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Posts from the ‘Breastfeeding’ Category

Supporting my Non-Breastfeeding Daughter-In-Law … Part I

 I first realized the initial true feelings Sadie had regarding breastfeeding before they were even married.  I was staying with my son and his fiance — my future daughter-in-law– while attending the ILCA conference in 2006. We were at an ice-cream stand on a warm summer evening. There was a family with young children nearby. The toddler fell down, then while the mother comforted him, he snuggled to nurse for a while. I looked on admiringly. Sadie was disgusted. She commented on how that was totally ridiculous for a baby that size to be breastfeeding! And in public no less! “It turns me off even more about breastfeeding! I will NEVER be doing that!”
I had often cared for young girls with negative feelings about breastfeeding in my career so that didn’t surprise me. What I wasn’t prepared for was that this young woman was going to be the mother of my future grandchildren. I was a little afraid inside. I don’t know why exactly but I was.  Somehow, it hadn’t entered my mind that she may not want to breastfeed. I took for granted that she’d want to breastfeed like all of my family had, and like all the next generation young females had indicated they would. That was wrong of me. I didn’t really know this young woman yet. I didn’t know her dreams, desires or plans regarding motherhood. I had to be able to support her– no matter what!

So how do I discuss this with her? How would you? Do I even go there? Does she even want to talk about it? All you breastfeeding moms with young sons out there….. have you ever thought about this?

As a breastfeeding advocate and a health care professional, I always encounter situations where a mom and/or her friends, partner, family etc., talk about breastfeeding negatively with obvious emotion and often certain misinformation. I try to carefully find an avenue to open the door to an informative discussion attempting to gently educate and dispel untruths. Sometimes that is challenging. Sometimes it is my professional responsibility.  Sometimes it is just an overheard remark by family and the opportunity isn’t quite ripe for a discussion so I can only say one little line with humor to “put in a positive plug” so to speak. It takes experience to know when to talk and a greater wisdom to know when to shut-up.

That day –> I choose to stay away from her personal feelings and instead said a few positive things about how the cultures around the world regarding feeding were so different from our American culture…. I was meeting amazing people at the conference… the average world weaning age was around 4 years old…etc…etc.  I talked about how her future husband was still taking a bottle at age 4 and how he needed that. Then I asked her if she had been breastfed. She was a twin and her mother had not wanted to breastfeed, so no.  She then told me that her mother tried to breastfeed her younger brother (Sadie was 14 at the time) but she had cracked bleeding nipples for 2 weeks and both her mom and her brother were always crying. Can you imagine how that experience, that imagery would stay in the mind of a young 14 yr old girl and impress her own feelings about breastfeeding? I’m sure! This had probably happened to many girls in America.

Through out the wedding plans and the actual wedding, Sadie and I were just fine. I was loving getting to know my new daughter-in-law.  I wanted to be a good mother-in-law and not interfere at all unless they wanted help or advice. Life was good. I let them alone and we enjoyed great visits/ great times.

Then Sadie got pregnant.

SO EXCITING!!! Now we have entered into my realm of expertise. I couldn’t help but ask some pregnancy health questions, feeding questions. I didn’t go crazy- believe me. She was open and sharing. I wanted to know a couple things every once in a while after she came from the doctor. I was wanting to have a feeding discussion with her so when the opportunity arose, I seized it. I was so thrilled that she told me she was going to breastfeed!!! I encouraged her to get some knowledge in ahead of time, like maybe a class or a book. I also said I’d be available to help or do whatever she needed. That may have been the last we spoke of it. At least while she was pregnant.

Our relationship then went straight downhill and it had nothing to do with breastfeeding! I had heard from the happy couple that they were going to have a boy according to the ultrasound. I was thrilled! So excited! I congratulated my son and later in the conversation mentioned to him that it is pretty good but not 100% accurate and that occasionally the U/S can be wrong…. I said this to protect them from possible disappointment. They both said they knew that and things were fine. We then had a case at my hospital where the baby was not the sex predicted by ultrasound! Like a stupid jerk, I immediately told both my son and Sadie. The reaction from Sadie was harsh to say the least. I got a long email from her stating that they had discussed it and they want me to be only a grandmother and not a nurse for any future communications! OK then. I had obviously overstepped! I needed to pull way way back. I was very hurt though. I had tried so hard NOT to be in her space. I deliberately tried to wait for information instead of seeking it out.  But I screwed up. I did. Now I felt like I couldn’t say anything…. EVER…. about pregnancy, birth, breastfeeding….. my life, my work–stuff I knew a lot about! This sucked!

So I kept quiet. I didn’t let her know I was bothered. I tried to just talk like a grandma. What the hell do they ask anyway? Does a grandma ask how do you feel? Does a grandma ask if you are feeling the baby move? Does a grandma ask how your blood pressure is? What the doctor says? Or does she just ask about the names, colors of the baby’s room and stuff like that? How was I supposed to know? I asked “nursey” type questions to any pregnant friend of mine so I don’t really know differently!! The pregnancy continued and I got very little information. Only what they told me…I kept being happy and cheerful. I was a little sad inside but I couldn’t let her see that. It wasn’t about me. She was the pregnant mother– not me!!!!  One time I asked if it would be alright to get a call that labor started so I could drive the 2 hours to the hospital. I wanted to know if it was alright to be in the waiting room. Sadie said “Of course! Why would I even ask that??? I’m the grandmother for crying out loud!” (Oh…that’s what we grandmothers do) YAY!

I got a call from my son Dave one Friday afternoon while I was at work. He was animated and excited and proudly told me that Sadie was going to be induced on Monday! (She was 37 weeks as of today and would be 37 3/7 on Monday). I immediately thought something was wrong. I started asking if the baby was OK, her fluid levels, her BP etc… “Yes relax yes everything is just fine mom!” I said “Well- why do they want to induce her?” Dave said “Because he’s cool, he likes us, and I cut his grass.”      *** ARE YOU F-&$%*& Kidding ME???? ***** is what I’m thinking.  Out loud… I said: “Oh Honey, all the experts frown on inducing this early if there’s no medical need. Please talk about it some more and find out some of the risks.”…… “There are no risks Mom, I trust him. He knows what he’s doing.”. Later I get another phone call from my son where he told me he did not appreciate that I couldn’t be happy when he was telling me good news.  I just said I was only wanting to make sure he made smart decisions now that he’s going to be a parent etc and just tell me when and I will be there. I had to shut up.      What would you do? Would you say more????

The next day, Saturday, he called and told me the doctors moved it up a week. A week from Monday. Who knows why—I’ll never find out. At least she’ll be 38 3/7 weeks. The baby had other ideas. Sadie went into strong labor one day before her scheduled induction. Her labor was not long for a primip at all. A total of 8 hours. 45min of pushing. She had an epidural. Just Dave and Sadie in the room. The waiting room was filled with her family and myself and my daughter. I was told by the other grandma that the baby had already been to breast!! YAY! I was invited back to the room to meet the baby and it was a wonderful moment. I didn’t ask any questions just commented on how good Sadie looked and how good the baby looked. I think I was afraid to do anything except smile.. I was very happy and everything looked good.

Later in the room, there was a bottle of Similac in his bassinet. The room was filled with visitors. Sadie asked me if I could feed him. I only asked when he ate last. She said it had been hours and she couldn’t get him to eat. I sat down with my new grandson and started to work on feeding him. That’s exactly what it was. Work. He had some kind of disorganized sucking pattern. He seemed to have a weakness on one side of his mouth and didn’t form a seal well on the nipple. I have seen a lot of this before and have worked with both breastfeeding and bottle-feeding babies who present this way. I was able to get him to take 15 ml and he went to sleep. Sadie and Dave were relieved. The next morning, I came to the hospital with some outfits etc… As soon as I arrived, Dave wanted to go have brunch with me. The baby was alone with Sadie.  🙂  During the meal I asked him about being a new dad etc.. and I asked him how well the baby was feeding. He was difficult to feed most feedings and Sadie was feeling upset. I asked him if she was still interested in breastfeeding and he said “I don’t think so mom. I don’t think so.” SO at least I knew. I had been afraid to ask because of the history and I wanted to be offering the correct information if they asked me feeding questions. I wasn’t upset. I really wasn’t. I wanted Sadie to be comfortable and happy with her decisions. I didn’t want her to feel at all “pressured” by me or my line of work.

I started to think of how I could help Sadie the most. I began to show her ways to support the baby’s mouth on the nipple and techniques to improve the suck. Dave and Sadie initially began to rely on me for feeding help while I kept encouraging them each independently. They got the hang of it. The baby got the hang of it. My little grandson started growing. I drove down to their home for babysitting when Sadie had to go back to work. She used all available relatives to avoid daycare and we were all happy to help. When she came home from work, she’d always politely invite me to stay for dinner. I figured she didn’t need me around at all, she needed to reconnect with her baby. I would leave once she got home. When I’d babysit.. she’d leave me a list in the morning, I’d do as much as I could and document for her what her little baby did while she was at work.  He still had feeding issues… but they weren’t difficult if you knew what to do. Most often, I never even saw my son. Just the baby. One time Sadie told me I was the only one who did things the way she wanted.  Can you believe that??? I was beaming inside. Her own family wouldn’t try to get food in him, they would say “He won’t take it!” “He’s fine Sadie.. when he’s hungry he’ll eat.” They interjected their own 2 cents and felt comfortable doing and saying things to her as they had all her life. I would never be able to talk to her that way.

So she thanked me. Thanked me for hanging in there. Thanked me for doing what she asked. Thanked me for respecting her requests.

Thanked me for being such a good grandma!  ;-

 See also: Part One and A Half  Then:  Part II  … The next pregnancy and baby

Consumer ALERT–> FDA Bans “SimplyThick” Breastmilk Thickener

SimplyThick

Does anyone use this product in your

NICU??

Did you use this product for your baby?

This product is used to help thicken feedings of breastmilk or formula for infants with swallowing issues or even to help with reflux.

Some Preterm Infants have become ill with a serious condition called NEC (Necrotizing Enterocolitis– where the lining of portions of the intestine become inflamed, lack adequate blood supply and subsequently, parts of the intestine can die). This particular problem is most often found early in the premature baby’s life before discharge home.

“To date, the agency is aware of 15 cases of NEC, including two deaths, involving premature infants who were fed SimplyThick mixed with mothers’ breast milk or infant formula products. “

Symptoms to watch for:

  • Bloated distended abdomen

  • Bloody stools

  • Vomiting greenish tinted milk or

  • green fluid

If you see any symptoms like this, please

contact your babies doctor and get

prompt medical attention.

Read more:  FDA ALERT

Happy Mother’s Day Antique Art

HAPPY

MOTHER’S

DAY !

1859 "Abundance" engraved by T.Vernon

1850 "The Gypsy Mother" engraved by E.Portbury

1840 "The Gypsy Mother" engraved by Greatbach

In the world of childbirth, Mother’s Day is a very special day. I have enjoyed years of watching a women become a mother either for the first time or again and again on this very day. It is always wonderful to share that experience with them. Fabulously Joyful!

But today, I get to be home, pampered by my hubby and just milling about… I came across some wonderful websites carrying fabulous vintage engravings and various clip art. I absolutely adore antique engravings! I have some framed and others saved for something I’ll get to one day… 😉

This first few photos above are images courtesy of antiqueprints.com depicting mother and children. There are two WONDERFUL Antique Breastfeeding Engravings! These are all steel engravings with hand color in the first two.

The remainder of art below is from a website called “The Graphics Fairy” and all of these photos are to Karen’s credit over there. Beautiful!

Enjoy!

Victorian "The Mother" engraved by the Illman Brothers

1880's Antique Engraving Children with Cherries

Beautiful old painting of a Mother with Children

Old French post card

Wordless Wednesday~ Twins

Yesterday I saw the BEST Twin talk video which I will put at the end of this post..

But first….. I wanted you all to have a look at some luscious twin breastfeeding photos I found on Google. I am in a twin mood today.

 

This has had over 2 million hits on YouTube!

 

Happy IBCLC Day !!

Today is IBCLC Day which is held the first Wednesday of March every year!

 

Ecard from ILCA

As a former IBCLC, I know how hard many work to support and protect breastfeeding moms and babies everywhere. This profession deserves our recognition today and everyday…..Thank you all for your hard work.

Happy IBCLC Day! Good job!

Wake up America

March 2011 Vanity Fair fold out cover. Olivia Wilde…. Dear Facebook, does this picture offend you? America- why is this ok and #breastfeeding in public offends??

Wordless Wednesday: Fabulous Skin to Skin & The Latch Connection

Success! You CAN Do it Right with a Preemie!

Short Little Success Story

Recently had to attend a birth for a 34 weeker who had been threatening labor since 32 weeks. She had been given a regimen of steroids and antibiotics per our protocols. The parents had a beautiful birth plan. They wanted Skin to Skin at birth, baby nursing before any separation and were adamantly against formula if at all possible. Both were frightened of the preterm birth, worried for their child’s safe transition and concerned that none of their wishes would be carried out.
I had the opportunity to discuss some of these with the Neonatologist and the parents before the birth. The doc was all for doing as much as they’d wished for at birth (that we could) provided the baby did not require respiratory support…

The baby was delivered hollering at us, alert and pinked up nicely! After observing and examining him for a short period, the doc gave the go ahead for Skin to Skin as long as I could stay and observe. Happy to oblige, I had that 4 LB naked baby up on mom in no time surrounded by her warmth and love.
I did the babies first glucose check (while STS) which was at a great level. Mom proceeded to start latch attempts. The baby did nuzzle and lick the copious colostrum she offered but wasn’t able to accomplish a latch. Vitals were stable, they were snuggling… but by an hour– the Neo was getting antsy. I had to take him in to the NICU with Dad in tow. No resp symptoms. Pink stable and alert. Placed up on the warmer table and connected to all the monitors for observation, he had his second glucose check. We expect it to drop at this time which is the normal nadir. It was however 38 which meant we had to feed. I asked for 5 min. This mom had a copious colostrum flow. The baby was not symptomatic. I had another RN watch him while I scooted back to L&D with a pump and small collecting cups. I figured we may have to hand express because many moms don’t respond to a pump quickly. This mom did respond and in a few minutes we had about 10 ml !!
I took that right in to the NICU leaving mom to finish a pumping session. We syringe fed the 10 ml and a subsequent glucose check was 54. Mom sent in a container of 15 more ml 🙂
They got to have a beautiful experience with their preterm boy who never got any formula … at least not in the NICU before discharge.

Yay!

*Promote NORMAL Birth and Breastfeeding* & more New Year’s Resolution Ideas for all my Co-Workers… Any Ideas?

I am continually working (baby steps- a little bit at a time) on improving what we do to care for the moms and babies in my little neck of the woods. Sometimes it feels exciting, positive and helpful….. but other times frustrating or futile.

Since I have been recently consumed with my newest career as a NICU nurse, I have seen some of my earlier successes of positive changes (on the mother baby unit and L&D)…. slowly. turn. back. to previous bad practices ….. I come over to the units and I see so many of the older traditional care models in place again which we had worked hard to place in a vault! You get new doctors, new nurses, new anesthesiologists etc… and they don’t give a crap about any guidelines or protocols for a natural process! However if the CDC changes their Hepatitis B, HIV or  GBS protocols… they are all over it….  In. A. Heartbeat.

Why is it so hard for these professionals to relinquish control over all aspects of the birth process? Why can’t they look at any of that research? Why aren’t any of the recommendations for encouraging VBAC, discouraging scheduled CS’s without a TOL or keeping mother and baby together while delaying routine procedures taken as seriously?? Why?

I think I know why…I do.  But that isn’t really what I wanted to talk about today.

I want to provide some encouraging – positive – inspirational ideas for my fellow nurses, practitioner or heathcare provider to do what is best for each mother and baby in their car. Even if you all pick just one… it can make a difference. So don’t feel overwhelmed. Just try to add at least one of these to YOUR daily practice.  These suggestions are meant for situations without complications requiring urgent intervention of some kind.

Readers: Please ADD more in comments if you have them!

  • Promote and Preserve NORMAL Physiologic Birth……  Try NOT to interfere. Please really find out what that means if you don’t know. Seriously. (sorry but please… my friends… it’s not about hurrying it up or getting it over with and closing out the chart!)
  • Spend time each month reviewing Evidence-Based practice recommendations and changes with regards to Birth and Breastfeeding. You’ll learn something!
  • SKIN TO SKIN…if you do nothing else… make THIS your project for EVERY mother/baby in your care. If you do this for them– nature can have a chance. Get them S2S at birth and several times each day to help with breastfeeding! (this one is my favorite!)
  • Yes… Skin to Skin can be done in the O.R. Teach your fellow co-workers when just DO it!! Come on TRY IT!
  • Keep a mother’s wishes at the forefront of your plan of care. Her birth plan is very important to her! Advocate for her and empower her. This is her birth, not yours.
  • Advocate and Empower your patient to make truly informed decisions about her care. If she doesn’t have the right information to make a real INFORMED decision, please help her get the information or provide it for her!
  • Embrace the idea and recommend Doulas to your patients. Keep a list of local doulas available and provide them at prenatal visits or out-pt testing.
  • Question the doctor/midwife when an induction and or Cesarean is scheduled. Just ask why and discuss… Bring up points you’ve learned in your reading and find out the practitioners reasons for inducing. There is a way to discuss without challenging. Sometimes –> everyone learns from such a discussion. Perhaps the practitioner will realize his reasons for some cases may not be appropriate.. who knows?
  • Breastfeeding and Formula feeding are not equal choices and remember it is inappropriate to indicate to a mother directly or indirectly that they are equal. She deserves correct information before making an informed choice. Utilize teachable moments to discuss the superiority of Human breast milk as the food for human infants. Show her where she can get more information before making a decision. Honor her decisions once she has made them.
  • Keep the baby with the mother until the FIRST Breastfeed has taken place. Please delay all your routine procedures and help the mother (if needed) to start breastfeeding! This is recommended by ALL the experts.
  • Keep the baby with the mother AT ALL TIMES. Almost everything we do can be done at the mother’s bedside. Think about it.
  • Keep the baby with the mother AT ALL TIMES means at night too. Separating mother and baby so “Mom can rest” had been shown to be a barrier to successful breastfeeding. Encourage frequent feedings based on feeding cues.
  • Teach and empower the mother. Include how to recognize feeding cues, signs of an effective feeding with appropriate latch, and how to recognize an overall good feeding pattern.
  • Support the mother, support the mother, support the mother.

For some more ideas.. I have numerous previous posts about breastfeeding education, support and sited references such as the Coalition for Improving Maternity Services Ten Steps for example and other important issues.

Breastfeeding Evolution amidst the NICU Technology

 

 

Powerful Skin to Skin

Evolution

I love babies. I love being a nurse.

I love all the evolution of technology through which I have practiced. I love how I have had to continually evolve myself. I love helping mothers help themselves, advocating for them and their infants, facilitate when needed to support them making their own choices and watch as they evolve….. becoming the best mother they can be!

I know I haven’t blogged lately and it is because I have been having a bit of a rough transition… my latest evolution…  in my new NICU job. Orientation is somewhat difficult for me. I had previously been arriving at work already at the top of my game (for the last 25 years or so) and I have now found myself a student…. every. single. day. It is almost like I have gone to a totally new facility! EVERYTHING seems new or different. All new equipment/monitors/procedures/policies/protocols/doctors/practitioners/and staff.

The babies are the same. Since some are much more preterm than we have cared for in the past… their issues are more complex. Some are the same as we have always cared for, but with neonatologists now on board, the approach to the care of these babies is evolving.

I am unlearning some of what I have always known and relearning things in new ways.

Evolution

I was able to prepare and submit the mission statement and policy on Breastfeeding for our NICU population. The neo’s are extremely awesome on breastfeeding or breastmilk feeding promotion and support! So we have a very good start for breastfeeding support in our new unit. Excellent actually! I am happy to report that since opening our unit, most of the babies thus far have had a total exclusive diet of breastmilk or fortified breastmilk! I think that is fabulous! There have been some moms who after discussion and encouragement to provide breastmilk, wished to formula feed and their choice was supported without further discussion or question. My new co-workers have been very professional about that. There were a few who provided colostrum initially and then decided not to continue. This was also supported.

Coming from my previously comfortable world of lactation in the full term nursery, I find myself on a journey to find a balance between technology and nature……  precision, absolutes and finite accuracy vs the inconsistency, variables, and imprecise intake of an infant at the breast. We are calculating daily the actual fluid and kcal energy intake of each baby and comparing that with the kcal/fluid requirement per kilogram of weight. Changes are then made accordingly. Most of the preterm population is unable to take in their required fluid and caloric needs solely by mouth. Most have parenteral nutrition in the form of a glucose/ Amino Acid protein and Lipid (fats) at first by a central line or an IV (TPN) and gradually switch over to taking all their requirement by their GI system (Enteral). They don’t have the stamina to take it by sucking/drinking and they require a nasogastric (NG) tube so the remainder of food can go in by gravity or feeding pump (gavage feeding).

 

NG tube

I actually love learning all this. I thrive on having a detailed clear clinical picture of my patient. I am very detail oriented which is a good thing. Because of this precision, the measurements and the calculations—> actual breastFEEDING is not often seen until much later in the game. I understand this. I do. I want so much to be very helpful at transitioning to full feeds at the breast. I have to wrap my head around it each time (all the while being a student in all other aspects of the infant’s care) researching how to best advise each mother. We range from visits every other feeding to visits once or twice a day. Skin to skin is the most powerful tool I can use when faced with limited exposure or opportunity. Sometimes when the mom is arriving for my patient, I’m involved in other things and unavailable to do anything other than providing some private skin to skin time. Encouraging any licking, suckling or other feeding behaviors at the breast during gavage feeds is also good. When the baby gets more and more ready to take oral feeds… what I’ve seen so far is that they are already preferenced to the bottle nipple. The weight gain has been established, the precision of measurement seems to have become slightly less rigid. It seems that there is adequate physician support to encourage full feeds at the breast. There are hundreds of experts out there who have gone thru this, and reorganized policy and procedure to protect breastfeeding in the NICU.

I have to evolve myself again and re-learn more about transitioning to feeds at the breast before the bottle becomes a primary feeding implement. Once I can  find my footing- I hope to be strong and confident enough to start teaching moms and my co-workers.

Breastfeeding is NOT an exact science!

I need to figure out when the exact science of Neonatology can accept that….

into the feeding plan for each individual baby!