Author Archives: Meri Levy

Good Faith Estimate Notice

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

Under the No Surprises Act, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services. 

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.

Meri Levy, LMFT is an out-of-network provider and therefore is required to provider a Good Faith Estimate and to inform you that lower cost care may be available through an in-network provider.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

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Reading Your Baby’s Cues

People have a physiological reaction to the sound of a baby crying. Our hearts pound, our blood pressure rises, and we start to sweat. This reaction causes most of us to try to stop the crying, regardless of how tired, irritable, or hungry we might be ourselves. And that’s a good thing. It’s how our babies learn to trust that their needs will be met and that the world is a safe place.

But sometimes (often!) new parents wonder what the baby is trying to say? What does the baby need? We run around randomly, trying different remedies: jiggling the baby, rocking the baby, changing her diaper, offering a breast or the bottle, or a pacifier. And sometimes the baby still cries. We desperately want to eliminate the cause of the crying, and we become frustrated, angry or guilty when we fail.

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Co-Parenting With a Partner

The First Year Can Be Rough, by Meri Levy, MFT

family twinsIf you’re like me, I really thought that, despite my decision to breastfeed, my husband was so gung ho about being a Dad that we would share the parenting responsibilities pretty equally once our first child was born. I was in for a rude awakening. Breastfeeding meant that much of the time I was literally attached to my new baby, and when I was not, I had an easier time calming him than my husband did. And even when I didn’t, I couldn’t stand to have my husband trying to comfort our fussy baby without stepping in and trying to help. Whether due to biology or psychology, I was so attached to my new baby that I couldn’t tear myself away long enough to really get a break. As a result, I became more comfortable in the baby care role, and he became less.

There are many reasons why fathers often take a backseat in the early days with a new baby. Whether because of a hormonally-afflicted “helicopter” Mom, an inexperienced Dad, a baby who is more easily calmed by the mother, or gender-related attitudes about who does what, newborn care often falls disproportionately to the mother. And since Mom is generally recovering from childbirth, likely adjusting to breastfeeding, undoubtedly sleep deprived, and in the throes of huge hormonal changes, this disproportionate share can become a BIG PROBLEM. You know that saying that “if Mom isn’t happy, nobody is happy?” I think the truth of that statement is widely underestimated.

So, we’ve got a Mom who can’t let go to allow her partner to care for the baby, a Dad who is either mildly incompetent or feels he is (or is being treated like he is), a baby who’s getting used to being cared for by Mom, and a Mom who is at the end of her rope and feels like she just can’t get a break (and is not sure she would take one if she could). Not a recipe for a happy family.

Negotiating who does what, recognizing the barriers to fairly allocating parenting and household responsibility and actually making and carrying out a plan to address those barriers and create a cooperative, supportive and fair allocation of workload is one of the major tasks of the first year of parenthood. Working out a plan for who does what, figuring out how to set goals for change if change is needed, and implementing those changes, can make a world of difference.

I once read a study (and I don’t have a citation, but I like to believe that it is true) that claimed that of all the factors that might predict the well-being of children as they grow up (e.g. praise, affection, discipline, structure, etc.), the one variable that is most predictive of a child’s future well-being is the degree to which his or her parents have a cooperative relationship around parenting. So, if that is true, it matters less who does what (or if it is done correctly), and it matters more that parents are supportive of each other as parents and partners.

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Becoming a Parent to Your Newborn

By Meri Levy, MFT

Regardless of your expectations, the arrival of a first baby is, first and foremost, a radical role adjustment for the new mother and father. As you grow from being a child to an adult and into a partner in an adult relationship, most of us experience shifts in our relationships as daughters or sons, sisters or brothers, and friends or lovers.

But the birth of a baby changes everything! Now perhaps your most significant role in life is as a parent. This is an altogether new role, and babysitting experience aside, there is no real preparation for it. But it is truly amazing to see how our babies foster and nourish our growth as parents, almost from the beginning.

While you adapt and grow to fill your new role, it can be difficult at times to hold onto formerly cherished roles, as a professional, a friend or lover, and an independent person in your own right. You may find that you are redefining yourself in ways that make these roles change (e.g. leaving behind a career, changing roles in your marriage, etc.)

Ultimately, however, we are ourselves. While we adapt to our role as parents, we also must adapt our view of parenting to include who we are as individuals — to allow ourselves to fit into our vision of a good parent.

Some mothers plan to stay at home full-time, but must still figure out if staying at home with their new baby is what makes them a happy mom. Or conversely, working mothers may find that they cannot leave their baby in another’s care. For fathers, you may have expected yourself to be the provider, but you still must figure out if spending the weekend satisfying that picky client at home is how you want to be a father — or if your partner is even the better choice as the bread-winner! And parents must weigh all sorts of other priorities, to friends, yourself, and the world, in figuring out how you will incorporate being a parent into your life.

No one can do this for you, because you are as unique a person as your new baby, and uniquely qualified to create the best family for your child.

If the process of evolving into the parent you want to be is more challenging that you thought, working with a therapist who specializes in this transition is a good way to work through your competing goals and figure out the path that is right for you.

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Good Grief! Adjusting to Parenthood

Letting Go of What We Give Up When We Become Parents, by Meri Levy, MFT

In becoming parents, along with the love and joy that a baby brings, we often face issues that arise relating to our own childhood experiences. For many people, the unmet needs and wants from our childhood simmer below the surface, and the arrival of a baby and the transition to becoming a parent can bring them to the forefront.

It is important to allow ourselves to grieve the losses that are a part of becoming a parent — the loss of nurturing we feel as the focus shifts to nurturing our child, the loss of independence, and our diminished ability to focus on our own needs — and work on letting go of unmet expectations regarding our own childhood.

The phases of grieving have long been studied and are well understood, although their duration, order and intensity can vary greatly, and each individual’s experience is unique.

The first phase is denial: in this case we deny feelings of loss because they seem inappropriate or are too uncomfortable to deal with.

The second phase is anger, and this can take many forms: anger at our partner for their lack of support, anger at our parents for perceived flaws, anger at friends for their lack of understanding of the changes we are experiencing. And even sometimes anger at our child, for the endless demands or because our baby differs from our expectations.

The third phase of grief is bargaining: attempting to avoid or undo our uncomfortable feelings. “If only I had a more supportive husband…, or an easier baby,” etc. These are ways we avoid dealing with the fact that parenting is incredibly hard work, and that our unmet needs from childhood have not and most likely will not be met.

The fourth phase of grief is depression. This can include intense sadness, feelings of hopelessness, loss of interest in life, and a feeling of numbness. Depression is a normal phase of grieving, but when it becomes severe (i.e. thoughts of harming oneself or others) or persistent (more than two weeks), it is crucial to get help.

The fifth and final phase of grief is acceptance. We feel comfortable in our new role as parents. We accept, and can even joke about, how our life has changed and how our child has become the center of our world. And importantly, we do what we can to nurture ourselves, without blaming others, without feeling guilty, knowing that we deserve taking care of, even if the only one who can do it is ourself.

Take a test to see if you have Prenatal or Postpartum Depression

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Nurturing the Nurturer

By Meri Levy, MFT

Taking Care of Yourself as a New Parent

As parents, our job is never-ending. For the next 18-21 years, you are either “on duty” or “on call” 24/7. Strangely, while this never-ending job doesn’t necessarily get easier with time, it often seems less like “work” as our children (and we) mature, and more like “life.”

But it is easy, as we grow into our role as caretakers of our children, to forget another important person who relies upon our care – ourself. We all make this mistake sometimes. If you don’t make sure that your own nutritional, health, emotional, and spiritual needs are met, who do you think will? It has been my experience that the answer is “no one.” As much as our partners may want to attend to our needs, they cannot do it for us. No one but you really knows what it is you need, and many of the things that fulfill us as human beings cannot be done for us.

No one but you can make sure that you eat a balanced diet, get regular exercise, indulge in treasured hobbies or activities, get needed downtime, or connect with beloved friends and family.

How important is it to make sure that your own needs are met? Only you can say. One mom might be able to tandem-nurse twins and a toddler while home-schooling her older two children and never see a movie or have dinner out for five years. And be perfectly content. Another might feel burdened and overwhelmed if she doesn’t have lunch with a friend or enjoy a leisurely uninterrupted bath weekly. Or maybe you need an hour every day to drink a cup of tea and read the paper or a good book. You are the only person who can say when your engine’s running low on gas, and what it takes to fill it up.

And it doesn’t help to feel guilty about what you need to do to take care of yourself. If your child needed a nap long after his peers had given it up, would you tell him to “tough it out” and be grumpy for half the day? No, you would do whatever you could to arrange things so that he could get his nap. You deserve the same recognition for your unique temperament and needs.

And you don’t do anyone any favors if you let yourself run on empty for too long. No one wins if you allow yourself to run out of gas on the side of the road. And everyone is affected when you are running low, not just you. You don’t make it to the finish line any faster if you never slow down and take it easy.

This is your life. And raising children is a path, not a destination. You cannot travel the path with joy and stamina without giving yourself the same care you give your children. So take some time this week and plan a couple of activities you can do that will help “fill up your tank.”

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Self-Care for New Parents

The Importance of Taking as Good Care of Yourself as You Do Your Baby

By Meri Levy, MFT

This is a topic that I cover regularly in my new parent support groups, because it is so important to remember as a new mom or dad. It is easy to feel that the needs of your new baby, and even your partner, outweigh your responsibility to take good care of yourself. But this is a dangerous trap, because you are only as good a parent as you are nurtured as a human being.

This is not meant to be a guilt trip about getting your nails done or taking time to work out. The whole idea of nurturing yourself is about minimizing the avoidable “shoulds.” You don’t want anything about your own self-care to feel like an obligation. Pick ways to take care of yourself that you look forward to, and that fill your cup. It could be as simple as a long, hot shower with the music turned up high (while someone you trust minds the baby). Or taking an hour at Starbucks to read the paper over coffee while your partner has some baby bonding time.

Each of us as parents needs to listen to the voice inside of ourself that tells us when we’ve reached our limit. Parenting with heart requires living with heart, which is only possible if you feed your own spirit and body, and set appropriate boundaries to prevent building up resentment.

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Increasing Your Breastmilk Supply

Making Sure Your Breastfed Infant Is Getting Enough to Eat

By Meri Hanson Levy, MFT, CLE

Ever wonder “is my breast-fed baby getting enough to eat?” Click the link for tips to tell if your breastfed baby is getting enough milk. Most nursing moms make more than enough milk for their baby, but sometimes nature needs a little boost to get things moving in the right direction.

If you’re trying to increase your milk supply, here are some ideas from my experience working with new moms and lactation consultants at the Center.

  • Try fenugreek seed capsules or More Milk Plus. We’ve seen that Fenugreek capsules and More Milk Plus are the best natural products out there to increase your milk supply safely and effectively.
  • Nurse often — at least 8-12 times a day during the first two months. Your baby is better than any breast pump at stimulating your milk supply. And emptying the breast completely tells your body to make more milk. To encourage your baby to empty your breasts more completely, use gentle breast compression to bring down additional milk when your baby begins to swallow less often during a feeding. If your baby is not nursing well or often enough, use a high-quality breast pump. You can use a breast pump after each breastfeeding to give your milk supply an additional boost.
  • Drink lots of water, get plenty of rest, and eat nutritious food. Many mothers are able to produce adequate milk on little sleep and an inadequate diet, but if your milk supply is low, your body may need to be nourished and rested in order to produce more milk for your baby.
  • Birth control pills (even the “mini-pill”), antihistamines and other medications may affect your milk supply. If you have any questions, talk to your health professional.

There are other techniques and products that can assist with increasing breastmilk supply. A good resource can be found on La Leche League’s Website

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Storing Breastmilk Safely

Making The Most of the Breastmilk You Pump

By Meri Hanson Levy, MFT, CLE

Make the most of your breastmilk storage by safely pumping and storing your milk.

  • Wash your hands before you pump. Starting with clean hands ensures your milk is free from bacteria that can spoil it more quickly.
  • Store your milk in 1-4 oz amounts to reduce wasted milk when thawing for bottles.
  • You can combine milk pumped at different times as long as all the milk is chilled before combining.
  • Refrigerated milk has more anti-infective properties than frozen milk. Use refrigerated milk before frozen milk if you have it handy.
  • Breastmilk can be stored at room temperature for up to 10 hours, in a refrigerator for up to 8 days, or in a freezer up to 6 months (if your freezer is cold enough to keep ice cream hard).
  • Use hard-sided plastic or glass containers with tight-fitting lids, or freezer bags that are designed for storing breastmilk.
  • You can thaw and heat breastmilk under warm, running tap water. Never boil or microwave breastmilk.
  • Mix or shake bottle before testing the temperature. It is normal for breastmilk to separate when stored.
  • If milk has been frozen and thawed, it can be refrigerated for up to 24 hours for later use. It should not be refrozen.
  • Once heated and offered to your baby, you may offer the remaining breastmilk one more time, but it should be discarded after two hours.
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Coping With Sore Nipples

By Meri Levy, MFT, CLE

You’ve decided to breastfeed, and you should feel great about it! You are doing a wonderful thing for your baby and yourself. However, there’s nothing quite like nursing a newborn to make even the most confident new mom feel like a complete amateur. New babies can be sleepy, squirmy, and fussy during feeding times, and having sore nipples only makes it harder to feel confident and patient with the learning process.

During the first two weeks breastfeeding, it is normal to have some mild soreness or tenderness in the breasts and/or nipples. The usual reasons for this are three:

  1. your breasts are not used to being used as a food producer, feeding method, and pacifier up to 12 times or more each day.
  2. early feeding sessions are more likely to create soreness, since the baby suckles harder to try to bring down the colostrum. Once there is real milk to reward the baby for his efforts, the suckling becomes more manageable.
  3. mom is more likely to tolerate a less successful latch-on in the early days, while she is learning how to feed, which can cause soreness.

However, if your nipples are extremely sore and cracked, bleeding, bruised or blistered, or if any more than mild soreness lasts for more than about two weeks, it is usually a sign that a deeper latch is needed.

PROPER LATCH-ON TECHNIQUE

The most important single factor in preventing and resolving sore nipples is to get a deep latch-on with the baby. If you feel the roof of your mouth, and then move back to the soft palace farther back, you can imagine how much more comfortable it is to have your nipple rubbing against the latter and not the former. In order to get a good latch, there are three factors that I think are most important.

  1. POSITIONING. Hold your baby securely for feedings, with the baby’s body aligned (the head is not turned to the side), the baby’s hips flexed, and the head free (in whatever position you choose, make sure that the baby is free to tilt his head back to open his mouth wide). Proper positioning is crucial for newborns to stimulate their reflex to open their mouth wide and draw the nipple far back into their mouth.
  2. ASSYMMETRICAL LATCH. The baby should be held somewhat below the breast level, so that the baby tilts his head back to open wide, and latches onto the underside of the areola first. One trick is to point your nipple at the baby’s nose, and when the baby opens wide and tries to latch on the underside of the areola, flip the nipple into the baby’s mouth. This technique often gets a deeper latch than pointing the nipple straight into the baby’s mouth.

When your latch is good, even if your nipples are sore, you should notice less pain during feedings. Traumatized nipples should heal quickly. If your baby’s suckling hurts like heck for more than just the first minute of feeding, you probably don’t have a deep enough latch. Use your pinky in the corner of the baby’s mouth to take the baby off the breast and try again.

COMFORT MEASURES FOR SORE NIPPLES

For ordinary soreness, or for increasing the comfort of traumatized nipples while they are healing, the following products are recommended:

  1. Glycerin gel pads can be chilled in the refrigerator, and cut into four pieces each to get the most out of each pad. They feel soothing, promote healing, and protect your nipples from friction while they are sore.
  2. Modified Lanolin nipple ointments. Long the stand-by for treating sore nipples, these ointments are derived from sheep’s wool and purified to remove allergens and contaminants.
  3. Natural nipple salves. For moms who want to avoid animal products and mineral oil, or who don’t like the goopiness of lanolin (or the fact that it can stain your bras), there are natural nipple salves from Earth Mama Angel Baby or MotherLove. These organic salves contain ingredients such as shea butter and calendula to help heal sore nipples, and they are safe in the quantities involved for your baby to ingest.

PREVENTING SORE NIPPLES

If you haven’t yet begun breastfeeding, there are some things you can do to minimize the risk of sore nipples.

Don’t bother using nipple creams before your baby is born or before you feel any soreness. Using such products once you do feel tenderness is just as effective as using them from the start, so have them on hand, but save the nipple cream for when (or if!) you need it.

Despite the common misconception that nursing less often is beneficial for preventing soreness, the opposite is truer. Nursing frequently or for long periods, with a proper latch, will not harm your nipples. But less frequent nursing can cause a couple of problems:

  1. Engorgement, leading to latching difficulties. When your breast is engorged with milk and tissues are inflamed, it can be very hard to get the baby latched on correctly.
  2. A very hungry baby who is difficult to latch on correctly without a lot of trauma to the baby, the mother, and the mother’s nipples

So, one way to help prevent sore nipples is to nurse often (at least 8-12 times/day), for as long as the baby wants. And, learn to recognize and respond to your baby’s early feeding cues, so you can feed before your baby is frantic.

WHEN TO GET PROFESSIONAL HELP

If you do not get relief within 48 hours from an improved latch, or if you are unable to obtain a better latch, there may be something more going on, and it would be appropriate to see a Lactation Consultant. There can be many reasons why you and your baby can’t get a good latch, from something simple to the more complex, and a Lactation Consultant can help you get it sorted out.

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