I set up Network Blogs with my old facebook account that got hacked using my active email address. To make a new facebook profile I had to make a new email address. Network Blogs didn't get hacked. Since then I have 70 followers on network blogs (THANK YOU for your interest). Network Blogs no longer recognizes me as author with a new address. Do any of you know how I can claim this blog on Network Blogs. If you leave a comment on facebook I will see it (I think). I would like to have this blog fully functioning and update-able.
Monday, November 28, 2011
Tuesday, November 8, 2011
Gut integrity -- nothing in the gut except breastmilk for 6 months. The thought amazes me. The life LONG benefits of optimizing sealing your baby's gut with nothing but breastmilk so the intestinal lining seals and matures. Sealing your gut would promote natural flora and keep proteins from being absorbed that shouldn't get absorbed by the gut. In turning possibly causing digestive problems and inflammation.
I am not sure many of our full-term healthy babies get nothing BUT BREASTMILK for this long. There is too many tempting tastes, religious customs, grandma's treats, tylenol for vaccines and fevers, Vitamins, and early use and misused formula given. I don't know that a drop of something that is absorbed in the mouth ruins gut integrity, but you get the idea.
I believe in gut integrity. I trust that if we keep doing research we will one day have all the Science to back it this up- NOTHING BUT BREASTMILK.
Neonatologist at the conference don't agree on what to supplement the NICU micropremie with. I say UNPASTURIZED mother's own milk is best without supplement if it's available. Someone else's premie milk is second best. Third best is donated milk from the bank regardless of age. I actually like the idea of unpasteurized milk even if it's screened donor, but it is assumed that all milk from a donor will be pasteurized. I am bothered by the thought that the live enzymes needed to seal and protect the gut are going to be killed... but better than formula. Formula offers know immunity.
The current practice in most places is using a cow protein based fortifier. Adding fortifier to milk is better than the worst option (just formula). There is some research being done on human milk fortifier. This is an all human product being added to mother's milk. But why add it? just give breast milk. In general, the studies show the more breastmilk / the less fortifer the less NEC (necrotizing enterocolitis- the problem that keeps neonatologist up at night in the NICU). This is a serious bowel ischemia. Think about it. Nothing belongs in the gut but mother's breastmilk. Of course these little premies should still be protected by the placenta in the womb, but why put cow's milk protein or anything but mother's milk in the premies intestines? Just to fatten them up quicker and make them "look good."
Despite all the time and energy on research being done on fortifier use in the premie, it is going to take me a lot of convincing that any fortifier is necessary.
Monday, November 7, 2011
I "absorbed" everything I could about Vit D at the conference, met the authors, and bought the book with all the research
I really want to show that we don't all need to supplement our baby in Florida, however, almost everyone, all ages, I test is sub-optimal. I hope to get it set up soon that I can do Vitamin D testing by fingerstick. That way I can check more babies.
The current recommendation is that we begin to supplement our babies with 400 iu shortly after birth.
If you are going to choose not to give your baby a Vit D supplement. This is what you can do yourself. With my current clinical experience I believe this would be effective.
Get Sunshine, both mom and baby
Take 4000 iu while pregnant
Take 6400 iu during lactation. This is the amount it takes to get 400 iu into the breastmilk daily.
Take surf lessons. :)
For darker skinned women in Florida this is especially important. Perhaps over time and with increase awareness we can redefine what is best for all women and babies and minimize supplement exposure.
I have not seen Ricket's. Vitamin D is a powerful antioxidant and anti-inflammatory. If you want to boost your immunity Vit D is important.
I also believe in gut integrity. I want nothing in the babies gut but breastmilk. I want the gut to seal off and mature with several months of exclusive breastfeeding whenever possible. The "seal" has benefits long beyond the duration of breastfeeding. I really hope to reconcile the need for D and maintaining gut integrity.
With awareness preconception and during pregnancy, I hope we can keep our D levels up.
New Insights Into Vitamin D: During Pregnancy, lactation & Early Infancy
Wagner, Taylor, Hollis
Sunday, November 6, 2011
I have just got back from The Academy of Breastfeeding Medicine Conference. It was in Miami and I was there 2 1/2 days for 22 continuing education hours. With lots of thoughts, I'll probably frequently blogging over the next few days about breastfeeding.
I was very touched by a Platform Presentation on Down's Syndrome presented by Barbara Phillips MD. Mother's of who breastfed babies were surveyed. Here is some of their responses that I had jotted down during the presentation:
"Never considered that DS would even have affect."
"I didn't know that low tone, meant I couldn't breastfeed, I just breastfed."
"The diagnosis of DS made me even more determined to breastfeed because I knew he was at a disadvantage in so many other way. I wanted to give him this benefit."
"Slowing down to nurse, was beneficial to me in that it made me slow down."
Do you feel touched? I thought moms of babies with DS would be discouraged like everyone else from breasrfeeding. I am sure many are.
The title of this presentation was Learning from the Moms. It was shown with support these mom can do quite well breastfeeding.
I love the title. I learn from moms all the time. I enjoy being on our local LLL facebook page because there is so much to learn. I know I was at a big physician meeting and I learned a lot. I know what the Academy wants us to know from around the world, but the experts are right here local-- the voice of the collective moms. No matter how much I post, I learn more from you.
Not all sessions were emotionally/maternally moving. Some were quite political and academic, but I realized how important being around breastfeeding moms is for new moms. It's more than just receiving and exchanging information and support, but there must be something about being around other lactating moms that helps your instincts and milk flow, miss your baby, want to cuddle and hold your baby. I know mothers past lactation have said the get a sensation years after they wean... seems to be the same idea.
Friday, September 30, 2011
I have tested 7 lactating mothers who have babies between 6 weeks and one year.
So far all the mothers have sub-optimal Vitamin D levels.
All live here in the Treasure Coast (or are close). (This is South Florida, in case you don't know). All are involved in La Leche League and educated on this controversy about giving Vit D supplements to babies.
I do not have any fully breastfed babies tested yet.... Veins to small, don't want to put a healthy baby through that, and other reasons, it's not getting done.
I have one supplemented baby who tested adequate who also takes Vitamin D.
I have been testing a lot of adults who are not lactating. Many come back low.
I am not making any scientific or clinical conclusion yet. I think we all need an Rx to go to the beach this weekend!
Posted by Denise Punger MD IBCLC at 9:30 PM
Saturday, September 3, 2011
I have recently had a cluster of consults for induced lactation for adopting a newborn. I want to lay out some thoughts.
I follow the protocols from asklenore.com
Here is a link to the regular protocol.
There is no typical "adoption."
Everyone's situation is so uniquely different.
Not all women are adopting because they are infertile. Some want to expand their family both biologically and through adoption.
I often asked the adopting parents to consider how they feel about approaching the healthy birthing mom to express some colostrum or provide breastmilk. One of the most recent mothers found out about induced lactation because the birthing mother told about induced lactation. Some birthing moms are even willing to let the baby latch and suckle. This would be the best for the baby. Some people raise concern that the birthing mom will experience strong attachment and change her mind. I don't know if this concern is founded.
I learned from another mom, that her adopted child nursed better than her biologic children! This mom is planning a twins adoption now and starting the protocol again.
Some moms don't mess with herbs or prescriptions and just put the baby to breast with a supplemental nursing system. They may have had not enough time or just don't want the medication. Even if you used the protocol, it is still a good idea, to be familiar with this option to meet the babies full nutrient needs in case your supply isn't fully in. Medela makes a supplemental nursing system and lact-aid.com. ( I do have the supplies of both systems in stock, if you like to look at them.)
What to supplement a newborn with if you can't bring in your own full supply?
Birthing mom's milk, donated milk, make your own formula, commercially prepared formula.
Most moms don't know the ways to get breastmilk.
1)Once involved in a local breastfeeding support group many woman find other local moms with extra stored. 2)Facebook has a group with Human Milk for Human Babies (this is Florida, you can search for your region) where those in need can find those with donations. 3)There are pasteurized milk banks (expensive and not enough of them, mostly serving the needs of a hospitalized preemies, special situations, and research), and 4)For-profit milk banks (I do't know enough about these). I am biased towards the first two choices.
Get yourself a sling or babywrap to promote bonding and milk production. It's a great idea to attend a LLL meeting and have the support of an IBCLC lined up.
If you have a medical condition or concern, I may also be able to help you with approaches that won't interrupt breastfeeding.
Saturday, August 27, 2011
"Your book is the most borrowed book in my library."
I know women in my area enjoy Permission to Mother because they get to know my practice and family better and read stories about mothers they recognize, but that I appreciated her feedback knowing that it has been a good resource in her area, too.
"I live in a very conservative area and these women were sometimes surprised at first by the book's candid approach (as well as mine) but I've enjoyed the various "reviews" when they return the book:
"Sure does make you think"
"It helped me to laugh about everything instead of being as worried,"
"It's about time someone said it like it really is."
Posted by Denise Punger MD IBCLC at 2:27 PM
Tuesday, August 9, 2011
The lab test will be at your lab and you will responsible for for any portion not covered by insurance. I will provide you with the best diagnosis codes and results of your test.
I am looking for self-motivated, volunteers(mothers and breastfed baby), enthusiastic about furthering our understanding about Vitamin D deficiency in South Florida.
Starting Thursday AM, if you have contacted me to participate, you can pick up your script for lab work.
You may contact me here to express interest: email Use Vitamin D as your subject.
I will confirmed that your lab requisition is ready before picking it up from my office.
An example of how I may share anonymous results on my blog would be:
1. 2 month old Latin male exclusively breastfed -- suboptimal levels.
Posted by Denise Punger MD IBCLC at 8:45 PM
Friday, July 29, 2011
This schedule of WIC/LLL events are awesome. I wish I could be at everything, like a weeks vacation. Looks like so much fun! I didn't realize that WIC was having so many activities. Facebook is a great way to reach out (there is an event page for each activity) and I hope their is lots of attendance at all the events.
Tuesday, August 2nd, at WIC office on Avenue C from 11 am to 1 pm Babywearing Fashion Show.
Wednesday, August 3rd, at WIC office 531 Lake Whitney Place, SLW. 11 am Permission to Mother. Dr. Punger will answer your breastfeeding questions.
Wednesday, August 3rd, at WIC Office 531 Lake Whitney Pl, SLW 2:30 - 3 and 3 - 3:30 Yoga classes by Jenn Cohen.
Thursday, August 4th, at WIC office 531 Lake Whitney Pl, SLW 11:30 - 12 and 12 - 12:30 Yoga classes by Jenn Cohen
Friday, August 5th, at WIC office 531 Lake Whitney PL, SLW 11 am to 1 pm Babywearing Fashion Show.
....and the following week be sure to hit Panera Bread in Vero, 2nd wed of the month La Leche League meeting, where you can meet our newest Leader!!!
Posted by Denise Punger MD IBCLC at 8:59 PM
Monday, July 25, 2011
I wore playtex for many years (do they still make bras?). After I found medela, I realized my playtex bras fell apart quickly and gave them up. I tried bravado, but found they lacked the support I need (13 years ago, things might have changed). I have one from motherwear... this was before I had medela and I was feeling huge. It was the best support ever for heavy pp breast. Once my first son was born, I wear a bra 24/7. I am not comfortable without one, ever. I still wear my medela sleep bra around the house and at night. The tanks didn't come out till after my third. After a few months pp I was comfortable in a tank without a bra. If I wear my tanks now to exercise, I put a sports bra underneath. I wear them around the house without a separate bra. The first time I bought nursing bras, I thought to myself, "Do I really need this? I'll only need it a short time!" haha-14 years of maternity and nursing bras...that's a short time... my size has changed through the years with pregnancy and weight management issues. I've had quite a collection. Makeshift- sports bras were not comfortable to me. I have never worn a target, k-mart, or off brand bra... I need support. The latch on playtex I could release and put back with one hand. Medela can be released with one hand, but I need two hands to put it back.
Now for what I don't like... I never wore one, but it must be popular. I see it a lot. Not sure what it's called and if more than one company makes it... but I don't like when the cup is thick and "molded." What I observe is that it is hard to pull it truly out of the way so that the breast position is not distorted. Your breast should be in the natural position when the flaps are moved out of the way. If you can't get your cup out of the way, either get it out of the way, or consider another style. Newborns need your breast and nipple to be in natural position and no fabric in the way of learning to latch.
Disclaimer: I currently sell Medela bras in my office. When I run out of inventory I am not stocking up again. It's too much to keep up with all the different styles, colors, and sizes. I don't have space for the inventory. I am not paid for this review.
Posted by Denise Punger MD IBCLC at 9:55 PM
Thursday, July 21, 2011
I know nursing twins is hard and time consuming. Tandem nursing took up my focus for years (a bit different because one is old enough to benefit from solids and distraction from another caregiver). My breastfeeding advice to a woman expecting twins, if they want to breastfeed exclusively is to not plan to do anything else for the first 6 months after babies are born except hold babies. With a singleton, I got that advice; that was probably the best advice I got.
Of course, that's not always real life. We all have other elements of our life to consider particularly earning money and paying bills and the educational requirements to be employed. I had to let go of optional things for one baby. Deciding on your breastfeeding goals and if it is realistic (and what other things to put on hold) would be something only the mom (or parents) can decide. I am glad to support you with where you are at.
On the positive side of things, some mothers don't need the full 6 months to get in the groove and find themselves incorporating the babies into life more easier or sooner than expected.
I just appreciate knowing what your goal is, so I can be most helpful.
Posted by Denise Punger MD IBCLC at 6:27 PM
Monday, July 18, 2011
Here is another beautiful comment left by Daryllyn. I wanted to make sure everone has a chance to see it. A part of my feels that feeding at the breast is a lifestyle choice. I have not been that successful getting babies past 4 months old to latch on, but there is always exceptions. Thank you for sharing this story with me.
noelani has left a new comment on your post "How late is too late to re-lactate?":
When my fourth adopted child was placed with me, she was 6 1/2 half months old. I was still nursing my 2YO and really wanted to nurse her. She had spent most of her life in the hospital and had issues with both her physical and emotional health. I was told that a baby over 4 months could probably not be taught to nurse, but I tried, anyway. At first, things did not go well at all. I applied everything else I knew about attachment parenting and made a great deal of progress with her. For months, I tried to be happy with that, but I couldn't do it. Finally, I decided to consider every aspect of her experience of bottle feeding and then tried to make small changes toward breastfeeding. The day before her first birthday, she became a nursing baby!
Since then, I have been in touch with other adoptive moms who wanted to get older babies started breastfeeding and needed encouragement. Some of their children have been well beyond infancy when they began breastfeeding. The results have been tremendous, especially with children who have experienced a great deal of trauma and/or deprivation in their early lives.
I would encourage any mother who has an interest in re-lactating to go ahead. It may take a lot of patience and creativity, but it can be done!
Sunday, July 17, 2011
I was happy to get this comment to a post buried way down in my archives... I want to make sure you all get to see it. Thank you Daryllyn for sharing!!!
I was very happy to come across this site today! I have breastfed my six adopted babies, born between 1983 and 1995, using the Lact-Aid. Domperidone, which is the only drug that is safe and effective for use in induced lactation, was either not around or not available to me. I never knew very far in advance of the babies' arrival; sometimes less than 24 hours. I just started nursing on demand with the Lact-Aid when they got home. In a short time, I was producing drops of milk and that slowly increased as we went along. I needed to supplement until they were taking other foods, but they got a significant amount of milk from me. My last four children nursed until they self-weaned, at an average of a little over two years old.
I want everyone to know that, although advanced preparation can be helpful, any mom who wants to can start nursing with the Lact-Aid, whether she's had a chance to prepare in advance, or not.
I like the fact that this site focuses on nurturing. In recent years, the option of inducing a milk supply in advance with medications and breast pumps has had an unfortunate side-effect in that some adoptive moms focus so much on pumping milk that they never get nurturing at the breast established. I think they, and their babies, miss out on the best part!
Wednesday, June 22, 2011
The left side is more pro-vaccine choice.
The right side is more for the complete schedule.
A long time ago, I read making an Informed Vaccine Decision: A Parent's Guide to Childhood Shots by Mayer Einstein MD and How to Raise a Healthy Child in Spite of Your Doctor By the Robert Mendelsohn MD. Both of these books would be far to the left opposing vaccination and actually coming right out and saying "Don't Vaccinate".
Whether or not we agree on vaccinations, I know the issues. I'd rather you concentrate on learning about empowering birth and breastfeeding if you don't have time to read everything. I can help you make a good choice.
I've often wondered if pediatricians or other doctors visit my blog with an open mind or if the critical type follows me. All are welcome. Please come back.
Posted by Denise Punger MD IBCLC at 10:49 PM
Saturday, June 11, 2011
Many assume physician practices make a lot of money off vaccines. Maybe there is a lot of profit for some doctors. I am naive as to how they are making the vaccine profit (that makes them so stubborn). I know the manufacturer gets the product sale, but I am not sure what drives the Pediatrician to be so insistent on the full vaccine schedule. Capitalism motivates and perhaps that's why it is so hard to find doctors who are flexible with vaccine choice. Or is it really the fixed-firm altruistic belief that the complete schedule saves lives. ( I realize I am really putting myself out there....)
I'd like to consider the financial incentive:
Medicaid distributes vaccines to participating pediatricians (I think), but I am not a part of that program. I don't know much about it. Is there incentive for the provider to push?
The physician gets to bill for the office visit, but that's the office visit and not the immunization. Would some visits be lost if there would be no vaccination administered. Sure, there would be. But that's the families choice and I am not responsible if they don't choose to see me (It should be clear if you are missing appointments without mutual agreement, I am not repsonsible for after hours care.). In my practice situation, many still come in for the recommended visits for questions, concerns, education, breastfeeding, nutrition without the pressure to vaccinate and the reassurance in having my emergency availability. The visits equal out. At least for me it does not make a case.
I have never been given (or even offered) a bonus or any kind of incentive for vaccination children. If I've been indirectly offered a bonus for vaccinating adults, I am oblivious to it and focused on what I am (not) doing. I am not eating their free-lunch either. I'd rather have my smoothie.
I am not saying these incentives are or aren't out there. I am just not sure.
Perhaps it's in the volume. Maybe in bigger, multi-physician practices the financial incentive is in the quantity. I am just relatively small volume seeing patients of all ages in the mix. "Vaccine-volume" doesn't work to my benefit. We don't have one nurse dedicated to vaccines all day.
Health Insurance reimburses for administration. They do not reimburse for these items regarding vaccines.
Refrigeration (including keeping cool during storms)
Needles & Syringes
Staffing & Training
Extra time needed for chart-work
Production of Forms for the Chart
Education of Families
Expired Products (if anything expires, its a complete wash-out)
Our purchase (and reproduction) and distribution of School Forms
Follow-up phone calls regarding side-effects and complaints. (Fortunately, I don't get many of these calls).
Quite honestly from an overhead standpoint it would be just as well if you did not vaccinate at all and I can simply document DECLINE VACCINATION on the office visit note.
I like to disclose this. Because it's not what you'd expect.
Perhaps, without significant financial incentive to my small practice, it is easier to be opened-minded to accept patients in my practice who do not fully vaccinate because it's a monetarily neutral decision. Let me just say, maybe I'd even come out ahead in overhead if I did less immunization (My nurses might like it too.). Really, it would be very hard to truly analyze this. I am just glad I am able to offer flexibility and feel good about it.
Posted by Denise Punger MD IBCLC at 9:21 PM
Thursday, June 9, 2011
When I started my Breastfeeding Practice 7 years ago, I mistakenly thought, I had to provide pumps for sales and rentals to be successful. I thought I could not have a breastfeeding practice without pumps. I loaded up with the two leading brands and rentals.
I am totally wrong. I hardly sell or rent a pump.
- When I sell my last Medela Pump (which happens to be cheaper than Targets price) I am not going to stock up on pumps anymore.
- When my contract for hospital grade rental pumps expires I am sending my rental pumps back.
I will continue to provide replacement parts for Medela. I have some parts for the Ameda style pump, but overall Ameda and other promising new pump brands don't seem to be in too much demand in my area.
The mothers who come to me who legitimately need a pump, seem to have them before coming to me. Someone in the area is doing well with pumps sales/rentals. Target? the Hospitals? the Medical Supply? They are doing so well at selling pumps, I don't need to.
No pump. NO PUMP. I can't sell a single pump. I want the baby to nurse.
Mothers of preemies, the hospital will certainly supply you with the highest quality rental pump.
Others with medical problems (sore nipples, fussy babies, under or oversupply), be leery of what you are purchasing. If you need lactation support, get the right information.
Posted by Denise Punger MD IBCLC at 11:42 AM
Tuesday, June 7, 2011
I am getting more and more babies and families from Miami to Melbourne (both 2 hours away in either direction) coming to the office. This is a typical question I get asked.
How does well-child care work with your patients living so far away?
This is what seems to be working for the healthy family that needs a medical home.
Best if I get to meet the parents before the birth. Nearly 100% of the time this is very beneficial to you because knowing you have a medical home for your family that supports your choices is a big obstacle out-of-the-way. I like to see both the mom and baby together at first visit after the birth. I like to see the baby breastfeed and reassure you that feeding is normal (or solve problems). If time allows, I can help you with your wraps or sling and cloth diapers. If feeding is working, likely everything else will fall into place.
The baby's well visit schedule :
1 week -2 weeks (or sooner) (Mom is seen, too, as breastfeeding and family lifestyle are discussed.)
4 weeks-2 months
From 1-2 years old every 3, 4 , 6 months depending on circumstances
From 2-3 years IF a problem every 6 months
3 years an older, once a year
This is probably less well child visit appointments than most traditional pediatric practices who have you coming back for everything. One mom from Miami, told me, " I just should have driven to you in the first place because I sat three hours in another doctor's office, only to not get any help (and the discouragement caused me continued distress) ." If this well-child schedule seems to be too much, I am open to discussion up front. I understand homebirth, midwives, and doula care. Even if you eventually want to have a Pediatrician closer to home, I am a good transition from midwife to well-child care. Often older children come in only once-a-year. The whole family can come in together and be done with it.
Vaccination Status is not an issue. I don't require pediatric blood draws.
I find that breastfed, stay-at-home babies don't get sick as often as we are conditioned to think kids do, so I don't think that moms are making the long drive too often with acutely sick kids. Many times I have called in something to hold you over until you can safely drive to the office. If it turns out you have a chronically fussy baby or very sick-kid, the arrangement with me may not work.
For many parents, they prefer my style of well-child visits (and will go to the urgent care locally if it is that bad that one time). Obviously for injuries and emergencies it is appropriate to go urgent care or ER no matter who or where your pediatrician is. That may never be necessary for most kids and it is most important to have the professional support in the meantime for your breastfeeding, co-sleeping, babywearing, vaccination choices, etc...
I find when I get to know families, walk-in clinic visits for fever and illness are less frequent. I can usually manage an illness with close communication. I try to empower families to need less visits overall. I take pride in that I can offer after hour care, but please not there will be charges or follow up required for after hours care. I have utilized flexible services like phone consult and E-care services to accommodate different needs and after-hour needs for families near and far. In-fact if you live close I am very flexible, too. All this applies to you too!
Posted by Denise Punger MD IBCLC at 10:30 PM
Monday, June 6, 2011
I haven't posted an update on David's speech therapy and reading since Nov 6. Wow does time pass!
David is an emerging reader finally at 7 1/2 (practically 8). After a long break from structured lessons, we got started again in Level 3 of Barton.
I took a break because one thing after another kept me busy and I couldn't focus myself on teaching him. He didn't seem ready. He kept fighting me everytime. I decided it wasn't worth the attempt.
Neither of his brothers read ANYTHING at 7 so I decided not to be so hard on ourselves and relax.
David has coninued to go to speech therapy nearly twice a week. He has made enourmous progress since I started taking him in October. I am not sure how much longer he'll need. His speech is pretty clear, but I still feel their is benefits to be gained. He really likes Libby his therapist. She's found lots of ways to reward him with motor activities, puzzles, and games. He has benefitted in more than on way from speech therapy.
Posted by Denise Punger MD IBCLC at 3:09 PM
Wednesday, May 18, 2011
Did you know I have Medela Nursing Bras in stock. Here is my inventory of sizes and colors. We can provide a comfortable room for you to try them on and can help you with size. I generally find that Medela soft cup bras run full. Like if you are an F or G, a DD would work for you, if you are a D, a C would work likley work for you. These styles are durable and functional, but may not as sexy as some of them out there. :) I am not a certified fitting specialist, but I am pretty good. One of my staff used to be certified.
Medela Seamless Softcup
Medela Comfort Nursing Bra for day or night
Nude extra large
If you would like to know the best time to come in to try one on in privacy, contact us at twofloridadocs.com or call 772-466-8884.
Posted by Denise Punger MD IBCLC at 2:31 PM
Saturday, April 30, 2011
From One Jewish Mama to Another, March 12, 2011
By Liz P-L -
This book is amazing--I wish I read it when I was pregnant so I could have avoided heartache and doubt BEFORE my little one was born. Dr. Punger's journey from doctor to mom and then to her amazing blended life is inspiring. As a Jewish mom that questions conventional wisdom regarding birth and the early years, I especially appreciated Dr. Punger's candidness about her experiences as a young mom and her spirituality. The letter to her boys (included in the book) about their Jewish names is beautiful. There are not many resources out there for Jewish moms that need "Permission to Mother" so this was an extra special message for me. There are not a lot of heroes in this world like Dr. Punger that have the courage to speak the truth of what it means to be a woman and mother from a thoughtful, emotional, physical, and spiritual perspective. I will refer back to this book as I raise my daughter when I need to remember that we indeed have the right to raise our children in ways that align with our core beliefs. I also appreciate her example of blending her career with motherhood and perhaps find that aspect of the book most inspiring.
She was 'lively', April 28, 2011
The book was excellent! Once I opened it, I couldn't put it down. I was intrigued as to how this doctor had the nerve to use the services of a doula, at the hospital; and then, go on to have a footling breech birth at home. As I read each chapter, I was convinced that her experiences were for the many women who will read her book, and receive the answers they need. The most inspiring section of this book is, most certainly, the manner in which she prepared to deliver her last child. She so eloquently describes how she focused on the tetragrammaton, the sacred name of God, putting her trust in HIM; and He not only heard her; but, strengthened her to persevere such an obstacle of great proportions and triumph dramatically.
Indeed, she was `lively'. This is the word used in Exodus 1:19 to describe the Hebrew woman who delivered their children without the assistance of a midwife, in order to save them from Pharaoh. Let it be known, however, that I wouldn't of known this had Dr. Punger not interpreted this Scripture in her book, Permission to Mother. It is a MUST READ!
Posted by Denise Punger MD IBCLC at 8:56 PM
Friday, April 29, 2011
For Older Moms, April 26, 2011
By Connie Allen Pridgen
I can say what a blessing to have met Dr Punger, by accident, as a dr. who believes in all the things I do and doesn't question me. My daughter is 19 and wish I raised her the way Dr Punger has raised and is raising her children and her teaching other moms how to raise theirs...naturally....Another book I would encourage her to write......is transition from mothering to peri-menopause and what happens next....as she is quite useful and knowledgeable in that area as well!!!! Read her book and her blogs, but become a patient, it truly is life changing ask me and my husband and we have only been her patients since Jan.!!
A "MUST-READ" book for all mothers, February 4, 2011
By Jenn Cohen --See Jenn's Blog, The Natural Mama
This book is a "MUST-READ" for all mothers! I have bought several copies for my pregnant friends. This book totally opened my eyes more to natural births, breastfeeding, attached parenting, etc! I enjoyed Dr. Punger's honest and knowledgable accounts of not only her own birthing experiences but also of today's "typical" birthing senerios. She encourages and empowers women to trust their bodies and their instincts as mothers and embrace nature! With so many other "parenting" books out there, this book truly sets it's self apart. I have personally read this book several times, gathering more from it each time. I had planned a homebirth with my son and at 20 months now, he still breastfeeds, co-sleeps and co-bathes with us. He is an extreemly healthy, bright and independent little boy and I thank Dr. Punger for her inspiration and "permission to mother".
Posted by Denise Punger MD IBCLC at 7:49 PM
Wednesday, April 27, 2011
A book every woman should read before having children, April 8, 2011
By Kristeen Oliveira
I really wish I read this book before my daughter was born! It's a raw eye opener on the subject of natural birth, breastfeeding, and bonding with your children. Dr.Punger helped me tremendeously with low milk supply issues with my infant. I owe it to her that I was able to continue breastfeeding my daughter into toddlerhood. I refer all my nursing mommie friends to her and recommend her book to any mother or mother-to-be. Help other customers find the most helpful reviews
This book is an inspiration!, March 23, 2011
I recently have received this book from my sister in law. She gave it to me when I became pregnant with my third baby. I always have had trouble breastfeeding and wasn't sure if I would breastfeed with my third, but after reading this book I am inspired to try again! I am also preparing for a natural birth this time around, even at home! Denise has inspired me and I know I can do it now! I can also add that because of her book and blog that I am eating much healthier than I did when I was pregnant with my first two. I would definitely recommend this book to any mother, whether you are pregnant with #1 or #5, or you are just a mom looking for a great book with great information!
Posted by Denise Punger MD IBCLC at 6:42 PM
Tuesday, April 26, 2011
passing it along to my daughters in the hopes that it resonates with them and hopefullly it will empower them as much if not more than it did me. Another word that comes to my heart to describe this book is validating. To have a woman who has had the exposure to the world of all things medical come forward to share her journey on mothering the way she chose is and will be so validating for many women and men who question themselves over criticism from those they respect and trust (esp the opinions in the medical field). Everyone who loves to read knows that some books are so special they crawl in your heart and live their forever well this is one of those books for me. If you need a fresh perspective on parenting and or you need some validation this is def the book for you.
Posted by Denise Punger MD IBCLC at 6:04 PM
Monday, April 25, 2011
Patients often come to me because they have concerns about vaccines. They want to move away from vaccines. They want some freedom and flexibility. I am selected out by a unique group of parents that understand good nutrition more than most, understand the deleterious affects of preservatives, dyes, HFCS and other toxins in food, have high breastfeeding rates (and bf for the biologic norm), actively involved in their children's education, and are around decreased amounts of second-hand smoke. It may be hard to compare my group of patients to other local pediatrician's practice vaccine outcomes or Pediatrician's in other areas. Many families choose not to immunize in my office, but from those that do this is the most they get in my office.
From 0-2 months
Nothing. I will not give a vaccine before 2 months.
From 2-6 months
Most families will wait till ~6 months to get Hib and/or Pediarix, but I can start now.
From 6-12 months
Pediarix x 3 doses (Can be done at 6, 8, 10 months or 6, 9, 12 months)
Hib x 2 doses. Hib was back ordered for several years. Much of my "vaccinated" practice never got Hib because it wasn't available. (Can be done with Pediarix or opposite months. Most of my "vaccinated" kids get it with Pediarix.
I can provide Pediarix (Heb B, DTaP, polio) and Hib without each other. I can also provide Heb B, DTap, and Polio seperately).
That's it. Up to 5 shots.
From 12 months - 24 months
Pediatricians give Chicken Pox and MMR at 1st birthday. Most of my families who do eventually give these two wait until school entry or more developmental maturity. There is a 4th doese of DTaP due this year. A 3rd Hib can be given this year.
That would be 3 (maybe 4) more shots, if you get these.
I provide boosters for K. 4 boosters are "required." Polio, MMR, Chicken Pox, DTaP. I do not give these at one visit. I will do 2 and 2, 1 month apart. For Kindergarten entry I get referrals from the school, so I get more requests for these than I do the primary series from families that started with me with new babies.
A No-Hassle Medical Exemption is available from me whether you started shots or not.
Friday, April 22, 2011
Tonight I am reflecting on the 4 years PTM has been out and what's new since. I am impressed with the diversity of mothers who have benefited from my work. The variety of reviews should be helpful to you as you could quickly determine if my book would be helpful to you or goes against any deep convictions you have. True, I want to preserve breastfeeding. You could call this a collection of articles on topics of concern to mothers and how they all relate to breastfeeding. I have been pleasantly surprised that even women, who have babies that didn't breastfeed, still find inspiration in my words. I am encouraged that the birth stories I share have given women courage to speak up for and reflect on their birth experience in an empowering way.
The basic needs of new mothers are the same. My personal autobiography of my childbearing years won't change. The way we get information since publication has advanced. Social networking is big. Yahoogroups was how I stay connected prior to printing, but I am quite impressed with the birth and breastfeeding community on blogspot and facebook. I would have loved a blog journal of my last pregnancy. I am most impressed with a facebook group matching up moms in need of milk with moms who have milk, Human Milk 4 Human Babies. There is a lot to be said for human milk donation especially since it's not heat treated. Despite facebook's adversity towards breastfeeding photos, the on-line extended breastfeeding community has reached a new level. Mom's are more openly willing to share their photos. I've been candid, but not to the level you can find on facebook now-a-days. Once, I thought Bernadette and I were like the only ones pouring out birth and breastfeeding updates via yahoogroups and our print magazine, Mother to Mother. It's a pleasure to get on my feed and have you sharing news stories quickly and instantaneously.
Since publishing, there have been birth documentaries to come out; Business of Being Born and Orgasmic Birth. See them both.
My own journey with nutrition has involved and I can support the desire to eat vegan and vegetarian while pregnant and breastfeeding (and I totally understand the cravings may keep you from your ideal goals.) I took my nutrition journal to its own blog.
Weaning is a process. I was still producing milk at the time of publication and nursing the baby. I am no longer producing milk, but he is still lingering. Some babies wean all of a sudden in a day or a week or a month. After 14 ½ years of nursing, the last 1 ½ years have been the weaning years.
Many call me courageous to speak out. What gives me confidence is my experience with vulnerable moms. All my topics were carefully considered before including (and before posting to the blog). As an author, I was hoping the book would help me find the woman that needed me. PTM along with the help from blogs and facebook have definitely helped mothers in need find me. I continue to find that in a highly technical world most mothers appreciate having permission to mother.
Bernadette and I met when I was pregnant with my second son. Traditional educated with a full-time career and completely vulnerable myself, I was totally fascinated with the world of a homebirthing, breastfeeding, homeschooling, doula, mom of 10. She has had tremendous influence on my mothering journey and opening the doors to possibilities of raising my boys in ways that deviated from societal norms. Through the years the internet has helped us stay connected and to allow us to support each other with our common goals. As one of the busiest moms I know, Bernadette's communications are a treat to me.
I sincerely hope you will take the time to read Permission to Mother from cover to cover. Read it again. You may be surprised that you find a new theme speaks to you the second time reading. Good or bad, I love your feedback. I would love for you to find me on the web.
You can also find me at:
Facebook: Denise Punger Coquelet, Permission to Mother, Coquelet & Punger
My amazon, Permission to Mother page
Posted by Denise Punger MD IBCLC at 10:20 AM
Wednesday, April 13, 2011
I am approaching 10 years in private practice. I have been in a unique situation where I can support parents choices in regards to vaccination.
The concern about vaccination is not just limited to parents about the childhood schedules, my senior patients also voice concerns. I have been able to support my older patient's decisions to vaccinate or not.
At the end of seven years this is what I have observed in children.
I have not seen consequences of "not vaccination." For example, I have not observed significant illness or tetanus that could have been prevented by vaccination. I have very few hospital admissions amongst my my pediatric patients following my schedule for well-child care (which is often individualized). ( I have lots of one-time consults and naturally don't know what happens to them.)
I have not seen serious consequences of partial/delayed vaccination. For example, I have not seen "fine-today, not fine tomorrow." No one gets vaccinated before 2 months. Most parents tend to delay vaccination in my practice at least 6 months. We are NOT vaccinating sick children, failure to thrive children, or preemies. When parents accept MMR vaccination, it is almost always significantly delayed until social developmental milestones are obtained (or the lack of development noted and plan made.).
The less serious side effects I have seen of an injection is pain on injection. Some babies and children tolerate a shot well. I've seen a few rashes or knots at the site of injection. Sometimes the injection technique has unfortunately not been the best. The side-effects in a partial/delayed schedule seem to be few (I don't recall many parents reporting fever.) or maybe they don't report it to me. A few have changed their minds and discontinued vaccination. I appreciate feedback from families if a negative experience has been noted.
I have not offered full immunization. Most families seeking me out, seek me for supporting their decision and are not interested in Hep A, rotavirus, pediatric influenza or pc. I can not comment or compare positive or negative incidences to routine pediatric practice because I don't follow the full schedule. I don't offer HPV to young girls. All physicians providing vaccination should be open to discussion with their patients.
I have not enrolled in state computer system to record shots. Records are kept in our office at this time.
Getting a medical exemption is not an issue. Starting vaccination and declining further shots in a series is not a problem.
In my elderly population, more or less I am not seeing "consequences" of not vaccination.
Keep in mind I tend to have a healthy population of patients. Breastfeeding rates are high. Families tend to be conscientious of nutrition. Also, families tend to be aware of exposure such as tobacco, false-food products, community exposure. Making good lifestyle choices influences how we respond to infectious illness. In my practice, I observe that families are active in their pregnancy choices and birth plans which in turn has lasting beneficial affect on the baby's health.
Today's epidemics are diabetes, obesity, high cholesterol, hypertension, cancer, and arthritis. These conditions are far better of manged with nutrition and lifestyle.
Saturday, March 5, 2011
It's often very satisfying to help a mom with a tongue-tied baby because there is almost INSTANT relief.
If I suspect tongue-tie, I recommend taking care of it as soon as possible, if the mom wants to continue breastfeeding.
This past week a mom came in with her two month old. She had constant nipple pain almost from the first latch. She described her baby as clenching and intense. She has been treated for several rounds with anti-fungals. The baby never showed any symptoms of thrush. Out of desperation, baby was treated, too with anti-fungals. The only thing that consistently relieved nipple pain was to pump and give the nipples a rest from the baby's latch. The focus of treatment was on thrush and keep giving mom more anti fungals. Mom was also doing elimination diets wondering if something in her diet was upsetting the baby making him intense.
What made me suspect tongue-tie?
1. Nothing else helped.
2. I always think of tongue-tie because it's what I do.
3. Yeast doesn't occur at the first or second latch. (However with nipple damage, she could have at some point had an infection.) Also, yeast is hard to treat, but not impossible to treat.
3. The only time she got a break was when the baby wasn't latching.
Okay, so I looked at the baby's mouth. I wasn't that impressed, but there was a posterior frenulum. It wasn't long. It wasn't particularly noticeable. I could see how other professionals not so focused on tongue-tie could easily overlook this. I recommended clipping it because the mom's history was right-on: nipple pain from birth, baby was intense and clenching.
Mom nursed baby right away after frenotomy. As suspected she noticed a decrease in pain, good milk transfer, a satisfied baby, a relaxed snugly baby. And he wasn't very intense anymore.
What do I learn from this. Tongue-tie may be suspected by just listening to what the mother is saying. A baby who is not getting adequate milk transfer, seems to be biting, clenching, and intense is probably a baby that would benefit from a frenotomy. (especially when "everything" else isn't helping.) Obviously, confirm suspicions of tongue-tie by checking the baby.
My approach to tongue-tie may not be very scientific based, but it's one that works for the families that come to me.
I found this relatively new professional group uniting tongue-tie professionals, International Affiliation Tongue Tie Professionals.
Saturday, February 19, 2011
The boys are full of pride. That's what counts!
This has been very meaningful for Scott. Scott wants David to have a Bar Mitzvah just like his: At home, small and intimate. I take Scott's opinion as a high level of satisfaction.
William has pride too, but in different ways. He's glad he had a party and sleep-over with friends and good food. The meaning for him will sink in over time. Unexpectedly, he went to a Bar Mitzvah today. Now if you asked me, who would have been in synagogue first (after the Bar Mitzvah) from my sons, I would have never picked William. Scott has actually asked to go to a service as a man, but William had the fortunate opportunity to go with his buddy and I think his pride and connection is apparent.
John is happy because we didn't run out of food (runing out of food was the one thing that would have embaressed him) and everything from the party-end went smooth. He felt like we handled the amount of people without a crisis and even thinks that at next party we could handle more. ( A NEXT PARTY... that's really great that he is is so inspired!)
I am happy because I fulfilled my responsibility in rekindling the Jewish spirit in my home, teaching Judaism faithfully to my children, and providing the boys with this opportunity.
Our adult guests said they felt uplifted by the ceremony. In fact, one guest, called me this morning, after a week, to tell me how uplifted she felt all week, she felt inspired to reference the songs and prayers in her Bible. How special she felt to be included in an important event in our sons lives. I got similar feedback nearly everyday from our guests this week.
William said the teens had fun.
So, I am very satisfied with how things went.
I thought I got a break from studying. However David is even so excited that he asked to start studying his Hebrew letters that night on behrmanhouse.com. He has opened up his student center almost every evening.
I was a little worried that after the celebration there would be a let down that there was nothing else to look forward too. Like TV and movies build up Birthdays and Holidays. There was no build up. You don't see Bar Mitzvahs on TV much and the boys had only been to one or two Bar Mitzvahs previously.
In planning we asked the boys what they wanted. They chose the prayers and music. They had input into the food choices. They made the guest list. Not to be sappy, but if we invited you, we really missed you. Really, really missed you.
Posted by Denise Punger MD IBCLC at 8:56 PM
Saturday, February 12, 2011
Our guests asked ahead of time if the ceremony is usually at a Temple. Yes, a Bar Mitzvah Ceremony is traditionally held at a Synagogue during regular Saturday service when a boy turns thirteen. With our family being an eclectic spiritual mix, the boy’s learning style, and my need to be unique, we decided to do it this way. Plus we wanted to open our new home to you.
In Judaism, the rule is, is if the mother is Jewish, the children are Jewish. With each passing generation, like many modern Jewish families, my family seemed to be getting away from the traditions that make us Jewish. With so much separation from customs, ironically, my biggest inspiration to rekindle the tradition is from you, my family and friends, who I observed, were faithful to your spirituality. Before we started our formal study of Judaism we actually attended congregation and camps with many of you. I was health-fully jealous that many of you had well-grounded spiritual homes. Although today we represent different denominations, every one, here today has influenced and inspired the boys to reach this mile stone.
Posted by Denise Punger MD IBCLC at 11:49 AM
Thank you for allowing me to become a Bar Mitzvah today. To me becoming a Bar Mitzvah means becoming a man in G-d’s eyes. This day is important to me because I want to become a Man in G-d’s eyes and I am ready to become accountable for my Jewish responsibilities and to make this world a better place through the mitzvah’s I perform.
I would like to thank a few people for helping me get to this place today. I want to thank my mom for her persistence to follow through on her desire to raise me to get a Jewish education. I would like to thank my Cantor Debbi for being available to our family, for her accommodation and flexibility. I would like to thank my Grandma Irma, who sets an example of praying for us all the time, and my Grandma Maxine for taking me to the Jewish stores to get ready. I want thank my dad for writing the BIG check and letting me have the celebration here at the house. I want to thank the rest of my family and friends for being here today and along the way.
I want to make this world a better place. I pray that I am able to go to college and have a good job. I pray to be happy and healthy and one day I want a family of my own. I pray that my actions and model may be an example to others.
I pray for the world. I pray for Israel. I pray that the country has a credible government. I pray for the safety of the people living in Israel. I pray that the Armed Forces come home safe. I pray for no terrorism and for the American economy to get better.
Posted by Denise Punger MD IBCLC at 11:05 AM