Breastfeeding support can truly make or break a mother’s breastfeeding experience. Yet, with so many local and online options, how’s a mother to choose which support will actually be beneficial? Today we’re chatting with Sarah Ortega, a mother of four, a certified lactation educator, and the moderator of Nevada Breastfeeds, an online Facebook page that offers support to breastfeeding mothers.
The Boob Group
Breastfeeding Support: Local and Online
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Sarah Ortega: Breastfeeding support can truly make or break a mother’s breastfeeding experience. Yet, with so many local and online options, how’s a mother to choose which support will actually be beneficial? I’m Sarah Ortega, a mother of four, a certified lactation educator, and the moderator of Nevada Breastfeeds, an online Facebook page that offers support to breastfeeding mothers. This is The Boob Group, episode 18.
Robin Kaplan: Welcome to The Boob Group, broadcasting from the Birth Education Center of San Diego. I’m your host, Robin Kaplan. I’m also a certified lactation consultant and owner of the San Diego Breastfeeding Center. At The Boob Group, we’re your online support group for all things related to breastfeeding. Have you checked out the fabulous articles on our blog? We have several moms who have offered to blog about their breastfeeding experiences for The Boob Group and I was completely blown away by their stories. If you are interested in sharing your breastfeeding stories, feel free to contact me through the link on The Boob Group website which is http://www.theboobgroup.com. Today, I’m joined my three lovely panelists in the studio. Ladies, will you please introduce yourselves?
Crystal Mullet: My name is Crystal Mullet. I’m 27 years old. I’m a pharmacy technician. I have two children, three and eight weeks.
Erin Esteves: My name is Erin Esteves. I work at international business. I have one child of nine months and my age is my secret. [Laughs]
Megan Weber: And, I am Megan Weber. I am 26 years old and a billing clerk and I have two children, a three year old and a four month old.
Robin Kaplan: Well ladies, welcome to the show.
[Featured Segment: Ask The Experts]
Robin Kaplan: Before we get started with today’s show, here’s a question for one of our experts. “Hey Robin, I have a little question for The Boob Group. I need some advice on transitioning into nursing a toddler. We have always nursed on demand and I feel so grateful to have overcome our early challenges to have a healthy and rewarding nursing life. But, these have been just a tad bit frustrating lately. Nursing on demand is sometimes turning into demanding to nurse or comforting a baby who truly needs a bit of assurance with a quick little nurse sometimes turns into comforting whining and demanding baby who would otherwise not blink an eye or whatever upset him were not from my or my boob’s presence. At 15 months, we’re not ready to wean at all. I’m not even sure I want to restrict to a schedule. But, I do want to discourage the current pattern where if slightly frustrated, he becomes extremely agitated unless he can nurse. Again, only when I’m there, this is what clues me in, he doesn’t really need the comfort, if that makes any sense. I would love to hear some thoughts. Thanks so much for your time. Jannie.
Rose DeVigne-Jackiewicz: Hi Jannei, this is Rose DeVigne-Jackiewicz. I’m a lactation consultant helping healthy moms and babies and I have to work Kaiser Permanente. And, I just wanted to see if I can help give you a visit and answer to your question on nursing your toddler. First of all, congratulations for continuing to nurse ‘cause it’s definitely the best thing for him. However, he’s probably figured out toddlers, what is that? Definite tough time of transitioning and it could be very erratic for babies at this age. You are their safe haven and when they get frustrated, they know the safest place in the world is mommy. And, in turn it may become frustrating for you ‘cause you act as if you get frustrated, they show the temper tantrums, it’s a quick way to calm him down and but, it is also used as a way for them to quickly checking in and reconnecting with mom throughout the day.
Several options that you can do just to kind of help him when you know it’s just kind of a frustrating moment or your right in the moment, a minute of doing something is to, you know, to call him by name and say just a minute. My daughter would tell her little one, “ I need you to hold your patience,” and that would redirect her for about one or two minutes. And then, she would gradually get a few more minutes so that he knew that he was going to get it but, he had to wait just a few minutes. But, it’s typical for toddlers to be very hit and miss. You know, they want to nurse but they don’t. And then, they want to come for just a quick short nursing and so, really what you’re going to is very, very common and it takes a little bit of working with him to may be teach him a little bit of patience to may be wait one minute to five minutes and as he gets older, he’ll realize you’re always there. But, he can count on you and that’s the best way. He comes right into you knowing he’s safe there. So, hopefully this is helpful. Take care, bye, bye.
Robin Kaplan: So today, on The Boob Group, we’re discussing the importance of local and online breastfeeding support. Our expert, Sarah Ortega is an experienced breastfeeding mama of four, a certified lactation educator and the moderator of a widely popular Facebook page called Nevada Breastfeeds. Thanks so much for joining us Sarah and welcome to the show.
Sarah Ortega: Thanks you! Thank you for having me.
Robin Kaplan: Yes, it’s our pleasure. Sarah, can you tell us a little bit about Nevada Breastfeeds and what inspired you to create this Facebook page?
Sarah Ortega: Well, Nevada Breastfeeds is really a place for moms to get support from either myself, getting direct help with their different problems or concerns, even just questions. They don’ necessarily have to be problems. Or, they can get help from other women on this page. We do have a couple of men but, the large majority of people in there are women. And so, they can just come to this page and get mainly support with breastfeeding but, there’s a lot of other things discussed on there as well.
What inspired you to create this page?
I had been kind of thrown into the world of breastfeeding by accident which was a really great blessing kind of in disguise. And, it just showed me how much moms need the support and we have a couple of different breastfeeding groups here in Reno that are available to women, different days, different times but, to see how well the numbers are in these groups and knowing how many women are actually having babies and wanting to breastfeed and trying to breastfeed and whether that it’s successful or not, they’re not reaching out for help on a personal level, you know, going out of their house. And so, with Facebook, it’s just so nice and such a great way to reach people and also a part where they would never even have to leave their home if they don’t want to.
Robin Kaplan: That’s fantastic! Ladies in the studio, would you say that you use Facebook pretty regularly?
That was quite easy. And do you use Facebook to find breastfeeding support?
I did it originally but now, I’ve been actively looking for the support on Facebook. So, it’s nice to, I’m literally on Facebook every probably 20 minutes if I, you’d be scared to know [Laughs] how often I’m on there. But so, it’s nice to have, you know, a little pop up on my timeline about breastfeeding. It just reminds me of what a great job I’m doing. [Laughs]
Robin Kaplan: Yeah, absolutely! How about you Erin?
Not initially, no! It’s not something that I specifically sorted out on Facebook. But, I have particularly with the San Diego Breastfeeding Group. I do visit the Facebook page often and rely on it for information and articles and so forth.
Yeah, I’m part of that group too, San Diego Breastfeeding and I think that’s a great resource.
Yeah, and what type of questions are you posting on there, ladies?
Well, when my son was just refusing to nurse and it was like, midnight, you know, I didn’t know who to call and so, I went on there and, you know, asked what’s going on. I was worried, you know, I think he was three months at that time and he was whining and so I had this nice group of moms responding and easing my worries. Now, he’s not whining and everything went okay.
Okay cool! How about you Erin?
Well, I experienced a nursing strike when my son’s teeth came in. [Chuckles] Excuse me and it was through not Facebook in particular, but, through the internet and different sources that I actually realized that it was a nursing strike, what it was and what I could expect and how to go through it. So, without that support I’m certain I probably would have stopped nursing.
That’s pretty significant. [Laughs] Absolutely.
How about you Crystal?
I find I’m fairly new to finding the support on Facebook. So, I haven’t quite made that jump to actually post it myself. So, it’s more of reading it and just being an observer at this point. But, in the future I’m hoping I’ll have problems. [Laughs] Hoping that if I do have a problem that’s somewhere I can go definitely.
Yeah, and it’s not like you would be necessarily posting it on your blog, like, “I’m having breastfeeding challenges.” [Laughs]
I want everyone to look at my nipples. [Laughs] And a nerd from high school would enjoy that. [Laughs]
Exactly! Sarah, what kind of support were you able to offer breastfeeding moms through Nevada Breastfeeds and kind of what support those beyond what you think you can offer on that page?
Well, this is something that I work very hard to provide support but, not outside of my scope of practice which is not a very broad scope. I’m still kind of, you know, learning and I do work with an IBCLC here in Reno. She does a private, she has a private practice company and so I am able to bounce a lot of questions off of her and make sure that I don’t step does down. So, I do a lot of different things. I post articles that are well into breastfeeding and mostly, you know, to moms as in general. So, I always try and tie it down to breastfeeding. But, sometimes it doesn’t but, that is really the jest of the page of breastfeeding so, there’s articles where they can comment on them. Sometimes, it does cause a debate. I try to monitor that very carefully. I don’t allow women to batch one another on there or I don’t allow it to get too heated because it used to be the same place where women can come in and talk about things that are, you know, a concern without feeling like the or being attacked for whatever reason.
So, I monitor it very carefully that way. And then it’s also set up where you can post questions directly on the wall and that way other women can come on and make comments and help support, you know, give you information that might help. But, there are times that it’s really not appropriate for keeping it posted on the wall because they really do need specific help from a professional. So, in those situations, I will remove it from the wall and send it to, a private message and kind of work with them that way and again if it’s something that’s outside of my scope then I start referring to someone that will really be able to help them with their problems.
That’s really great to know because, you know, that was one of my concern as a lactation consultant if I was gonna do something like this is where does it become, I can’t answer this online like, I need to have a visual, I need to see and so that’s a really good point that you make about removing it from the wall and then just, you know, speaking to that person directly and offering them what their resources are in your community so that they can actually get the help they need. Which kind of questions do you find it most common be posted on about breastfeeds?
Gosh, I would say the biggest one is pumping. How to pump, when to pump, going back to work and you know, just trying to make that all work together and how does breastfeeding and pumping works, you know, together so that you are able to keep your supply, you’re able to keep your baby breastfeeding successfully and not losing it about when you do return to work or school. There’s a lot of different, certain things of course. And then, also, gosh, I think one of the most popular questions is, “ I don’t think that my baby is getting enough, what can I do to increase my supply?” and, that one always gets me. I really struggle at that because it’s 50-50 half of the time, their supply is fine and they’re just questioning themselves because mothers also worry and, you know, and the other half of the time, they really do need help and I just don’t believe that taking a pill is the answer. I think that, you know, you really need to figure out why it’s falling and how long it’s been falling and then, what you can do that’s really going to work and not, you know, follow these different, drink 5 glasses of water and you’ll be fine or you know, just kind of miss these out to increase your supply and then now you’re another week out and so, nothing to be really want to be different as well.
Yeah, and so, how do you answer all of these questions and work and take care of your family because that just baffles me? I have no idea how you do all that.
It’s definitely taken some time to establish boundaries. I’m not very good at that just in general. So, when it came to this page, you know, when it was small, it was really easy, I could answer a question at 11 O’clock at night. It wasn’t a big deal and then, you know, I would get a little bit of grief from my family and I understand that. I had to remind myself that, you know, these aren’t, these questions need to be answered the second that they’re asked. So, I tried very hard to just work it on my family and what their needs are and then, as far as my job, I have been very fortunate to find a job here in Reno with a maternity store. She is very supportive of breastfeeding so, she loves me too and much with the people here I work with so, of course, my job comes first but, it’s really been a really nice relationship.
Seriously, that’s fantastic! Alright, when we come back, Sarah and our panelists will be discussing their favorite local and online resources for breastfeeding support. So, we’ll be right back.
Okay, so we’re back. Ladies, have you found that the online breastfeeding support that you’re receiving is helpful? You know, one of my concerns would be that a mother would only be receiving anecdotal advice maybe from other moms which obviously is hugely beneficial. But, like, Sarah had mentioned, sometimes it reaches beyond that and ends up into kind of needing clinical help and that she would most likely receive from an international board certified lactation consultant. And so, do you find that that’s kind of the case with the forms that you’re working in? Or, and that the advice is helpful, some are contradictory?
I think that on, like the San Diego Breastfeeding group, I know some of the moms on there and some of them are lactation consultants or are going to school to be lactation consultants. So, I kind of have to think about, okay, who are these moms, what is their background, what kind of education do they have and a lot of them will not only provide their advice but, they’ll provide like, links to websites so you can read and see, you know just how accurate this information is.
Yeah, that’s a really good point. How about you Erin?
I always cross reference everything and it’s my own OCD. I want to make sure that the information I have is as accurate as possible. So, while I do go to anecdotal, with count I also back it up by going to like, Stanford or the Mail Clinic or the, you know, medical journals that sort of thing to back it up.
Yeah, how about you Crystal?
I go on support, I enjoy the anecdotal things. I enjoy reading about the other like, if a mom had trouble and then how she got through it. It’s nice to know that side of things. You kind of have to take all the advice and information that they give you with a grain of salt knowing that it’s possible should or not be accurate with our information. And then, you know, back it up with the websites and it’s nice when people post and they say, “I know this because...” and then they back it up with a website or, you know, something that’s that you know would be accurate. But, I do enjoy the anecdotal things that helps me through the day sometimes just to read the struggles and the triumphs of other mothers.
Absolutely, I think that’s why blogs are here. We’ve honestly taken off so much and why women actually spend way more time on blogs than, reading blog articles than men do because I think sometimes we are drawn to those anecdotal stories and also one of the main reasons we wanted to have blog articles on The Boob Group, on our website because, there’s nothing like hearing, you know, when a mom goes through something and seeing her. Sometimes, you know, mostly coming out on these sites but sometimes not and just having her process in being able to kind of just the human sight of that and so, I agree with you. I think that there’s definitely a purpose for both of them by just making sure that you are also, you know, it’s wonderful when people include
links to articles. Sarah, do you find that you do that too where if you’re answering questions you might guide someone to an article online?
I do, it depends on the questions and how specific of an answer they need. So, if they tell me that, you know, they’re trying to increase their supply because they’re baby is 3 weeks old and still, you know, pretty far from birth weight, then I don’t bother with articles. I immediately refer them to get help where they can really sit and figure out what’s going on and how they got to this place and if it’s something more along the lines of, I think it’s a little bit well and, you know, I’d like to increase a little bit to have a little bit of a stock pile, you know, then I can do some link thing with articles and it’s always from a trusted source. I very rarely just Google sometimes. You just, you never know what you’re reading there. So, I always try to do trusted sites that way. But, for the most part I would prefer to refer people out and then most of the time I don’t take that suggestion because they really want a quick fix answer and I don’t feel like you can get that online. Again, it really depends on what the circumstances are though.
Yeah definitely! Ladies, do you also attend breastfeeding support groups? And if you do, how does your online connection and discussion kind of mesh with that in person contact as well?
I do attend a support group every once in a while. I haven’t in the past two weeks but, I try to every week. And, I find that knowing that a lactation consultant at that group, if I do have a question about information I got online, I know I can ask her. And, I do, a lot of the questions I ask her are about the information I received online. So, it’s nice to know I have that person to go to. I know specifically who I can go to ask and get the correct answer to that question.
That’s a really good point. I’ve never even thought about that when I thought of the question. [Laughs] But, you know, it’s like you’re getting both sides of the coin there. So, you’re getting the personal stories as well as making sure everything is accurate. That’s fantastic. How about you, Erin?
I have to agree with her and myself, personally, in the beginning months, I attended more regularly. But, I still have in the back of my head I know that every Wednesday from such and such time, if I have to or if I need to or if I would just like to, I just pop in and hang out with all the other bummers and it’s very reassuring.
I think that we’ve kind of, my friends and I have we unintentionally created a support group. We come together for, you know, kid play dates for our older kids and it turns into a big roll sitting there nursing our kids and talking about the ups and downs then, there we go, we have our little group there. But, yeah, in the beginning, I would go to the hospital for those groups and I find that now we’re kind of in the flow and the breastfeeding is going okay. I haven’t felt the need to go back to those right now.
So, what other online and local resources do you think are helpful in supporting breastfeeding moms?
Well, locally I think it’s really good to get involved with the breastfeeding community and support groups are a great way to do that. And what they’re saying as far as, you know, you go in there the first couple of months because that’s when it just seems to be so important and it doesn’t matter what you have to do. You’re going to get there because you want to know how much your baby weighs or you need to talk to someone who is dealing with the same thing that you were last week or you have that question for the lactation consultant. So, it’s so important for you to be there in the beginning and then it will become easier than, you know, once your friend comes up and then it’s not quite important so, we see that in our groups as well. They just kind of start kind of a new group of moms every three or four months. So, just as a sign I would say if you can make it back to those new moms, I think that’s great too so that they can see, “Oh my gosh! They were in the same position I was three months ago and they’re still breastfeeding and their babies are doing well and they have come by” or, you know, whatever the case is, they see the other side that it’s not always going to be so difficult.
That’s a really good point and I’m glad you brought it up because I am feeling quite bashed actually that I haven’t made a point because it was my returning to one of the support groups that was really pivotal in my changing and my, changing my attitude specifically so good point, thank you.
Yeah, well, it’s hard to think that way, you know, because you come out of it and you just, you feel so good not to be so dependent, you know.
Yeah, one other things I see in the support group that I lead is there is a group of moms who have been coming for a while and they’ve also formed their own kind of sightseeing or play group or whatever. So, they see each other much more frequently than at the support group. But I love when they show up back at the support group with their six month old, eight month old, a year old baby that is just celebrating their first birthday and you just see the eyes of the new mom with her two week old light up and that’s exactly what you said Sarah that they’re like, “oh my gosh! They really look like they just took a shower.” And they’re all going for lunch afterwards like, I had friends that I can do that with and so, but it is wonderful to have these moms who are confident breast feeders and they might still have a few questions here and there a bit to kind of be, I don’t use the word elders but, it is the matriarchs of the group, you know, that they can share what they’ve learned and also just provide this like, “hey, this is, look how cool this is to have a six month old baby that’s sitting up and so interactive and my two week old doesn’t even smile at me yet.” So, it is really cool to see that. And Sarah, whatever online resources do you like?
Well, I enjoy recent blogs for the same reason. I think it gives people hope that they can get to these things and it’s nice to read those, you know, when you’re feeding at 2’O clock in the morning or pumping at work and you know, all of these things that when you’re looking for something to do so, it is nice to read those blogs and articles. So, I really like http://www.bestforbabes.com. Of course, they post some really great things and http://www.kellymoms.com, her Facebook page and her website are both really great. So, those are my two favorite resources and then just finding blogs from real women that don’t really have an agenda. They aren’t trying to sell a product or Google or I’ll look for my favorite, you know, websites or Facebook pages to find those stories and other fun stuff to read. But, I think it’s just very important when you’re online to know who you’re getting the information from. And so, that way you can really do process it from there and know this is a really trusted source and going to really listen to what they have to say or just, “oh! This is really fun to read. I can just know the difference. “
Sure, one other things I’d like to do also is if I find a blog that I really like I check out their blog rule to see who else they’re following [Laughs] coz it’s just a great way to kind of expand like, “ okay well, I like the way this person is writing and so I probably will like what this other person is writing too. And if not, it’s no big deal.” That’s one of my favorite little pieces of a blog. Ladies, what other online and local resources do you find your breastfeeding information or connect with the breastfeeding moms?
My main one that I go to is an app on my phone for What To Expect. I use the What To Expect app and on there is a forum. I initially downloaded the app to track my feedings coz it has, you know, stuff like that on it. But, on there has a link to the forums and it’s great to read like, at 2’O clock in the morning, feeding, you know or my husband’s watching something stupid on TV. [Laughs] So, I’ll go to my forums so, that’s the main one I do and then just a few breastfeeding ones that I follow on Facebook. So.....
Very cool! How about you Erin?
Well, other than my mother in law or a few girlfriends that are still actively breastfeeding, Kelly mom I go to a lot and of course San Diego Breastfeeding group is my no. 1 spot for information. And because also, I know that if I’m in a serious position, I can text Robin. I can shoot her an email like, you had mentioned earlier knowing that there is a person in particular that I can go to for help, is amazing.
Great, cool! Thanks!
I really like the website and I found this when I was pregnant and I swear I think I read very little word of it. It’s http://www.breastfeedingbasics.com.
Oh yeah, that’s one of my favorite as well.
I’m always on that webpage and I also just really rely on the Facebook page and also, I have a friend who’s going to school right now to be a lactation consultant. So, I love looking at her textbooks. [Laughs]
That’s a really good idea. You know, the couple of the ones that I love are, Best For Babes and Kelly Moms. Those are the ones I think most lactation consultants refer to a lot. But also, I’d mentioned in another episode. The Leaky Boob, she has fantastic, she gives great articles and they have a forum on there as well, as well as Kelly Mom does too which I didn’t realize that her forum was so active. But, you know, she has a web page and her Facebook Page and then she has a forum where it’s kind of the same type of thing you’re talking about with these Facebook pages that, you know, you can ask questions which are wonderful. And then, finding Facebook page, you know, groups like Novada Breastfeeds or Sandiego Breastfeeds where you not only have moms coming in and talking but, usually there’s a few lactation consultants who are answering everyone for a while like, I find that, you know, if I see a question I’m like, I can totally answer that in two seconds. I love being able to share that information and also I was a breastfeeding mom as well. So, I can speak from perspective too but I think these resources are phenomenal. So Sarah, since Novada Breastfeeds now, it already has over 2500 friends. Are there any claims to expand this page or possibly hire other moderators? Because, I just can’t imagine that as this continues to grow and people, or when people are listening to this episode that you might have a whole new ton of or group of likes on there and wanting to join, you know, how or what are the future plans for NovadaBreastfeedings?
You know, I don’t know. It’s so hard to say right now. I’ve only been doing this for about a year and a half and so it’s definitely bigger than I had expected it to be which is amazing and I’m still happy about that. The problem is I don’t really think it’s a problem but, I don’t get paid for this page so, I can’t imagine hiring somebody to help me. [Laughs] I am hoping, you know, I am looking into the world of blogging and it makes me a little nervous but, I’m definitely looking into different options that way and then, you know, hopefully, have some people come along that will be like, you know, that would like to help me that has a heart for this and just wants to help women with breastfeeding and new mommy hood really, you know, it’s just not breastfeeding.
Absolutely! Are you planning on becoming an IBCLC?
Yes, I am! I have my lactation credits for the classroom with the Molly Tetrow course. I think I need a few more hours that way and I’m definitely working on my classroom hours as well and I have my one hour with Robin with IBCLC that I work with. So, she’s just been amazing in teaching me and showing me what’s the side of the hospital and what’s really going on when women leave the hospital and go home and they just feel alone.
Yeah, and that’s why you’re helping with every single day. [Laughs]
Yes, it’s been fun.
Well, thank you so much Sarah and our panelists for your insight and some local and online breastfeeding support. I have a feeling that our listeners will be feverishly looking up your recommendations as soon as this episode is over. So, thank you so much for your time.
[Featured Segment: Boob “Oops”]
Before we wrap things up today, here’s a breastfeeding oops!
Hi my name is Erin and I have a nine month old little boy and this is my boob “oops”. [Laughs] We recently went to the San Diego Zoo for my company picnic and I had only once before breastfed in public and that in itself wasn’t adventure. So, that day I didn’t anticipate breastfeeding at the zoo. However, my son became very fidgety and desperately wanted the comfort. So, we found what at that time was a very secluded part of the zoo and we sat down in a couple of the benches and of course, I never use a cover at home because I’m just breastfeeding at home. So my son does not like a cover and at the age of nine months he’s well strong enough to get rid of that cover. So, I’m breastfeeding. I’ve got the cover. I’m fighting with him with the cover and all of a sudden I realize that three tour busses have pulled up not 20 feet away from me and everybody is exiting and coming to look at the exhibit that I’m sitting in front of. [Laughs] So, of course, I’m trying to look very calm and not part of the exhibit. [Laughs] But, my son, he’s pulling and pulling and I realize that this just isn’t gonna work. And then, to my horror, I turn to my left
and two of my male colleagues have seated themselves at the very big table next to us and I’m trying to nonchalantly look away. But, it’s very obvious that they’ve seen me and I was just mortified and my husband came over. He tried to cover me up and yeah, I just turned around and said. “Oh hi!Guys!” as if nothing had happened. But, that was my boob “Oops” at the San Diego Zoo.
If you have a breastfeeding “oops” you’d like to share with our listeners, please call our Boob Group hotline at 619-866-4775. Thank you so much to our experts, panelists and to all of our listeners. I hope you’ll visit our website, http://www.theboobgroup.com and our Facebook page to offer your recommendations for your favorite local and online breastfeeding support resources. Thanks for listening to The Boob Group, because mothers know breast.
This has been a New Mommy Media production. Information and materials contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. For such information in which areas are related to be accurate, it is not intended to replace or substitute for professional, medical or advisor care and should not be used for diagnosing or treating healthcare problem or disease or prescribing any medication. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified healthcare provider.
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