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Posts from the ‘My 35 cents’ Category

Repost~ The Guilt trip~ Breastfeeding, Bottle-Feeding and…. Somewhere In-between…. Why the Guilt?

There has been so much discussion circulating in the blogosphere right now about breastfeeding.  I thought I’d add my 2 cents because….I have an opinion and….. I have just a little experience in this field both in study (2 year Lactation course, IBCLC for 10 years, current CLC) and in practice (35 years).

I thought I knew so much in 1988 after nursing 3 babies and assisting others for nearly 15 years. I actually thought I could just take the IBLCE exam based on my experience!

I was so ignorant and naïve!

I started to talk to some IBCLC’s and my eyes were opened wide to the real world. Up to that point, at that time, (I sadly and guiltily admit) I had no idea about the volume of study and research in the field of lactation. I had NO idea just how wrong we were doing things at my hospital.

I launched into a lactation course, soaking up all I could, 3 years of study preparing for certification. I set out to change the world… at least my world. I wrote big proposals for the hospital. I applied for grants to fund a lactation program. I developed education competencies for the staff. I started breastfeeding classes. I thought everybody shared my passion, that they too would want to learn …. because I was right!!

Instead I was the target of all the boob jokes you could think of and I had almost no support. My ideas were rejected left and right.

Long story short…it took me a long time to come to terms with accepting small changes, taking baby steps…..continuing to do the best job I could with each mother-baby couple and to keep a positive outlook. I needed to remain realistic about how much I could actually accomplish one step at a time. Slowly I began to have people under my wing trying to learn. Yeah!

I learned a lot about how to approach physicians, co-workers, managers and most of all …. mothers.

I am not an expert in journalism or critical analysis so this is my opinion of what is going on right now.

There have been some irresponsible journalists, those who have a bigger platform than most of us, writing negatively about something they have not studied or truly researched. They are expressing their opinion and including an emotional component which has, in my opinion, gotten the reaction they hoped for from breastfeeding advocates as well as those who concur with the authors. More hits, more readers. I feel they have twisted the facts to benefit or support a point they want to make. I read some of them.. other’s I really just scanned then brushed off so I don’t know everything that’s been said. On the positive side, these articles possibly give us a larger platform to provide correct information to a larger public in reply.

I read a lot of blogs and I really respect and admire all the research that many breastfeeding advocates put into their fabulous posts. These are educated women who are trying to provide current accurate information! (@phdinparenting, @bfmom, @MommyNews , @JakeAryehMarcus, @blacktating ,@AmberStrocel, and so many more). I applaud their passion and breastfeeding advocacy. They are doing a very important job. Breastfeeding IS very important and deserves advocacy, protection and support! There are still large scores of women out there making choices with only tiny bits of information, who really do not know the important benefits of breastfeeding. It is because of this, and because we still haven’t met the US Dept HHS Healthy People Goals for 2010, that breastfeeding advocacy needs to continue. I have been there, advocating in a time where I faced great adversity and a lot of negativity. I am bothered that it still exists…and exists now in so many new ways.

I am more disturbed that some mother’s out there are upset. I always try to understand just WHY a mom feels guilty if she chooses to formula feed or do some combination of formula and breastfeeding. I always hope she’s made her choice with good information and that it is her own true choice. Then good for her! I am not to judge. She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know.  She needs to come to terms with that herself,  and not punish herself and or publicly criticize the advocates saying they are causing the guilt.  Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty. I read a comment from a mom somewhere that said something like… “perhaps if moms knew it wasn’t all or nothing, maybe more would try breastfeeding.”  My first thought was..why do they even think that..are there really mom’s who feel it has to be all or nothing? Is this causing the guilt because they don’t think they can breastfeed exclusively for the first 6 months as the experts recommend??

Over the years, I have learned this:

  • It is inappropriate for a health care professional to indicate to a mother directly or indirectly that formula feeding and breastfeeding are equal. Human breast milk is the superior food for human infants. Properly prepared infant formula is an acceptable substitute for those who cannot or choose not to breastfeed.
  • The first approach is probably the number one factor in gaining a mother’s interest in what you have to say.
  • The education process to a mother needs to be in small doses, sensitive to her unique learning abilities, her cultural beliefs and practices and most importantly, her choices and individual breastfeeding goals.
  • With that in mind, try to provide her with the information she needs to make her decision.
  • Never overestimate a mother’s desire to breastfeed her infant.
  • Never underestimate a mother’s desire to breastfeed her infant.
  • Listen to the mother; help her define her true desires and goals.
  • Many times, the first question she asks may not be what she really wants to ask.
  • The mother’s individual breastfeeding goals, how she defines them, how important they are to her and how she relates them to her actual breastfeeding experience all help define how she measures success.
  • Support the mother, support the mother, and support the mother.

Here are the top 3 responses to the feeding choice question pertaining to breastfeeding at my facility on admission:

  • “Breast and Bottle”
  • “I’m going to do both”
  • “I’m going to ‘try’ to breastfeed”

To each of these I respond very positively with something like… “Great! Tell me what you’ve learned about breastfeeding.”     I will then ask the mom a few questions to somehow find out her true wishes.

Then I say  “We will support and honor however you wish to feed your baby.  I’d like to give you some information so you can really understand and then tell us what you’d like to do.”

I explain some things,  i.e.: how the milk production works, the importance of early feeds etc.. and how formula introduced at that time could  interfere with the process of production, the baby’s ability to latch properly and so on… I usually end with..”We usually recommend to  focus on breastfeeding for now and then offer bottles later after milk supply is established if that is how you’d still like to manage feeding”. ETC…ETC….  Here’s what I then see:

  • There have been so many mom’s who — after a little  bit of information decide they would like to focus on breastfeeding. There have been many who totally fell in love with it.
  • There have also been many who really didn’t want to breastfeed after one single feeding.
  • There are many many still that like to breastfeed and bottle feed in combination right from the start. If they have the right info and understand how things may progress… I still say “Good for you!”
  • I have seen many continue that way for months and they are very happy with that.
  • I’ve seen many mom’s “partially” ( I don’t like to say it that way) breastfeed and feel very proud. I say “good for you!”  They don’t think of it in terms of “exclusive” or “partial”… It’s more like any breast at all…. is breastfeeding vs. no breastfeeding at all.
  • There have been many who also never wanted to try until all of a sudden they see milk leaking!
  • I’ve worked with mom’s where I can see tremendous improvement in her situation, I think she’s going to keep going…but she decides to totally quit. I simply praise her for all her efforts and help her feel proud of herself.
  • I’ve worked with mom’s who have hardly put forth any effort to overcome small obstacles, I think they will probably quit outright… Then..I find out they are the ones exclusively breastfeeding down the road.

I got a comment from a breastfeeding mom @TheFeministBreeder that I absolutely have to share. She describes her own experience in the full comment and on her new blog post.  She comments:

“Yes, I think that’s the most important part – informing a mother of any and ALL benefits/risks to supplementing, and helping them work through the option they choose.  But to tell a mother to supplement without explaining that it could undermine her efforts is just plain mean.  And too many medpros are doing it.  I’m glad there are more nurses like you who will give out the real information to empower a woman to make her own choice.  My smart friend always says ‘It’s not really a choice if you don’t have all the information.’ “

For those mom’s really trying to breastfeed and struggling, there’s more than I can say right here to cover that. I’m sorry for your struggles and hope it gets easier for you. It is important to have a skilled competent support person assisting you who listens thoughtfully and helps you get to the root of your problem… and helps you define and realize your goals. If you are experiencing guilt from your struggles or from not being able to fulfill your goals, desires to breastfeed….I think that kind of guilt is different from what I’m trying to discuss here. I am not a an expert on that. It is valuable to get the best help out there that you can as soon as possible.

I’m adding this after reading some comments on other blogs.. When approaching a mom to observe or assist with the latch process…. Permission is a must! I ALWAYS ask the mother if she would like any assistance with the latch or if  I may observe how well her baby is latching….. If that answer is yes… The next question is ALWAYS.. May I touch your breast? (if that needs to part of the process). I prefer to help moms by having the mom and BABY do the latch. I try to keep my hands out of it.  All nurses and LC’s should practice this. I am sorry for the mom’s who aren’t asked permission to be helped or touched.  😦

One of my favorite things I like to say to any breastfeeding mom is:

“Try not to make any final decision when it’s dark outside”.

On another note, regarding some reader comments on various blogs about public breastfeeding, a skimpy bikini or the bathing-suit issue of a favorite sports magazine show more skin in a provocative, sexy way than any mom breastfeeding. Even the movie stars in their gowns with plunging necklines are showing almost the entire breast! Somehow, that is OK. There are volumes of video footage and photos all over the place… even on billboards. It is sad that the public opinion of a baby breastfeeding (the most natural way for him to eat) is something that should be done in private … yet young girls are encouraged by media to bare more and more skin. Of course being discreet while feeding is important, but I can assure you, most girls in a tiny bikini are thinking more about “tacky exhibitionist behavior” than a mother breastfeeding her baby. Why aren’t law-makers focusing on any of that?

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My Breast Pump and I didn’t get Along 

Can I Pump my MILK?  Should I? …

or  Not.  Even.  Bother.


My Own Struggles with Pumping and Working

and doing what worked for me

Welcome to September’s Carnival of Breastfeeding!!!

I have this post AND an additional post All about Pumping including choosing a pump and how to Practice Pumping before going back. After you read this, check out the other posts on this month’s theme of “Breastfeeding and Work” linked at the bottom of this post. All links will be added as I get them hopefully by the end of the day Monday, so be sure to check back for the full list!

breast pump

A little history

As far back as I can remember, the only breast pump we had around in nursing school or when I first started working on the maternity unit was this thing that looked like a bicycle horn. This picture above is for an old “Breast Reliever”. It is glass with a rubber bulb to squeeze for suction. This particular antique is from the earlier half of the 20th century. We actually had a similar type glass model in Nursing school and on my 1st OB unit in 1974.   Historical use of breast pumps shows the first patent was issued in the 1800’s and a patent for a mechanical version was issued in the 1920’s. Information was scarce then. Not too many nurses knew much about it.  Mother’s were instructed to use it if they got engorged. I can’t believe it would have been very helpful.

pump70sold horn pump

We got a newer plastic version of this pump in the 70’s but still didn’t have any clear instructions for use. I was never taught by instructors or fellow nurses, so all I could do for the patients in my care was review the instructions on the box with them! I don’t even remember what that said. Those old horn pumps were trouble. They were traumatizing to the breast and the rubber bulb was just a trap for bacteria.

I remember one mother in particular in 1975 had been readmitted with bleeding, gone to the OR for retained placental fragments at 2 weeks postpartum. She was breastfeeding and having trouble. I took care of her postop. She said “I can’t believe how much milk I have, what can I do?”  I promptly went for the only pump we had and went over the directions with her. She was saying it hurt but felt better at the same time because it did help to drain some of the milk.  I didn’t much know then about how the retained placenta can delay hormonal shifts and your milk coming in. She and I both thought at the time it was because of being separated from her baby!

ANYWAY

By the time I had my first baby in 1979, (YES- 30 years ago) I had become more familiar with pumps because I had a friend pumping and now I was very personally interested. I wanted to pump just like her! I want to store milk for my baby when I went back to work. Her baby was 3 months old and she had gone back to work. She pumped in front of me once to show me how easy it was. She used a cylinder style hand pump similar to this picture. She got 8 ounces of milk in about 10 min!

70s pumpIt had one chamber inside the other. To pump, you would place the cone over your breast and pull the outer chamber up and down. This was a very popular style pump at the time. Easy right? I promptly went and bought one! I can do this!

My son was born weighing 6 lbs 9 1/2 oz. Breastfeeding got off to a great start, there were no problems at all. I was very confident about that and had great support from my best friend. My son weighed 7lbs 2oz at 2 weeks and nearly 10 lbs by 6 weeks.

I had plenty of milk!

None of which hit the bottom of the chamber when I first tried to pump….  no matter what I did! I knew nothing about the technique of pumping. I worked and worked at it.  I could playfully squirt milk across the room. I had squirting contests with my sister. We cracked up laughing! I could not get any milk with the pump.

I had never practiced. I thought that once I was away from my baby, I would just pump… thought the milk would just come out like my friend. I went to work, let myself get a full feeling and tried. Nothing.  I woke him up when I got home and made him eat!  The next day… same thing.. Nothing.  Luckily I only worked 2 days a week so I nursed him all the rest of the time. I kept trying- week after week– I thought I just had to get used to it. I am sure I was very stressed each time, never using any of the tricks I teach moms today.  I still never thought to practice when I was home with the baby. The most I EVER got after 45 min of pumping was one ounce.  I gave up and only fed formula while at work. My body adjusted and I was happy doing what I was doing.

I wrote a guest post over at Breastfeeding Moms Unite on pumping including choosing a pump for you and practicing to pump. All moms are so different and many have no trouble at all expressing their milk. Others have  trouble releasing their milk to this plastic “thing” on them that doesn’t feel like their baby. It’s just not the same! In that post I say:

I have found it’s important for mothers to understand that pumping is a substitute for the real thing and that it takes practice for lots of moms. I always say to expect hardly anything the first time you try then whatever milk you may get is wonderful! One very important point to realize is that whatever you see come out with a pump or hand expression is NOT a reflection of how much a baby gets in a feeding when he is well latched and effectively feeding.  What you see come out with the pump is what your body released at that moment in time. Even women with a great supply and healthy growing babies can have trouble learning to pump. The baby is the master … you are merely trying to imitate him! The type of pump used and when you pump in relation to the age of the baby as well as the time of day, frequency etc. can have a big impact on your results.

My second baby was born in 1985 . Another 6 pounder at birth with rapid weight gain, a great milk supply for me.  I had some improved pumping results with him partly because of better pumps and mostly by sheer determination to help him heal through major surgery at  3 months. The Children’s Hospital had a hospital grade electric pump, a pumping room and directions on what to do. Because I was able to provide milk for him in the hospital, I had renewed faith in myself that I could pump once I went back to work.

pump 80s

There were different pumps, better pumps available. I tried my old pump and some piston style pump like above. I don’t remember the name of that either. I tried many…still waiting to pump again till I had eventually gone back to work. There were some battery/ AC adapter electric ones to buy. I had one, but don’t even remember the name.  I had to push a button to make the suction go on and off –>  otherwise there was constant suction on your breast and no control on the degree or amont of suction. Some people told me to keep the suction on till it started to flow then push that button on/off.

Well it didn’t flow, it hurt. I never released any substantial milk for any of these pumps. I wasn’t able to keep it up. I ended up doing the same as I had with my first son. I made a routine which worked for me of nursing all the time at home and formula when I was at work. We didn’t have any hospital grade mechanical pump until the 1990’s at my hospital, long after my third baby and after I became a Lactation Professional.

I had dealt with so many other issues after my third baby that pumping was never much of a thought in my head. I simply fell back into the routine that had worked for me with the first two babies. She is the baby that nursed the longest even after I went back to work!

Looking back, I think if I had access to the information I know now, and the availability of today’s high quality pumps…I might have, possibly would have had better success pumping. The most important point is that I still felt successful  and was happy with my breastfeeding relationship for all my children!

After all, I could squirt my milk the farthest!!

😉

More Carnival Posts:

Are YOU an Activist? Healthy People 2020 Public Meeting Announcements

developinghp2020

 

ARE you an activist?

Do you want to have input or learn more??

What do you know about the Healthy People 2010 National Objectives ……. and how the breastfeeding goals haven’t been met?

 

The PLAN ~ The GOAL:

(From the Healthy People website:)

Healthy People 2010 challenges individuals, communities, and professionals, indeed all of us to take specific steps to ensure that good health, as well as long life, are enjoyed by all.

 Healthy People 2010 objectives for breastfeeding in early postpartum period, at 6 months, and 12 months are 75%, 50%, and 25%, respectively. Healthy People 2010 objectives for exclusive breastfeeding through 3 and 6 months of age are 40% and 17%, respectively

 

  So how are we doing???

From the CDC website regarding Breastfeeding Data:

Breastfeeding rates have improved since 1999, but fall short of Healthy People 2010 objectives regarding duration and exclusivity. Among children born in 2006, 74% initiated breastfeeding, whereas 43% were breastfeeding at 6 months and 23% at 12 months of age. Approximately 33% of infants born in 2006 were exclusively breastfed through 3 months of age, and 14% were exclusively breastfed for 6 months.

 

Check the CDC website above for a complete evaluation of how we measure up. I am so happy for thoses states who actually accomplished these objectives! There are some that exceed these goals and others who are really behind. I think because of this, the national picture as a whole is misleading, reflecting an average of a lot of highs and lows. It doesn’t show a true picture for those areas struggling.  I want to learn more to help my area move up towards the goals.

What can we do to improve and work towards accomplishing these goals ????

 I got this important email letter today and promptly registered to go the meeting in Philadelphia on November 7th.  I want to learn all that I can about what goes into the planning and possibly what more I can do at my local level to help meet the breastfeeding objectives. From the US Lactation Consultant Association:

 

During October and November the Department of Health and Human Services (DHHS) will conduct public meetings in Kansas City (Kansas), Philadelphia (Pennsylvania), and Seattle (Washington) on draft objectives for Healthy People 2020. The public will have an opportunity to comment on the draft objectives at the public meetings, and on the public comment Web site. The comments received will then be used to revise the objectives appropriately. We hope that you will consider attending if you live near one of these sites. We will coordinate work on this with the US Breastfeeding Committee. This presents a wonderful opportunity to have our voices heard on national policy-making relative to breastfeeding.

I’m not public speaker, I am interested in policy making for the HP2020.

I want to go and learn from my well respected colleagues.

Check it out! Click on the HP 2020 icon at the top of the post!

Yard Sale = Huge Profits

Area Flooding

Area Flooding

Summer usually brings many many garage sales and yard sales in my neighborhood. Over the last 3 years, I have accumulated a large quantity of items that I just never got around to selling on eBay. I had been a fairly active seller…. sometimes making a really good profit!  The things I had accumulated lately either weren’t suitable for the eBay market or the fees charged would not make it worth my time and effort…. so they sat in boxes collecting dust. We had many antiques, collectibles, items from our old barn, chairs partially refinished, in need of repair etc..etc.. It was going to be the kind of yard sale I would love to peruse!
The day before the sale, as we tried to prepare and set-up, was the day when “Daniel” came up the east coast causing huge torrential downpours in my area… We had already advertised, I had to be ready for the dealers that come at 5 am! Waves of heavy rain hampered our efforts, collapsed tents and blown away drapes caused my husband to make a few trips out for more tarps and plastic drapes.
I knew we would not be ready  for the incredibly annoying dealers… so I parked my van sideways at the end of our driveway effectively blocking entry. I did not sleep before the sale and subsequently got a migraine to add to our muddy fun. All in all it turned out to be a profitable sale. The weather eventually cleared and we had waves of buyers instead of rain.

I have tried to tally our profits.. …..   keep in mind I don’t know how much I originally paid for some of these collectibles over the years…

Amount in my pocket at end of sale : $342.00

Total money paid by buyers over 2 days : $302.00

Start-up pocket cash for change : $40.00

Ad in the paper : $24.00

Markers, stickers, flourescent paper for signs : $11.50

Trips to Home Depot and Lowes for more tarps/plastic : $43.00

$342.00 in pocket minus costs and start-up cash = $223.50 POTENTIAL PROFIT

Handing over the ENTIRE $342.00 to my mom to help with her taxes—>

The look on her face and her tears–>

PRICELESS

😉

 

Frustrations in Obstetrical Care …Culturally Sensitive? Oppressive Male Partners?

027 The drama  that went on here this weekend would be fodder for 10 or more Jerry Springer shows!

~Unreal~

I kept thinking…

“Please help me”

I am not and never have been prejudiced or bigoted in thought process, personality or behavior towards others. I am actually on a campaign to help educate our staff on being culturally sensitive and delivering culturally competent care in relation to obstetrical, breastfeeding and newborn care…. I’m currently organizing a quick reference handbook so certain beliefs & cultural values are better understood by our staff.

This type of sensitivity is very important to me.

It may not matter how I say this. Despite me trying to convince you that I am not intending to offend any type of people…..someone will most likely get annoyed or upset. I don’t usually enter into this type of discussion. I am quite adept at diffusing anger. I am not singling out a problem with any specific culture, ethnicity, or country of origin. I am not attributing any certain behavior to any certain culture.

 

This weekend, we had mother’s giving birth who have recently arrived in the United States from the following  areas: Argentina, Poland, Liberia, Egypt, Iraq, India, Dominican Republic and Nigeria. Sometimes their husband,  boyfriend or significant other was from yet another different country.  These are not unusual immigrants for our patient population. It is however,  unusual to have such diversity in a single 2-3 day period!

My concern is this— As a health care provider– how do you even begin to try to understand another’s strong belief’s or values when you are treated with tremendous disrespect and confronted with attitudes which are unusually demanding of the caregivers to “provide” for any and all needs. Now this is of course what we do…. provide for the needs of those in our care. That includes our responsibility for understanding different certain religious beliefs, cultures and their various norms and values. But this should be done within an environment or culture of MUTUAL RESPECT.

As  much as it is our responsibility to provide for those individuals in our care….. to be culturally sensitive. I feel there should at least be some responsibility on the part of the patient — and or their family- to learn what may be expected of them …. to communicate their history, needs and or wishes to the doctors and nurses~~ or at least to try to understand when it is explained to them at the time of birth and not lash out with anger or disrespect to their caregivers.  Is it too much to ask for a little bit of responsibility to understand at least a little something about what is involved in childbirth, postpartum, newborn care and the legal recording of birth in the facility, state and country in which they have come to and chosen to give birth!  {Many times I have been told they came here so their baby would be an American citizen.} Am I allowed to ask that those from other countries try to be somewhat sensitive to and try to understand our culture? I am not trying to victim blame here.  Really. Many of the patients exhibited rude entitled behaviors and were very disrespectful to staff.  We are all “others” to each other –> but one big blending of society. Lets ALL understand and respect each other.

Some of the behaviors we dealt with include:

  • A mother is married, the father of her baby is NOT her husband. The FOB becomes physically violent that his name can not be on the birth certificate–yet– until there is an affidavit submitted that the husband is not the father…. This turned into an all out fist fight between the the 2 men. “SECURITY!!”
  • A husband refused to allow his wife to be examined in labor during his absence, yet left for hours at a time demanding the hospital provide for his transportation to and from his business 15 – 20 miles away.
  • This same father would not allow his wife to speak for herself…. then called our unit many times after the birth when he was not there to say he was sure his wife was suffering from post-partum depression and we needed to treat her!
  • An unmarried young girl had a PFO against the father of her baby — She did NOT want to see his family yet that FOB’s family demanded to be allowed to visit, displaying hostility, speaking loudly and threatening staff  in a non-English language outside the entrance to our unit!
  • Another mother delivered and the father of her baby was currently in jail on drug charges. She met the criteria (for other reasons) where she and her baby were screened for drugs…. Both were positive for cocaine and heroin… sadly.. 😦  This infant needed to be placed in protective custody of Children’s Services and treated for withdrawal. This is always difficult and heart wrenching. This mother spoke very little english, was ANGRY the tests were done and we were not able to help her understand a situation of this magnitude easily with the language line….
  • Frenzied inpatient banging on the window and yelling for the only nurses’s attention to simply ask a question or get more supplies for their infant even though she was involved in an exam with a doctor on a new very sick infant and had signaled she’d be there “in a moment’…
  • The family and multiple extended family members demanding minute by minute updates on a sick newborn, interrupting our care by knocking on the doors and windows to the nursery… after we have explained all  minute by minute updates to the parents of that baby who were at the bedside.  I have a feeling that culture may have placed a value on the elders decisions over the actual parents, but this mother did not want the father’s family to be in the nursery with her. They don’t understand HIPAA or even know what it is! My job is to support the mother and keep her informed and with her baby.
  • A family not wanting to answer most of the questions for the birth certificate because… it was simply an invasion of their privacy. Alright then.. it will remain blank and the Bureau of Vital Statistics can deal with it, right?
  • A father of a baby requesting then ultimately demanding to speak to the doctor ONLY for each and every one of his questions.. (I am just a nurse).. did I mention it was the weekend?? We don’t have doctors present 24/7 !

 

 

There are times when these situations unfortunately occur. Many times the individuals involved are Americans who are 2nd or 3rd generation of mixed ethnic background or are of no discernable ethnic or cultural background, have lived in this country all of their lives and still exhibit the same type difficult personality traits.  Since they are more “Americanized” shall I say-or however is politically correct to discuss it— it isn’t so difficult to diffuse hostility’s, discuss options, assist with birth, newborn care, breastfeeding, do birth certificates…etc. It is my opinion that sometimes they understand things better simply from living here. We will ALWAYS encounter individuals with difficult personalities regardless of background who may be demanding in nature. They may not initially understand what’s happening but usually respond well to a gentle receptive approach.

That was NOT the case this weekend!

I only wish for strength and future guidance to help and support those who don’t quite understand.

Don’t yell at me or treat me with disrespect.

I ask those individuals new to our country to help themselves a little and learn some of our language and the framework for which we deliver our obstetrical care.

Please.

Mama needs “ME” time…. How do you guys do it all?

Birth and Breastfeeding Blog? I haven’t been doing much blogging.. Hmmmm……I feel somewhat guilty…….I mean I feel like I have a lot going on in my life… but ~

I don’t have small children….. mine are grown and gone… for the most part.

I don’t work 5 days a week….I work 3..but they are 12 hour shifts

I barely cook… at least no really complicated meals… I’m not a crunchy (didn’t even know what that word meant) organic earthy person.. I try to eat well but — the easier, the better…or frozen 😉 is ok with me!

I don’t scrub-clean my house….. I like things orderly so I straighten, manage the dishwasher, blow the dust off frequently used areas, but hey, I gotta clean the bathroom.. that’s a must.

My husband does all my floors and his own laundry….. everyone in my house has always done their own laundry. My husband is just NOT a needy guy at all! He’s my dreamboat.

I’m not really married to my work… so to speak — but I’ve always taught my family that I have to care for people all day long at work…so they need to be independent where they can and help care for all their own needs. Mama is always available for the important stuff or talks.

Mama simply needs “ME” time..and a lot of it! It renews my spirit and rejuvenates my energy. Sometimes I feel like a selfish be-otch.. but I KNOW I need it. I’m worse with out it.

Today I worked on several work projects here at home…  Some PowerPoint, outlines for projects in my Clinical Expert Applicant Curriculum…. Specifically on Evidence-Based Practice and research;  Project participation within my organization… (searching for compelling ideas to stir up others enthusiasm); Community involvement; Cultural Diversity; Service Excellence and Preceptor/Mentoring of new nurses. Just a little somethin-somethin.

Oh and I forgot to mention a little thing called.. WORLD BREASTFEEDING WEEK !!   August 1-7  (more on that very soon)

A lot of the blogs I read contain regular well researched posts. I have over a hundred posts still to read in my reader! I want to tell my stories but I don’t always have the energy to figure out ways to tell the essence of the story and change enough to protect the identities.

So I do a lot of thinking and dreaming about what I’ll write on this blog — without really writing. Don’t give up on me yet.    If you are looking for something really cool or inspiring..I have it inside me head.. I do… it’s in there — still waiting to be gracefully typed with two fingers….

BUT

I’m probably watching a movie, reading a book or going out to lunch.
Fellow Bloggers… How do you pour it out on to the pages? I have a fairy tale impression of you all.

JUST HOW do you guys do it all?? Come clean with me.. are you all magical self-less supermom wizards?

At the beach !!!

Humpback WhaleI’ll be away and offline …on vacation at a Connecticut Beach House until after the 12th.

Later…………

Wordless Wednesday… 1950’s “Good Wife Guide” and more…

goodwif1A guide for a “Good Wife” and more…….  vintage 1950’s and 1960’s American culture Photos found on this amazing collection of photos. Great find!!! I really remember many of these things.. Born in 50’s, preteen to teen in 60’s to 70’s.

Fun Memories

Click here for all the photos!

http://www.billsretroworld.com/RETROLIFE.HTM

I recently found this first link wasn’t working now…so I found another copy of this guide here:

http://www.snopes.com/language/document/goodwife.asp

http://www.snopes.com/language/document/goodwife.asp

I’m Proud of my Hospital….~ this week ~

~I’ve reason to be a little proud of the care given this week.008

I hope this is a continuing trend of attention to detail, utilizing evidence-based practices and compassion, listening to our patients and providing them with options and the best possible care…. I’ll give you a few details about each as you read on… In summary, this week we have had the following situations:

  • A 25 week-er walk-in with a precipitous delivery stabilized & tranported quickly
  • Twins! Vertex/vertex –turned breech– turned vertex~ delivered vaginally
  • A Heroin/Cocaine  addict identified, baby able to be treated appropriately so comfortable transition
  • Safe Haven newborn about 1 day old.. placed up for adoption
  •  Homebirth Transfer handled with great respect overall and most importantly, the mother is happy with her experience.

Whew! We have a lot of busy weeks but they don’t always have this intensity or variety! I feel proud because there may have been a few things done differently due to recent conversations I’ve had…Plugs I’ve made… and I keeping putting in little plugs to try to gently increase awareness & educate. I am an Instructor in Neonatal Resuscitation and Lactation.. sometimes the troops listen when I talk about other topics…. I’m no expert but I try to be current, correct and compassionate in care. (My 4 c’s)

Okay… the details for the first 3… stay tuned for the others…..

~25 Week gestation walk-in~

She came in with mild cramps and pressure. She didn’t report any fluid leakage but did C/O pink vaginal mucus. We had her in an exam room pronto. She had a gentle speculum exam which revealed hour glassing membranes thru an approximate 4-5 cm cervix..visually.  Hour-glassing means that the intact amniotic sac has protruded thru the partially dilated cervix and expanded like a bubble  in the vagina. She went right into trendelenburg. The transfer teams were called. It was soon clear she would deliver here and the baby would need to be stabilized and transferred. The NICU team contacted us back they would be flying up to retrieve. The nurses caring for her were tremendously supportive.  All procedures explained, options offered and decisions honored.  They got her records faxed over from her OB’s office so we had a little history.

Like a well oiled machine (from all of our drills), all the emergency equipment was readied, pediatrician in attendance, roles clarified. Once he was born almost without warning, precipitously, all at once, about 30 minutes later. He was quickly assessed, wrapped in plastic, ventilated, then intubated. We had a peripheral IV in place in case he needed meds or fluid volume. He had a chest xray and a blood culture/blood count sent.  He was kept warm, ventilated and appropriately oxygenated and had stable glucoses. He weighed in at about 700 gms (about 1 1/2 lbs). The team arrived when he was about 30 minutes old. They checked all labs, xrays and his IV line. They gave him Surfactant and pretty quickly and carefully,  loaded him in the transport incubator then got him out to his mommy for a visit before he was transferred. They answered all her questions before they left and we helped her deal with it all. The doctors discharged her shortly after that so she could get down to her baby.  At last report, he was doing just as expected for 25 wks, no other complications often seen at that gestation, for ELBW (Extremely Low BirthWeight) had come up. He was actually improving each day! So happy for everyone!

~Twins!~

She came in to the hospital already in very active labor at 37.5 weeks gestation. Her twins were both head down (vertex/vertex). She labored quickly, uneventfully and delivered Twin A at about 1 pm. With the ultrasound machine in the room, they scanned over her still pregnant belly to see where Twin B was and if he was still in position. Turns out that once Twin A had vacated the womb, baby B had a lot of room and he had moved into a transverse/breech position. That means he was more bottom first than head first anymore. Most Ob’s now don’t attempt a breech delivery even with the second twin.  They are quick to do a C/S…. This day, however, …. the Ob in charge called over an associate to ask his opinion. They brought the mom into the OR and prepared to do a C/S  if they were unable to get the baby in proper position. The point is they were at least going to TRY!  With the U/S scanner and 2 assistants, they did an external version and worked Twin B  back into a head down vertex position without complication. He delivered vaginally about 1 hour and 45 minutes after his brother! The staff kept the first twin in the room the whole time so they could all be together. I spoke to the Ob later and congratulated him on a great job.. he said to me that he remembered what we had talked about awhile ago (when I had written the post about a C/S for the 2nd twin), and had researched it himself. I was happy that any little plug I had made had sparked interest in researching the topic and possibly even influencing a decision towards better care! I am happy to report that both babies went home with mommy on day 2!

~A Heroin/Cocaine addict~
We are attempting to put together some consistant protocols for drug screening so that we don’t miss the opportunities to protect a newborn in need…. Some may not understand how important it is to sometimes screen the healthy and innocent to weed out those with problems…. They don’t always present in an obvious way. From my perspective, those individuals who are hiding something are very difficult to identify from outward appearance only. We identified a heroin/cocaine addict recently who was a very beautiful, well groomed, well nourished, affluent (seemed wealthy) woman who stated she was just visiting in our area, and had no prenatal care info or records with her…. she was in rip-roaring very active labor at 36 1/2 weeks with heavy vaginal bleeding and fetal distress. We thought we were headed to the OR but the baby had other ideas. We had little time to get more information before the baby was born. There was a small abruption but luckily, the baby was vigorous and did not seem to have suffered blood loss. The admitting nurse had collected a urine sample with a catheter insertion and sent it for drug screen. It came back positive for Opiates, Cocaine and THC. The baby’s urine also tested postive for Opiates, Cocaine and THC. Because we knew, we were able to start the NAS (Neonatal Abstinence Scoring) for signs of drug withdrawal and identify the signs quickly. If the baby is unable to be comforted by swaddling or holding or if we had 3 scores of 8 or higher, there are protocols set up for medicating the baby. The baby did require medication within 24 hrs. Once medicated, she was such a happy sweet little girl. The nurses named her “Molly” and we all loved her. She stayed with us all week until the pediatrician released her andChildren’s Services placed her in a foster home experienced with this kind of care. Unfortunately, some of the big drug problems have hit my area. Our local paper just did a big series of stories on local Heroin addiction problems. Apparently it is cheap and accessible.

I am going to publish this part tonite and tell the other two stories soon…

No Prenatal Care? …..What are YOU Hiding??

No Prenatal Care is usually a symptom of something--hiding some type of underlying problem. Sometimes it's very ugly. The most common encounters we have involve illicit drug use during pregnancy. We need to develop a comprehensive Maternal and Neonatal Drug Screening protocol to protect the newborn.

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