Dr. Punger is a native of Long Island, New York. She completed High School, College and Medical School in Georgia. She met and married Dr. Coquelet (from Lima, Peru originally) during residency. Together they moved to the Treasure Coast and were both employed in Martin County for eight years. Too ambitious for employed urgent care work which limited the impact she can make on the breastfeeding community, she took a 'sabbatical' in NW Georgia and returned to the Treasure Coast a year and a half later to private practice.
When her first son was born in 1996, Dr. Punger found that breastfeeding came fairly easy, but was distraught at how many mothers had problems with nursing, receive wrong information, and unnecessarily weaned. As she became involved with the breastfeeding community locally, she realized how her pediatric and obstetric medical training encouraged her to support breastfeeding, but how little had it actually prepared her to help breastfeeding pairs when problems arouse. However, with access to the entire body of medical literature and help from the La Leche League(LLL) and attending the LLL Medical Associates Annual Conference twice, she soon found she could be a resource for mothers having breastfeeding difficulties.
Besides being a Fellow of the American Board of Family Practice, Dr. Punger became an International Board Certified Lactation Consultant (IBCLC) in 2000. She has been a member of the Academy of Breastfeeding Medicine and a La Leche League Medical Associate since 2000. Through membership in these professional organizations, she has 24/7 on-line access to breastfeeding experts around the world and can seek opinions and references quickly for special situations. Locally she chaired the local Treasure Coast Breastfeeding Task Force for two years. She attends local LLL meetings and has been a member of Florida Lactation Consultation Association for five years. She appreciates how the birth experience can affects breastfeeding and is actively involved with pregnancy support groups. She writes and photographs for local and international birth and breastfeeding publications.
As breastfeeding rates continued to climb and is continued to be increasingly endorsed by WHO, AAP, AAFP, and other major organizations, the need became apparent for a specialty devoted exclusively to the unique needs of breastfeeding mothers and their babies. By established Coquelet & Punger Family Medicine in 2004, Dr. Punger can pursue her interest in helping breastfeeding dyads, free of the politics of an employed position, yet continue out-patient Family Medicine. She is the only Family Physician in Florida who is also an IBCLC and she can uniquely treat the breastfeeding mother and baby as a pair.
She has three homeschooled sons. Her experience breastfeeding her three boys include employment and pumping, nursing through pregnancy and tandem, tongue-tie and donating her own breastmilk to a milk bank.
Maternal breastfeeding problems
low milk supply
too much milk/overactive letdown
medical problems - treatments that won't interfere with breastfeeding
Infant breastfeeding problems
- dental/surgical anesthesia
slow weight gain/failure-to-thrive
sensitivities to foods in maternal diet
infant medical problems
- teaching baby to feed at breast
- birth plan to optimize breastfeeding success
- individual breastfeeding class
nursing through a pregnancy, tandem nursing and multiples
returning to work or school
relactation - returning to breastfeeding after stopping
induced lactation for adoption
prescriptions for banked breastmilk
medical clearance exams for donating your own breastmilk
weaning verses nursing in to the toddler/preschool years
- why breastfeeding failed with last baby
To prepare for a visit:
Because breastfeeding involves both mother and baby, whenever possible, both will be examined. Mother will have vital signs checked, a breast examination to assess physiologic function (different from an exam that checks for cancer), and other exams as appropriate. Baby will have measurements taken, including a precise weight, a general checkup, and a specific oral motor checkup. Whenever possible, breastfeeding will be observed to determine the exact nature of the problem and how best to help correct it. Occasionally, a "test weight" may be done if a precise measurement of breast milk intake at the breast is needed. If a test weight is needed, it is important that the baby's diaper or clothing NOT be changed between the two weighings. Same day appointments are often available for emergencies.
Bring a baby blanket. Bring a drink and snack for the nursing mother. Bring your pump, SNS, pumped milk or supplement as appropriate. Avoid feeding your baby formula for four hours prior to a visit. (We can't teach a full baby how to latch). Neither mother nor baby should dress in one-of-a-kind, hard-to-wash clothing. Baby should wear something easy to remove. We don't want to stain it with blood or a gentian violet application for example. Bring in an extra diaper. If at all possible fill out your new patient forms ahead of arriving to the office and arrive early. This will maximize one-on-one time with Dr. Punger. She allots at least 45 minutes or more of time for dyads. Be familiar with the location of the office. We want our time with you to be quality time. A spouse or grandmother is encouraged and welcome, however, the whole clan is often proves to be non-productive and overwhelming to the dyad.
Dr. Punger keeps a digital camera in the office to take photos for documentation, education, publication, or sometimes just plain fun. Permission is requested first as she respects your privacy and modesty.
Payment policy -- As with any office visits payment is due at the time services are rendered unless previous arrangements have been made (including co-payment for both mother and baby). Coquelet & Punger Family Medicine is happy to file your insurance for you, or we can give you the information to do so yourself. We do accept straight Florida Medicaid and most other health plans. Occasionally services are not covered by individual health plan policy and you will be responsible. We make all attempts to file it in a way that will be most likely consistent with coverage. We are required by state law to charge applicable sales tax on any personal supplies that you purchase. For your convenience, we accept cash, personal checks, VISA and MasterCard.
Breastfeeding difficulties won't last forever. Your persistence will have its rewards. A year worth of formula and supplies are estimated to cost $1000 or even more if specialty formulas are used. A family investing in an office visit and even a pump still comes out ahead.
All too often we hear that a mother stopped breastfeeding or supplemented for medical reasons. When Dr. Punger reviews the situation, she finds the weaning often occurred because of misinformation. Be informed!
A breastfeeding visit does not substitute or equal a well-child check or well-woman. You will be scheduled for a follow-up or referred back to your primary care provider as appropriate.
Same day appointments are often available. Referrals from health care professionals and self-referrals are accepted.