve gone from living in New York City where we have everything available 24 hours a day to having just what’s in our house, and we’re grateful for what we have. There is just a lot of uncertainty.

 What effects are you seeing for the families you work with?

New parents are under extreme stress. They have partners who’ve lost their jobs, or they’ve lost their job. None of them know whether they have a job to go back to. They are living with so much uncertainty. Can they pay their bills?

And then add to that being trapped at home all day. Some of them were planning to have family fly in when the baby was born, and their family can’t come. I spoke to one woman who said, “I am by myself for the entire day.” She’s having to do a lot of things to keep breastfeeding going, and she said, “How am I supposed to do it?”

 And there is just no answer.

It’s heartbreaking.

With over-crowded hospitals and restrictions on who can accompany people in labor, what is the situation like for families preparing to give birth?

What I am hearing is that the pregnant families are so scared.

Every day, there is a new story about what pregnant parents are going through. One of the big hospitals here just announced that they are going to be testing every parent who comes in in labor, and if you have your baby before they get the test results back, they are separating you, routinely. Some hospitals are not allowing doulas and partners. 

There are so many competing factors. We can all see that slowing down [the spread of the virus] is so important, but we also know the effects of separation on babies, and we know the risk factors for parents when their babies are separated from them and the negative effect of stress in the postpartum period. What kind of short- and long-term effects are we going to see from that?

[eds notes: some of these policies have changed in New York since the time of this interview, find details here, paywall may be in effect. Find international guidelines, which recommend keeping birthing parents and babies together – with appropriate protection – regardless of COVID-19 status here]

What conversations are you having with families to help them navigate the situation?

When I talk to them, I acknowledge that this situation is hard, and it might be really hard. But I also try to help them go in with a plan. I tell them, “The more frequently you remove milk, the more milk your body makes. If it’s rough in the hospital, just start hand expressing and give your baby your colostrum and then get home. And then we’ll talk and we’ll figure it out when you get home. Just get out of the hospital and we’ll work on the rest of it.”

I have also been recommending that people learn to do hand expression of colostrum while they’re still home, because that is a really tangible thing that families can do. They know they are going into a very potentially isolating and scary experience, but they also know, “I’m already familiar with my breasts.” If somebody says, “Your baby needs to be supplemented,” you can say, “Great, I brought it with me.” You already know what your beasts can do.

You are currently doing all your consults virtually. How did you work through the decision to suspend home visits?

 I did my last home visit a week ago. At the beginning of last week, [my plan was to continue to] do home visits on a case by case basis. I planned to screen everybody and sanitize everything.

And then, the very last one I did was a uniquely terrifying experience. Not because of what was happening inside the parents’ home, because that was lovely. There was a baby, and a new family, and all the beautiful things that mean so much to all of us that work in lactation. It was great. And I washed my hands, I sprayed down my scale.

But to get in and out, I had to go through a large, open lobby that was full of people working from home in a big apartment building. I had to get into an elevator. I had to touch buttons. As I was about to get into an elevator, somebody stepped in and said, “Here, there is room for you, too.” And I thought, “The last thing I am going to do is get into an elevator with you.”

I had my husband drop me off and pick me up, because I would have had to use valet parking. I don’t want someone else inside my car right now.

There was so much fear. What am I bringing into this family’s home? And what am I taking out, because I am passing through so many public spaces?

I had to make the decision to stop home visits. The density is such a big factor in my decision.

And I do recognize that there is a harm to that—things are going to be lost for these families because they can’t have us in their homes. I lost a lot of sleep over that decision, and I know I’m not the only one. It’s not something I came to lightly, and I am very concerned about the families that don’t have access to [in-person] care. But at the same time, it’s just very frightening here.

At this point, I think it’s very important not going to judge anyone’s choice to do home visits or not to do home visits. No one should be shaming people who are still doing home visits. We need to trust our colleagues that they are making good clinical decisions, and if they are still providing home care, we should just thank them for it. And for people who have said, “I can’t do home visits right now,” we need to thank them for recognizing their limitations and for doing their part to keep families safe. We need to make sure everyone in our community feels like we are supporting each other, because that is how we’re going to support families.

This is not something to police anybody about. Nobody knows anything right now, and we do know that babies need help. So let’s just trust that the people who are still doing home visits are not behaving cavalierly.

Many IBCLCs are working with telehealth for the first time. What have you learned about how to provide a great consult when you’re working through a video screen?

We’ve all been dropped in feet first! I did a record number of consults this week, and they were all virtual. I went in with a little fear. I was thinking, “Do I really have the skills for this? I’m not a movie director.”

[When it comes to the details of using video], there are good resources out there to help you. For example, to [help you figure out] the sort of pictures you might want to get if you are trying to assess oral anatomy. Dr. Bobby Ghaheri has a blog post that gives advice for things like where to put the camera, how to take a burst, how to take a video. I share this post with my clients.

But in a big-picture sense, I have been getting a lot of questions like, “Do you chart differently for virtual consults?” People have been telling me, “I need all new things to do virtual.”

My advice is, you don’t need all new things. You are still the same lactation consultant you were when you were sitting on your client’s couch or when they were sitting in your office. We have to remember that the basics still apply. What do we do? We ask questions. We listen. We observe. We ask more questions. We take a history. Those are still the same things you will be doing.

[As I was starting to do virtual consults], I was thinking—there are things I do with my hands and I have so much knowledge in them. And now I can’t touch anyone. So I started to ask myself, what do I usually feel for? And how can I convey that to the parent?

So that means saying to the parent, “Can you put your finger into your baby’s mouth? Here is how I would do it.” And then physically demonstrating to them what I would do. And then not saying, “Do you feel this, this, or this?” But saying instead, “What does it feel like to you?” And then really listening to what the parent is saying and using your imagination to try to feel what the parent is saying they feel. And that’s different from putting your finger in the baby’s mouth and knowing what you feel. It’s a different way of interpreting data. But you still know what you’re trying to find out. You still have all those clinical skills.

I have also been recommending that my families that are concerned about weight gain get a scale to use at home, because we really don’t want them going to the pediatrician and there are no drop-in breastfeeding groups. So ordinarily, I would say, “Wait, we’ll keep and eye on it, and I’ll come back and weigh your baby.” Now, we’re not weighing babies, but families can weigh babies.

I’ve always believed that parents truly are the expert on their own baby. I tell them, “We’re just going to keep talking. And I’m going to listen to what you’re telling me.” One wonderful thing that’s happening is that we’re showing parents their own resilience. [We’re saying], “I am not there, but you are, and there are things that you know and can do. And I can teach you and counsel you and help you step into your own authority as a parent.” We are coming back to the foundations here.

That’s beautiful, because that’s what the best consult does anyway.

Exactly. So in some ways, not being able to be the expert with the magic hands could be good. There could be benefits that come out of that. I think I will personally grow as a clinician through having to do virtual consults. I might even keep them in the mix after this is all over, because I feel like they might be really helpful for certain things. Like if I don’t really want to drive 30 minutes to do a 30-minute pumping consult and look for parking, I could definitely do that virtually.

For IBCLCs who are feeling scared about virtual consults and wondering if you have what it takes to do it, you might not know that until you just jump in and start doing it. There are great trainings out there about how to do virtual consults. It would be a good idea to seek that out, and then you’re supporting another IBCLC who has skills to share. I am a big fan of learning from others.

What are you doing to take care of yourself and get support?

As care providers, we’re all under a lot of stress, and it’s crucial that we get our own support for that. Sometimes my clients tell me they are scared of something, and I think, “I’m scared of that, too!” But I can’t bring that into our clinical relationship. But then I have to walk away and I have their problems and my problems now. With the empathy that we naturally have as lactation consultants, everything is triggering right now.

The main thing I did was immediately find a therapist. I recognized that it was a critical need, as important as food and water and shelter. I need someone I can talk to and process this with, because it’s not going to work otherwise. This is too big. It’s not like, “Oh, you’re a little stressed. Do some deep breathing and self-care. Take some time for yourself.” No. This is huge, and it’s okay to reach out for professional help. It doesn’t mean you’re weak or there is something wrong with you. It might be the most important thing you do for your clients, if not for yourself.

You’ve been reminding your clients that birthing families have always been strong.

Yes. Right now, we can just do our best with what we have, and I think we have a lot more than we realize. We as clinicians have a lot of resources, and our families have a lot.

I loved an article that came out this week in The Cut, a New York magazine, with a midwife named Robina Khalid. I have been sending it to my clients. She reminds families that there is always going to be hardship, and there has always been hardship. But there have also always been parents and babies, and at the end of the day, babies don’t know there’s hardship. They just know you. And you can do this. That is the message I want to amplify to families right now.  

Are you a skilled lactation provider serving families during the COVID-19 pandemic? ILCA wants to hear your stories. Email at media@ilca.org.

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