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

Why is that some of the common childhood bumps, bruises or injuries have to happen for the first time when I’M in charge of the baby?? I swear…seriously.. I was right there! Please believe me! 😕

"The perfect Grandmother keeps the infant safe at all times and goes on daily outings..."

This is a continuation of Supporting my Non-Breastfeeding Daughter-In-law Part I

Let me back up a minute. I have been going down to Dave and Sadie’s regularly for help with babysitting my grandson Tommy. I was getting good at being just a grandma and not a nurse. He was growing pretty well even though we all had to put a lot of effort into getting adequate calories into the boy! He was long and lanky. A skinny lightweight. Both his parents are very tall so it may partially be just genetics. He had outgrown some of his feeding issues as he merged into toddler-hood. Then he turned into a finicky picky eater. Through out all this time, Sadie and I were feeling really comfortable with our relationship. At least I know I felt good about it and she told me she did also. We had developed a respect for one another.  She had been relying on me to come and help out from time to time.  I was always so happy to oblige so that I could see Tommy and enjoy some time with him. I remained respectful of how she wished his day should go for example, managing nap-time, playtime outside, meals and how to handle unwanted behavior. She didn’t have a lot of rules at all…just certain things she asked me if I could do to maintain consistency. No Problem. I know she appreciated it. Sometimes my son would call me to tell me that Sadie said I had done a really good job with the baby that day etc..  🙂

Tommy started talking! He mixed some letters in the beginning and came up with my name. Instead of “Grama”… it came out “Manga”! We all loved it and it stuck. Now I am forever… Manga! It is so delightful when when you are recognized and greeted with an excited little voice! And even more delightful when that sweet little boy calls you his own special name! We played lots of different things and I was having a blast!

One day as we were march-dancing to a little song in the living room clapping toys together, I sat down on the couch, getting tired, and Tommy came running towards me, dropped his toy, immediately tripped over said toy– flying face first into the coffee table! Oouch! He hit just under his right eye! He didn’t break the skin and his eye was fine. But darn it! He got hurt 😦  This was the FIRST face bump he had! One time he had bump on the back of his head from falling over a few weeks back and I had overheard Sadie telling one of her friends about it then saying “It did NOT happen while in my care, let me assure you!” I think my son was playing with him at the time. So needless to say, I was a little anxious to let her know what had happened but of course I had to tell her right away. I called her and explained what happened, how he was and that he was letting me hold ice on it while I had a video going and he was having milk. I KNOW she was upset…. what mommy wouldn’t be when something like that happens to their baby when you are at work. She was very good about it, asked me if I could take a picture for her and send it so I did.  Everything was OK… Tommy actually got his fair share of bruises and bumps!

The next one involving me was pretty upsetting. We were at my house, Tommy was in the high chair, his parents just left for dinner. I cleaned Tommy up and got him down. He ran past the sink where my husband was making the dogs dinner (Tommy had been playing with our Chocolate Lab all day) and the dog turned and snapped at Tommy as he went by!  That sweet little angel boy just sat on the floor stunned and didn’t even cry till I picked him up~ horrified~ and left the room to examine him. He had welts of dog teeth around his tender little calf. No broken skin!    Oh.My.God. This. Did. Not. Just….Happen!! Ice, snuggles with Manga, milk, favorite video and phone call to mommy again. They were both very upset but realized it was all an accident.  It was completely gone in a few days. Still. That was beyond sucky. 😕
I think part of learning as you go…as a parent helps you to de-sensitize yourself to some issues or things that you originally thought were such a big priority. You begin to accept some things as they are and not expect that you can have control over all the little things. This may have been what happened to Sadie. I saw her relax on things about which she had previously been so firm. I didn’t tell her I saw this transformation but it was there.

Sadie got pregnant again on their first month of trying!! They told me when we were out to dinner. I saw my son get up and move a lamp above my head saying the light was in his eyes, He sat back down again and said “I don’t think we’re going to make it up for Thanksgiving this year, mom.” “Why?” …I said (That was the one holiday they ALWAYS spent with my family…..) Dave says nonchalantly: “Because- it will interfere with Sadie’s due date.” I jumped up so excited!! (glad he wisely moved that lamp) then they said… “You are the first to find out Manga… we didn’t even tell Sadie’s parents yet!” I felt so honored!!  YAY!

Because I had previously been admonished for saying things in a way which I had felt was “just being  myself” and I obviously crossed the line, I wanted to be especially careful and respectful. There was always an underlying fear for me that I would screw up. I didn’t ask or talk about anything medical. I had learned how to just be a supportive Manga. Life went on, I was babysitting frequently and Sadie was already in to the second trimester.

“I want to make sure I get breastfeeding right this time.” Sadie said to me out of the blue while I was having breakfast with her one morning. “I’ve been reading about it and I want to do a lot of things differently. I don’t want all those people in the hospital. I just want it to be me and Dave and the baby.”  (I was quiet, letting her talk)    “I was really depressed after Tommy was born and I had tried to pump but not really very much so I never had much milk… I was reading you need to pump a lot” ( I felt so bad I didn’t know she had been depressed! She hid so much from me then…I should have seen it!)    Of course I was so happy to hear her say this on her own….  😀      In order to be most supportive, I needed to find out what her wishes and goals were… so that’s what I asked.  Then Sadie replied: “I want the baby to get all breastmilk for as long as possible.. I don’t care if the baby feeds from me or if it’s pumped milk.”… she continued… “I’m kind of afraid that I might not like it….  and I might want to see how much the baby drinks every time after what we went through with Tommy. What do you think?”

I said” You are an amazing woman! Anything you’ve ever put your mind to seems to be what happens! You should be able to do things however you like. I am so sorry you were depressed last time, that must have been so very difficult! (Pause for Hug) I will help you anyway I can if you want.” Sadie said she did want some help figuring out a good book to read and some info on pumping. I was totally happy! It wasn’t so much that Sadie had expressed her interest in breastfeeding (which of course I was over the moon happy about…) but more that she wanted to talk to me about things and wanted my guidance! I felt like we had really reached a milestone!

Once I got back home I got the PERFECT book ready to send her! “Breastfeeding with Comfort and Joy” by Laura Keegan. I had met Laura online and we struck up an immediate friendship. She has the best approach to showing moms how to really have a very comfortable and enjoyable breastfeeding relationship. I have used this book as a teaching aid at work to help moms really visualize what we are discussing. I find it invaluable. Sadie got the book in the mail and read it twice through! She loved it! She started asking me questions a few times a week… referring to the book and looking past her immediate goals to future issues and asking about that! For the first time, after her mother’s negative experience, her own bad experience to the point where she just gave up even trying…. She was now seeing breastfeeding in all it’s beauty! I thank Laura Keegan for this fabulous book! Helping to gently open the eyes of a young women and empower her!

After more discussion, and checking Sadie’s wish list, I decided I would also buy her a high quality pump. She had checked with her hospital to see what they had there and it made sense to stay with the same kind. I got her an Almeda Purely Yours Ultra. We had a little breastfeeding class and pumping info class on a Sunday afternoon. She had Dave set up a little pumping station in their bedroom. All the while, I really only gave her info she asked about, the basics of milk productions and the importance of skin to skin and self attachment. I went into detail on what she wanted and highlighted things that were important for good understanding and good overall management.

Sadie went into labor again at about 38 weeks. My job was to stay at the house with Tommy. I left work early and got down there just after he went to bed. There was a babysitter there who then left and I was all alone…. waiting to hear.  Finally I got a text and a photo… Another boy!! Joseph or “Joey”. The text was from Dave and said “he’s never left Sadie except to get weighed and he’s been nursing a lot already, mom!” I was so happy for them! The next day, Sadie’s dad came to stay with Tommy so I could go over to see the new little family. The plan was for a quick little visit so I didn’t interrupt their alone time. Sadie called then and asked where I was, how far away because the baby was ready to eat and she want me to see if it looked alright. (The surprises kept coming.. I was really honored once again..) I got into the room as she was preparing to feed. She seemed so confident as she positioned herself and Joey. He opened wide and self attached beautifully with a big deep mouthful of breast! Sadie looked blissfully happy, had no pain and was experiencing the positive signs of hormonal surge. Joey began to have a rhythmic deep sucking pattern with audible swallowing. I was able to point out all these positive things to both of them. Like a well rehearsed play, it was as if the perfect script had been well acted!  I would not have believed it could have gone THIS well for them if I didn’t see it myself!! I thought I was going to leave then and she asked if I could stay and help her with the pump to make sure she knew what she was doing with that in case she needed it later… She wanted to pump anytime Joey was not feeding well. He was a great nurser but she pumped anyway so she had an excellent supply!

To get to this point has been a fabulous journey of learning more about myself and learning more about how to be the best support to other moms in my care. Sadie went on to nurse Joey or feed him pumped breast milk exclusively for the first 4 months. She continued to pump and nurse after that but had started to also use formula at times. She did a fabulous job! She is very proud of herself.  One thing she said to me a few weeks ago was that she thinks having her babies, and especially nursing Joey, has really made her feel so much closer to me. *tear**

Then she thanked me for hanging in there…… again……….

Support the mother, Support the mother, Support the mother most important of all!

And the Manga… Support the Manga! Most Manga’s want to to the best for you…

Show us how!

Supporting my Non-Breastfeeding Daughter-In-Law… Part One and a Half

This is a form of general response to some comments/ an “addendum” of more history or “back-story” type of intermission.  So I am calling it Part 1 & 1/2. Part II about the next pregnancy is in the works and coming later this week or next….

I am amazed and thrilled at the volume of interest this post has generated. I’m not a big blog by any means (usually getting on average 35 – 70) hits per day even when I don’t write anything. Now I have over 700 hits for 3 days in a row. For some of you that’s normal… not me. It makes me want to make sure I get this right. Make sure the correct points are being made. Without monkeying around…

Breastfeeding Baby Monkey

I LOVE Sadie. I love her like my daughter. She is a very smart, strong, independent, confident and outspoken young woman. She has a large group of friends to whom she is always supportive, a good listener and would do anything to try and help with all types of situations. These types of things make me respect her tremendously! My son had met her at a party once in college then re-met her a few years later when she was near graduation and he was … well….. a college drop-out party animal at age 23 recovering from knee surgery after a car accident. (** drops head with embarrassed grimace **)  Sadie.. I always say.. finished raising my son. She did NOT put up with any of his shit.  She is responsible for or part of the catalyst (besides the car accident) in encouraging my son to turn his life around. He is now a 32 yr old successful business owner.  They are very much in love. They still talk for hours every day and crack each other up all the time. Lots and lots of laughter and fun!

I am very happy that so many of you understood that I was (and still am) LEARNING the new roles of mother-in-law and grandma. This is a story of my feelings and emotions as I attempted to do the best job I could….. respecting and honoring that my son and his wife were indeed the decision makers as they became parents, helping Sadie understand that she was most certainly going to be respected and supported in her feeding choices……. and learning to let go. I’m glad many of you realized that I knew it wasn’t always appropriate to provide information and advice … but sometimes, because of the professional I am and how important I feel it is for all mother’s &  parents to make informed decisions….. I found it hard to not say something if only for their protection.  I hope you all realize that I am not pushy and try to always be supportive. But I’m human and I can screw up…  I should have asked first what they read or researched about it before talking. As a breastfeeding advocate and lactation professional, I know that it is in my grandchild’s best interest to be breastfed. I also know that it is NOT my decision. This is a story of my journey to deal with all that so close to home and on a personal level.

I wrote this post “Breastfeeding, Bottle Feeding and…. Somewhere In-between…. Why the Guilt?”  two years ago and another.. “**ROAR** on Breastfeeding Guilt “ a little while after. I have a hard time with people having guilt- thinking proper education for informed decisions will cause guilt- others making rude comments about someones choice making them have guilt- a personal guilt anyone has because they don’t feel they did “enough”…. I just have a hard time with all that. I had guilt thinking I went too far with the kids…. (Dave and Sadie). Never did I want Sadie to have guilt because of something I said, how I said it or perhaps acted. It was important to me that the guilt factor was eliminated. There are so many opinions out there and mommy wars and stupid stuff actually (IMHO). We need to be supporting each other. ALL MOTHERS AND BABIES SHOULD BE HONORED AND RESPECTED. We don’t know their story or reasons for any choices they are making.  Some of you have had painful experiences and I am sorry that happened to you. I hope you can move past the memory to be supportive to the next person you meet… even if it’s just a smile. 🙂   For “Mama of 2″…. Your MIL is sounding unbalanced and in need of a psych eval IMHO. Seriously inappropriate! I hope you can throw out her comments with the dishwater (what an old fashioned saying…) which reminds me of an old favorite cartoon: (LOL)

That being said about the feeding issues. I want to talk about parenting. All the years that I have been a nurse sending new parents home with their babies, it has been important  that they are empowered to become loving parents with their own style. I have always encouraged them to discuss things among themselves and decide just what that is. I encourage them to smile and nod at “Grandma” or “Aunt Sue” and do things their own way. I had this same discussion with Dave and Sadie at the very beginning of the pregnancy. It isn’t my place to raise their child or decide what type of discipline for any situation… My role is to fill in while babysitting and try for consistency on their plans. Not to make the plan…follow it.

*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.

“The American Propensity to Shun Human Milk is a Public Health Problem”

A Historical Perspective

Bulletin: Chicago School of Sanitary Instruction (June 3, 1911)

This is a part of my comment reply placed to an individual who had commented on The Feminist Breeder’s  post “When It Comes to Breastfeeding, We Can’t Handle the Truth”

“There were countless situations over the last 200 years which forced caregivers (whether the natural mother or another individual)to resort to artificial feeding of one kind or another. It is amazing what some of them came up with to try to feed those infants! Necessity was the mother of invention. And many were able to survive. It’s wonderful that they could. Many more, however, sadly died. Many many babies were sickly or died in those times.
You say: “The matter is that formula/breastmilk substitutes became so helpful that people continued for centuries to make it work.” I agree.
But my take on it is that the necessity of an available safe artificial alternative to breastfeeding for those mothers who could not breastfeed their babies took centuries to formulate…to make it nutritious enough and safe enough and to come up with a safe enough feeding container. It was just that.. an artificial substitute.
Gosh– I am NOT an expert on this aspect at all.
I just feel that the heart of this conversation is that artificial infant feeding has risks. Risks that mothers aren’t informed about because society has normalized artificial feeding. Breastfeeding is normal feeding.
No one should ever take away an individual’s choice..EVER…!!!!!
Mother’s simply need better information to make INFORMED choices.
I’m very sensitive and careful in my approach to moms… helping them with information they need to make the best choice for them. Then I will ALWAYS support that mother 100%.
Here’s an interesting historical perspective link for your review from the American Journal of Public Health | December 2003, Vol 93, No. 12
It covers history from about 1890 to early 1900’s.”

“Low Breastfeeding Rates and Public Health in the United States”

Here are some quotes and excerpts from this article published in the American Journal of Public Health (December 2003, Vol 93, No. 12 ) discussing Public Health THEN and NOW.

Quotes:

“Late-19th-century physicians . . . constantly
decried the ‘children with weak and diseased
constitutions belonging to that generally
wretched class called bottle-fed.’ “

“Today’s medical community recognizes what their
predecessors knew a century ago—that the
American propensity to shun human milk is
a public health problem and should
be exposed as such.”

Abstract: “The medical community has orchestrated breastfeeding campaigns in response to low breastfeeding rates twice in US history.
The first campaigns occurred in the early 20th century after reformers
linked diarrhea, which caused the majority of infant deaths, to the use of cows’ milk as an infant food.
Today, given studies showing that numerous diseases and conditions can be prevented or limited in severity by prolonged breastfeeding, a practice shunned by most American mothers, the medical community is again inaugurating efforts to endorse breastfeeding as a preventive health measure.
This article describes infant feeding practices and resulting public health campaigns in the early 20th and 21st centuries and finds lessons in the original campaigns for the promoters of breastfeeding today.”

I found this article to be very informative and very interesting.

WHAT HAVE WE LEARNED???

Overheard Hospital Roommate Discussion on Formula vs Breastfeeding

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We don’t often “double-up” the new mothers on the postpartum unit but occasionally in times of high census, we simply have no choice. We were incredibly busy this week, so short term doubling occurred.

In one room there was an experienced 3rd time breastfeeding mom (BF mom A) born and raised in an Eastern European country and her roommate was a new first time formula feeding mom born and raised in the USA (FF mom B).

Both were within about 12 hrs of birth.

I had been in the room doing basic exams/vital signs for each baby, asking each mother how she thought things were going etc. etc…. I stepped to the doorway to converse with a co-worker about unrelated tasks and that’s when I started to overhear a very interesting conversation.

I admit it…    I eavesdropped–> I learned.

😮

I stayed in doorway reading a chart……..

FF mom B: “So — are you breastfeeding your baby?”

BF mom A: “Oh yes– Is best for us” (heavy accent)

FF mom B: “Does it hurt?”

BF mom A: “No no- not hurting, good feeling. You do too?”

FF mom B: “Me? No, I’m bottle feeding. My mom said that was easiest.”

BF mom A: “I see…”  pause ……. “Why you not breastfeed? In my country– we are told is healthy way- natural way, most everybody does this. You are told this- yes?”

FF mom B: “Well– yeah, I remember hearing that it was best, but I didn’t try to learn about it because I have to go back to work in 6 weeks and my mom said formula was the same or just as good. And everyone can help me feed the baby too.”

(I’m still looking at a chart in doorway waiting……)

BF mom A: “Is nonsense…sorry don’t know words..false?”

FF mom B: “What’s false?”

BF mom A: “Is false- the baby bottle is same as mother’s breast. False. You are baby’s mother, you do what you must, but all more important reason to know truths– as his mother– so I tell you…  You need truths….   just ask nurse.”

I’m thinking, this will either be a great opportunity to educate a new mom further OR I’ll be moving beds because the bottle feeding mom is now all upset with her roomie…..

FF mom B: “Is it true? (She asked me)…. Is there really that much of a difference?”

I said actually there is a big difference and I’d be happy to talk to her about if she’s interested. I felt this mom was possibly considering to breastfeed and I wanted to preserve that gently… away from any real or perceived pressure. I invited her and her baby into a little conference room so I could have a private conversation with her and give her information without the possibility of her well-meaning roommate piping in.

We actually had a very good discussion. She had a lot of questions which I was so happy she felt very free to ask ….such as all the health benefits, combining work and breastfeeding and how to get started now after 13 hrs.  I answered them and asked her if she wanted to think about it or if she was interested in getting started.

She said she’d like to do it now before her mother got here. She felt fine going back to her room. Since her baby had been fed a bottle only an hour before this started, I suggested she spend some time skin to skin and maybe…. her baby would root and self attach when he was ready.

I assisted her into a comfortable position and we snuggled a naked sleeping baby skin to skin. She was smiling but not feeling very sure of things. I told her to rest and I’d check up on both of them.

Her roommate chimed in “You are good mother learning this for baby. You feel better yes? I help- if you need- I help”

In the end, the baby nuzzled, licked & rooted about a half hour after being placed STS, but didn’t self attach. I assisted her to latch him in a football hold. She was very surprised to see colostrum and became quite engaged in the process. She was breastfeeding when her own mother arrived. This grandmother was kinda taken back at her daughter’s change of heart but was more supportive than the young mother thought she’d be.

Perhaps the roommate had another discussion I didn’t overhear…….. Sometimes you never know…..

The door to more education opens from many different angles. Sometimes pushed open from an individual with a different background.

I hope we have more happy beginnings like this in the future.

🙂

More Breastfeeding Cartoons ~ not #BAD09

I missed the Wordless Wednesday

I have nothing for the Blog Action Day 09

Instead, I’ll provide a little humor today

More Breastfeeding would help the planet anyway!

More Breastfeeding Cartoons by Neil

Enjoy!

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!

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.

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!

It 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.

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:

• Ask an LC: What About Pumping? My Guest Post over at Breastfeeding Moms Unite
• Breastfeeding At My Family Daycare by Melodie at “Breastfeeding Moms Unite”
• A Job where Everyone Breastfeeds by “The Milk Mama”
• Sorry, Facilities Guy by “Momnesia the Book”
• Taking Your Working Boobs to Work by “Marshins”
• Working and Breastfeeding a Toddler by “Strocel.com”
• Working and Pumping by “The Marketing Mama”
• Breastfeeding and working is possible, and you can make it work by “Motherwear Breastfeeding Blog”
• Do you really need a pump? by “Chronicles of a Nursing Mom”
• I Think This Officially Makes Me a Mommy Blogger by “Vanderbilt Wife”
• What about Breastfeeding When I go Back to Work? by “babyREADY”
• Tips for Breastfeeding and Working by “Breastfeeding 1-2-3′
• Breastfeeding and Working in the UK by “Breastfeeding Mums”
• The 5 biggest mistakes working & pumping moms make by “Blacktating”
• This is a Breastfeeding Office by “MumUnplugged”
• Beating the Employment Booby Trap by “Best for Babes”
• Nursing Mothers Need Workplace Support by “My World Edenwild”

Initial Low Milk Supply: A Breastfeeding Story – Case Study

     The History:

 One typical busy morning coming on shift, one of the couplets I received report on was a 3 day post-op C/S mom and baby who were scheduled for discharge this same morning.  She had been a long 3 or 4 day failed attempt to induce a vaginal delivery for fetal macrosomia (big baby) at 40 5/7 weeks before the C/S.  Lots of IV’s, lots of Pitocin… all before the birth.

Her baby weighed 10 lbs 4 oz at birth. We got in report that his glucose sticks had all been over 60 initially so they were stopped early on. His exams were normal.  His total bilirubin this AM was 11.3 at over 72 hours of age. He was “breastfeeding only”  (*sigh*from the nurse giving me report).  She then expressed a concern that  he was down 10% from birth weight weighing 9 lbs 4.5 oz today.  When I asked her about the feedings, she said he’s been nursing beautifully all the time but nobody’s had time to stay in the room and watch him feed. I asked about the output and she reported he’s been voiding, the last stool was a couple shifts ago.  Then the nurse added “We told her you were here today, Melissa, she has a lot of questions for you. ”

I was able to juggle some things around, have staff cover some of my other responsibilities temporarily to make this a priority. Since I am a general staff nurse, there are often more pressing situations. Fortunately, today I was able to manage the time to see her right away.

I went in and introduced myself to Meg*, Brad* and their son Mikey* (*names changed). They had indeed been waiting for me.  Breakfast was underway and Mikey was asleep in his crib. I asked her a few general questions in a relaxed manner about breastfeeding first to try to establish some background: Mikey’s energy level, drinking pattern, feeding frequency, and diaper checks.  It is important to gather information and observe the feeding  in the process of  a full evaluation to determine adequacy of feedings.  The information I got was concerning.  He spends a lot of time at the breast, falls asleep quickly, not very energetic with every feed, not much change in her breasts at this point and no stool since yesterday. I did not tell her I was concerned at this point, nor did I mention the weight yet. I asked if I could check him now and if  it would be alright if I observed the next feeding.. We determined that should be with in the next hour. I talked about feeding cues and asked her to get me if  Mikey seemed ready to eat before I came back.  His vital signs were normal, jaundice not too significant for his age, diaper contained a small amt concentrated urine, and Mikey went immediately back to sleep.  I felt he was OK at the moment and needed to go do a few other  things with other patients.

 

At this point I am feeling pulled in different directions because Meg’s situation could easily take hours of my already busy morning. I am upset that this has possibly been going on the last 3 days and hasn’t been evaluated properly, now it’s day of discharge! How do you do the proper evaluation, give the needed gentle support, make possible feeding plan arrangements in fragments of time? This is what I am trying to change…in my opinion, we the hospital, helped contribute to this situation of possible inadequate feeding and supply… we need to help her! I talk to the charge nurse and it’s cleared to keep my coverage the rest of the morning.. good thing L&D was quiet!

 

Mikey’s doctor comes in and thankfully it is a partner who is very pro breastfeeding and open minded to try options a mom may choose. I gave her report on his physical status, VS, weight, earlier glucoses, and the Bilirubin. I summed up my plan to evaluate feeding quality but suspected he has been ineffective at the breast & milk supply/production may be delayed. I added that I was going to check his glucose if he had low energy level, and encourage pumping or expression for the mom and get that milk into the baby as well as encouraging her to stay for a few feedings to work with me. The MD was happy with these ideas but requested he be supplemented (complemented) with formula at all feedings now until his weight came up. She supports the theory (as I do) that the birth weight can be somewhat inflated with all the pre-birth IV fluids mom rec’d and some of what he lost may be fluid.  The MD said that if things were better by afternoon, he could go home. She went out to examine him at mom’s bedside.

 

I went in for my feeding observation a little while later. Meg now knows his total weight loss and feels very upset. I give her a lot of support and agree with the doctor that some of that could be fluid. I then find out..Meg is an RN here at my hospital on another floor! It had not come up in conversation! So now I know she is even more worried because we nurses always think the worst! I do my best to think simple and encourage her to do the same… it is very early and we can turn this around quickly with a strong approach.

 

My Evaluation:

• Good independent maternal positioning, holding and offering of the breast
• Nipples erectile, breast tissue soft, pliable, small amts colostrum expressed–> mom reports her breasts were “swollen first 2 days”
• Latch fairly adequate but not optimal-> improved greatly with football position and instruction on asymmetrical latch approach (I’d like to say here that I have a” if it’s not broke don’t fix it” attitude. I don’t correct a latch for a mom who has no pain and good milk transfer, we talk about it in case it may come up for though)
• Mikey very sleepy at breast, difficult to maintain latch, no milk transfer observed–>breast massage during feed tried without improvement
• Due to continued low energy level (suspected caloric deprived state causing sleepy ineffective feeding behaviors) a bedside glucose was checked. Result was 49.
• Diaper dry–> the previous concentrated void was only his 2nd in last 24 hrs No stool last 20 hrs and that one was dark.

The mother’s feeding plan:

Many options and teaching points discussed with Meg including the need to boost caloric intake –>starting right now, methods to get her milk or formula into the baby avoiding bottles, a vigorous pumping plan to augment breast stimulation, alternate breast massage, how to observe for swallowing and milk transfer at the breast etc.. I also discussed with her how in my experience, sometimes it is like magic once the baby regains up to birth weight… they just take off!

She chose:

• Cup feed formula now while she pumped –>Mikey would not cup feed so we used a syringe, 18 cc, repeat glucose 62
• Pumping round the clock, double pumping –> Meg rented a hospital grade pump for home use
• Keep close eye on feeding cues, put Mikey to breast in football w/ latch process discussed earlier
• Closely watch signs for milk transfer, correct feeding activity while at breast, sucking rythym 1 or 2 sucks /swallow ( Brad was very involved in this process of learning the observation techniques)
• Use breast massage/ compression while baby @ breast through feed to increase milk transfer
• Goal of min 8 effective feeds in 24 hr..wanted to try for 10 –>agreed to feed expressed milk or formula 1/2 to 1 oz after each feed first 24 hrs until re-weighed next day
• Have as 1st 24 hr goal:  to see 3 -4 increasingly wet/clearer diapers and at least 2-3 good sized stools
• Return to MD for F/U bili and wgt check next day
• Call IBCLC for eval in next few days if weight not adequate and not independently breastfeeding/output  within safe parameters for age

The follow up reports:

• DAY 1 (In hospital) Mikey fed 3 more times in the hospital at 2 hour intervals.  Each time he had about 15 to 20 cc of formula by syringe. Each feed was improved but not adequate quality of milk transfer. Meg pumped 4 times before discharge not getting much first 3 times but 4th time she got almost 10 cc! Mikey had 1 conc wet diaper and a med sized dark stool. We re-weighed Mikey prior to discharge and he was 9 lbs 5.5 oz.  Meg left the hospital late that afternoon while I had been called to a STAT C/S. She was determined to go home after all the time she had been there! I called her later and she was on target with her plan.
• DAY 2 (first 24 hrs home) Seen at Peds office. (reported to me from MD)  Bilirubin 10.6, weight–> 9 lbs 7.5 oz! Baby more energetic, better quality feeds reported. Meg still power pumping, now getting 1 -2 oz per pumping and giving to baby with syringe and only used formula occassionally if no breastmilk.  Had 3 wet and 2 stools since discharge, stools lighter in color. MD arranged F/U weight visit for 2 days, will arrange IBCLC if no strong improvement before 2 more days
• AGE 6 1/2 days Seen at Peds office. (reported to me from MD) Weight–> 9 lbs 11 oz !!! Meg having fairly same routine but not always pumping if she feels Mikey had good milk transfer. She reported increased  breast fullness, 6 wetter, lighter urines and 4 mostly yellow stools in each of the previous 24 hr periods.
• AGE 2 weeks  I don’t have MD office reports but Meg called me to tell me Mikey was 1o lbs 7 oz at his 2 week check up and nursing a lot better EVERY feeding!! She was still attached to her pump, gradually decreasing the sessions, just felt safer to keep going with that. If she gets milk she was still giving it to him. This was her security blanket and she was happy doing it. She was very proud of herself and crying happy tears! 🙂

Meg’s case was a beautiful example of HOW a situation can turn around quickly.  An individual mother’s determination coupled with a productive plan can produce these results. All situations are different.

Every mother and baby deserve our best!

Not your Usual Birth Plan

 

A birth plan is usually a written plan from the mother to her caregivers describing her wishes, what type of options she’d like to take advantage of, things she would like to happen thru out her labor and birth, what things are important to her as she experiences birth.  There are various resources out there to help a new mom explore options and formulate a plan.. especially for a hospital birth.  It is important that the mom review this with ALL her care providers AND especially the L&D nurses…. the advocates who help you actually realize the goals with in your plan. I have a fellow L&D nurse blogger who has done extensive research on the topic and wrote a 2 part series on Writing Your Birth Plan- Tips from an L&D Nurse over at nursingbirth. I would highly recommend you check it out especially if you plan on a hospital birth.

Many times these birth plans accompany a mom’s prenatal chart weeks in advance of her birth. Over the years there has been a gradual acceptance of the plans in my facility where historically, there had been much resistance for the mother’s input what so ever.  Much like the attitudes towards homebirth…. The doctors or nurses would casually peruse the plan then toss it aside and have a good laugh…. saying…. ” oh- she’ll end up a section for sure!”  Unfortunately, they were often right about that– many of those early birthplans never seemed to go as mom wanted, giving the staff fodder for snide comments and remarks. Sad but true. 😦

Recently, we recieved a birth plan that was not at all like any other.  Maybe some of you have seen plans like this… maybe some of you actually wished for births like this…. Hey~ who am I to judge? …. I am only here to help,  it isn’t my birth.

Her Birth Plan requested:

• Pain medication as soon as possible….. I prefer to have an epidural as soon as possible
• Please do not try to make me have breathing patterns through contractions… I’m afraid I’ll be too nervous
• If a Cesearean is needed, please put me to sleep
• I want only my mother with me in the labor and delivery of my baby
• When the baby is born, I do NOT want to touch him until you clean him off
• You can do his eye ointment and Vitamin shot, bath and all procedures before I hold him
• I want to hold him wrapped in a blanket, not skin to skin
• I want the baby to be in the nursery as much as possible at night so I can rest
• I want to feed my baby formula from a bottle. I don’t want to breast-feed
• I want to stay in the hospital for the whole allotted time so I can rest

My first thoughts were… Sweetheart, you could have ALL THIS without even asking!” ……..

Sadly, despite all efforts to improve,  …  things still happen exactly like this for many births.  We just don’t usually see it written out as a formal request or plan!  At least this is how this mother wanted things to happen.

This little mommy came in and delivered vaginally. Her plan was very easily carried out. 😉  I am very happy to report that she and her son were healthy and she displayed very postive interaction with him. Very loving and caring. She was very very happy with her birth and with being a mother!

That is all that really matters in the end.  Options– and what you as an individual would like to have for your birth. How much education she had before chosing these options… I’ll never know.

 Now I am asking the rest of cyberspace world.. have you ever seen birth plans like this???

A Formula Rep turned my Maternity Leave Injury into a new career as an IBCLC? Really?

My contribution to this fabulous Carnival of Maternity Leave  , is a story of how during my maternity leave, an injury occurred leading to a career change specializing in Lactation… ! It starts with the birth of my third and last baby…… A  girl….. (after 2 boys) was also born by C-Section.. a first for me.

Well– first, let  me back up a few years… I’ve had a potpourri of maternity leaves. I have been a Maternity/L&D/Nursery since the mid 70’s.  I always worked full time and had never entertained thoughts of staying home with my children once they were born because the USA didn’t assist in providing any type of viable option for families who rely on two incomes or single moms with one income.  Prior to FMLA,  maternity leave was pretty much up to the employer as far as I understand it. The USA doesn’t offer any paid leave (unless offered by individual employer). For my first baby in 1979- I took 7 .5 weeks and went to a weekend 12 hr shift job which at least allowed me 5 days each week with him. 

 When my next baby was born in 1985, I worked at the same facility I am now. We were allowed to save up ALL Vacation, Holiday, and Sick time to be used collectively with your hospital allowed 12 weeks off.  I was able to have 5 1/2 months total, partially paid time to be with my new baby. Since he had to have surgery at 3 months, I needed that time and could have used more.. My leave was actually supposed to end on Christmas day (YUK).. however, they graciously allowed me to come back on the 26th… also his first day in Day Care. 😦

So back to my third baby in 1988~I had had a C/S — (that’s another story).  I had to be hospitalized for 10 days after the surgery with a whopping infection. A fresh incision and chills with a temp of 103.8 do not go well together! [Nurse Curse] Anyway, I made it thru–> healed and returned to life as a mother of three. The same type of collective accumulated paid hours were allowed withthe hospital’s offered 12 weeks. I didn’t have as many hours saved up as last time but was hoping for the best length of time.  One day in church, I held my little 2 month old baby girl on my shoulder with one hand, while using the other to hold the hand of my active 3 yr old boy as we made our way down the aisle. Suddenly, my boy squealed with delight and whipped over in a different direction. I held my daughter and did a sudden twist and reach for my son as he squirmed away. I immediately felt something “give” in my back.

It took a few days for me to feel the true extent of the injury. I thought it was just a little pulled muscle. After a 5 hour drive to my sister’s for a family visit, I ended up writhing on the floor with the unstoppable intractable “fire hot poker” pain of full blown sciatica…. all down my right side. I had to go to the hospital ER away from home, unfamiliar doctors, for help and drugs! Boy, I needed relief. As explained to me by the doctors… this was not the same as sciatica from many other causes. This was a swollen inflamed sciatic nerve… we didn’t know why yet.  The only thing helping at that point was medication and ice.. a lot of ice. I still insisted they give me meds I could take while breastfeeding, so they weren’t too strong.

I got home, went thru an MRI and diagnostic process, different doc’s, different opinions. I had a disc “blow-out” with”free extruded disc fragments” at L5-S1. Some felt surgery was needed immediately, others said to wait.  After careful consideration, we decided to wait and do some conservative type treatments with oral and epidural steroids. I still had to heal well enough to work, though. I spent many nights crying and wondering HOW I could work ??? How could I go and be on duty…running all over to keep up with the pace, helping people thrulabor and delivery…respond to emergencies…how?? I could barely care for my family! I called many friends while I was on periods of bed-rest and had various treatments during the time I had left of maternity leave. (I eventually did have to extend the leave a couple weeks for more recovery. I ended up witha 5 month leave altogether). I was searching for ideas.. visions of something less physically taxing which could combine my knowledge of labor/delivery/postpartum and neonatal care….. and allow me to continue working. I was, after all, the major bread-winner in our family!

Finally, a friend came up with an idea. He was actually a formula and drug rep for Ross labs.. TRUE!! But he was a friend, had heard I was hurt and stopped by the house to see how I was. He was a rep to many hospitals in the NorthEast and had exposure to what else was going on– what other hospitals were doing.  This was 1988, only a few years after the emergence of the Lactation Consultant profession. I had never heard of it. Sometimes word traveled slowly (by pony express) and things changed slowly in my little neck of the woods. He encouraged me to check it out and gave me phone numbers of LC’s at some of his other hospitals. I was really excited! I called a few and found out more about the lactation profession and the relatively new Board exam given every year in July to gain the credential of IBCLC.  I was actually naiveenough to think I could take the exam with my current knowledge base!  HA! (Unfortunately, this is what many nurses with a little experience think…we think we already know it all! Ha!) 

I called one of the LC’s at a hospital not too far from me. We talked a while and I had my eyes opened as to the extensive and vast knowledge base needed to become a lactation professional. I launched a quest for the best way to gain this knowledge. I joined LLL and went to meetings. I made home visits with the local LLL leader. I wrote many letters, made many phone calls searching for some type of education program. (remember– no Internet back then!)

Finally I found the perfect program for me. There was a correspondence course offered to be done all through the mail and phone calls designed to be an 18 month course.  It was a Lactation Consultant Course offered by BSC Breastfeeding Support Consultants! (the link shown is for their current course) Back then, you could be called a Certified Lactation Consultant after completing the clinical practicum and final exam. Because of continued back problems, I started this course in early 1989, had to take a few months leave from the course and completed it in early 1991. I then went on to continue studying and sat for the IBLCE exam in 1993 earning  my IBCLC status!

I have always continued to work as a staff nurse. I found a corset style back brace and found the best balance possible between family, back pain, work and more pain. I was able to get the pain subdued with steroids to carry on with life. In 1992, during a particularly gruesome relapse, I eventually consented to a myleogram… something I had previously NOT wanted. They also did a CT scan while the dye was in place. These tests showed my right Sciatic nerve had been pushed way up out of place by the disc material. I consented to surgery by a fabulous neurosurgeon the very next day. It turns out, the disc was actually adhered to my sciatic nerve!! He had to meticulously excise it off the nerve!!  My post-op pain was minimal compared to the pain I had before surgery. I was able to go back to full duty in 8 weeks!

Over 20 years later, I am still working as a staff nurse and am now a CLC… Certified Lactation Counselor.  Becoming a breastfeeding professional has enhanced and fortified my life! I am immensely happy I have gone down this road. To think it all came about as a suggestion from a Formula Rep!?!?!

Hope all had a great WBW 2009!!