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

matleavecarnivalbox

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!!

Hope all had a great WBW 2009!!

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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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Breastfeeding Barriers

 Barriers~

Even the word itself is foreboding.

Breastfeeding advocacy, lactivism, promotion are important to combat what is really a public health problem and should be a public health priority.     ~Breastfeeding should simply be the norm.

 

“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.
“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.” 

American Journal of Public Health | December 2003, Vol 93, No. 12

It should be SIMPLE~

It is one thing to talk or write a lot about breastfeeding advocacy and promotion… but WHAT does that really do to break down the hospital barriers. Even with some good ideas or some well-written  plans & protocols(ie. as recommended by The Academy of Breastfeeding Medicine)…. I’m here to tell you, all that does very little to actually change an individual  health-care professional’s actions. There is a critical void in the practice of appropriate breastfeeding management strategies and breastfeeding support from the health-care arena.

Working with barriers day-in and day-out can really open your eyes to what some of us, as lactation professionals or advocates, are dealing with on a daily basis. Many of us are ill-equipped to attempt to enforce evidence-based management guidelines.  There must be better support from the management of each facility, organization or Health-System. It needs to start at the top…. to say we now have an evidence-based breastfeeding policy is NOT enough. I believe it starts with each individual being responsible and accountable for their own practice. 

Action Taken~ 

I have written about how Breastfeeding was taught to me in nursing school and what our scary hospital policy looked like when I got started in this profession. 

I have written an article published in a local parent  magazine to coincide with 2007 World Breastfeeding Week supporting practices to keep breastfeeding SOFT and SIMPLE. 

I have been working on so many different ways to try to keep it SIMPLE… trying to reduce barriers. I have written countless competencies at work while trying to gently re-educate my co-workers. I have developed several PowerPoint presentations, poster in-services, poster displays etc.. to try to help my fellow staff members AND physicians fully UNDERSTAND the superiority & importance of breastfeeding and the use of correct evidence-based management advice, assistance or feeding plans. I have learned to be gentle and patient in the process….one step at a time.

I want to keep it simple for the mother…I’ve tried to work on a simple bottom-line approach to eliminate any maternal barriers of feeling overwhelmed or confused with too much or conflicting information.  

I don’t want mothers to think they have to “study” to pass the breastfeeding test….to “perform” correctly!

I encounter a variety of moms from vastly different backgrounds. There are huge differences in their own individual breastfeeding expectations and goals. We have a large breastfeeding/bottle feeding combination population at my facility. I’ve struggled to balance quality promotion and proper education to both mother’s AND the staff. I continue to to educate with acceptance of all individual mom’s actions. I have written about my approach and maternal guilt.

I wrote:

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.

Support the mother, support the mother, and support the mother.

This is what I have learned and how some of my approaches and strategies have evolved over the last 20 years so that moms and staff alike will listen. I have written these same things at work…. They are hearing me now. I have to say that at least they are listening and some are talking the talk. How do I get them to walk the walk? Only a select few truly care to try.  The following is some of what we still deal with…

Continued Problems …. Persistent Barriers ~

  • Getting the baby skin to skin in the birthing or delivery room–very inconsistent
  • Accomplishing the first breastfeeding in the delivery area (I even revised the nursing form to REQUIRE documentation of a reason WHY not breastfed….) Most common reasons..attempted, mom tired or mom declined. I have to wonder how often it’s really encouraged…and are they trying to help?
  • Some staff still thinking they have to give that “test” feed of water
  • Keeping a healthy baby in the nursery for hours under “observation” while nurse gets all adm paperwork done
  • Giving handouts to mom but not talking to her, not listening, not helping
  • Telling or directing mom firmly, like it’s an order… often with incorrect info- “you really need to feed that baby, wake him up every 2 hours no matter what”
  • Inconsistent observation of latch and feeding progress (At least some are really good at this!!)
  • Giving partial bits and pieces of correct info mixed with misinformation and not accompanied with actual assistance…… then reporting to me  “I said just what you taught me, Melissa!” (A challange to gently correct)
  • Keeping babies away from mother’s…esp at night so “she can sleep”
  • Incorrect use of  formula— given for so many many reasons that are most often because of all the problems above…… sometimes mom asks for formula…. but a little detective work, proper evaluation, assistance and education can possibly help avoid the formula
  • Not understanding the unique characteristics and needs of the ‘near term’ infant. 
  • Being understaffed when busy… we always have a mom/baby dyad with some need for frequent breastfeeding evaluation and assistance when we are crazy busy….they often get lost in the shuffle
  • Staff members not helping a mom because they tell them to wait for me… I am a staff nurse with multiple duties who happens to be a lactation professional. 
  • The discharge diaper bag from formula companies. ***SIGH***
  • Doctors giving conflicting out-dated feeding management advice
  • Doctors scheduling the first baby F/U visit for 2 weeks on first time breastfeeding moms
  • Persistent Lack Of Management Support and Enforcement of Exsisting Evidence-Based Policies and Protocols which I feel leads to staff apathy

I have been patient, really patient. I have seen progress…real progress. I feel so frustrated to be still dealing with some of these barriers. It is overwhelming and exhausting.  I haven’t been trying to do everything alone. I have “duplicated” myself several times. Some of those individuals are still here, others move on to other jobs, others become apathetic over time. Then we get new people who look at things differently with comments like… “This is what we did at __blank___ hospital..”

What do you suggest could help with the real change……the implementation process??

How do I get them to walk the walk???

Please comment and make a suggestion…  Do you have a good one I haven’t tried?

 

 

Adoption in a Small Town ~ The Agony of Knowing…. Part II 

Part II

Apparently Sarah had been having a lot of headaches and dizzy spells.  She is 19 yrs old now and had graduated high school, was attending the local college and had moved out of Karen’s home to live with her boyfriend, Justin. Sarah possessed a beautiful free spirit and Justin (who was the father of the baby she’d given up for adoption) was her true soul mate. They were still together.  It was easy to see how Sarah and Justin were truly in love.

Sarah went down to a large hospital in Philadelphia and had many diagnostic tests all confirming brain cancer. Her tumor was too big for surgery right away but the doctors were optimistic that after radiation and some chemotherapy, they could do surgery and remove the tumor. So far the other systems tests looked good. Sarah was a fighter and vowed to beat this thing!

During the chemo and radiation, she lost her hair. Justin also shaved his head! This wasn’t so popular back in 84-85. She was surrounded by great support! By the end of 1985, her tumor had shrunk she was able to have the surgery. They got it all…the whole tumor….all the cancer!  Sarah recovered easily, no long term effects, and went into remission!  Life became normal for them again.

My interactions with Karen and Sarah at this time were not as frequent. I had made an occasional supportive call or visit, but wasn’t involved in the whole process.  Karen was often in Philadelphia, sometimes for weeks at a time and I had had a baby. Neither of us were skiing very much over the past 2 years. My sister had gone to Europe on a 6 month trip with her new husband, so she had only stayed in touch with Sarah by the occasional card or call.

When I did see her or Sarah—the birth, the baby, the adoption … none of that was ever mentioned.

In the meantime, I saw Dr. E a lot at the hospital. I would ask about Joey sometimes, she occasionally had a new picture or new stories to share about his life with his parents  in Atlanta .  Dr. E talked about Joey with such love and pride, she had really bonded with him. She told me it was because she had to keep him with her until the adoption paperwork was finished. She thought I had a special interest because I cared for him from the beginning in the hospital and had helped her so much with infant care instructions to go home. She never knew I was friends with the birth family.

Sometime in 1986, about a year after the surgery, Sarah’s symptoms returned. The tumor was back.

Sarah grew sicker and it became apparent that this cancer might get the best of her, she might not beat it this time, might not make it. She went through more chemo, and decided against further surgery.  There were more risks this time; Sarah didn’t want to take them. She wanted to go home with Justin and live as much as she could.

I had become increasingly conflicted. I thought… ‘Sarah might not live, she or Karen might want to know how well that baby boy is doing’….. ‘They may want to see a picture or see the boy before Sarah dies…..’  I was having an overwhelming desire to let this secret out.

I wanted to shout: “I KNOW WHERE THE BABY IS….. I”VE BEEN WATCHING HIM GROW UP!!!! “

I had some misconstrued idea of my role in my head..the secret I knew could impact others greatly….I should tell …..Shouldn’t I????  If it was my daughter, I think I’d want to know.  I’d want to see her with her child before she died.  It was very inappropriate for me to think this– but I couldn’t let go of this idea, this strange notion in my head that Karen may openly question me about it someday—that I may be a source of comfort to her. My outward behavior remained professional, but inside my mind– nestled with the secret– the thought process was spinning on pure raw emotion. Clearly–I was having a hard time being objective in my thought process.

I decided to ask my friend who had adopted 2 kids; without telling the actual story; I gave her a ‘what-if’ …. Theoretical situation. –If someone knew that one of the birth parents of your children was gravely ill with a serious disease and may die….. Would you want to know?? How would you feel??

Her response to me “I’d be scared shitless! I’d be scared the birth families would descend on my life and want visitation. I’d be afraid my children would not understand. If there was serious health information I should know, I’d want the lawyer to tell me but that’s it.”

 I really needed her perspective.  This was not an open adoption after all. I had NO RIGHT to say anything! It was not my place at all. I took a huge step back, soul searched and pushed back all those emotional desires to tell…

I saw Karen, Sarah and Justin with some of the rest of their family at a Ski party. Sarah was vibrant, funny, laughing and having a great time! She had on a crazy hat to hide her scanty hair and it meshed perfectly with her personality.  We had a wonderful day. I felt much more peaceful about knowing.

I got word about a month later that Sarah had taken a turn for the worse, the tumor growth was aggressive and they had already arranged for a hospital bed & help at home…Sarah’s home.. with Justin at her insistence. Justin was the major caregiver.

While this was happening, I ran into Dr.E again at work. I felt uneasy and started to struggle that same raw emotional conflict. I chatted with her casually & asked her again if she had a picture of Joey.…this time I asked if she could spare one for our bulletin board upstairs where we have pictures of a lot of our babies. She thought that was a great idea. [I know it’s wrong, but I was thinking, someday, maybe I can show Karen and say– the adoptive family sent it to us on the unit. I couldn’t let go of the idea.]  Dr. E said “Sure.. great idea, I’ll get one for you!”

Sarah died peacefully in her home a few weeks later.  Her family was devastated despite how “prepared” they’d been. My family was also very upset. My siblings all tried to make it home for the service.  My husband, mom and sisters all went over to Karen’s house the night before the service.  There were a lot of people there.  Karen was pretty strong but at one point she cried “My baby is gone- she’s gone.. I’ve lost her!” I couldn’t imagine her pain, her grief. I cried with her.

It wasn’t about me—but I was suffering in a different way, struggling with what I knew…that a part of Sarah was out there… healthy and alive.  I couldn’t share that with anyone. I cannot tell them. Going home in the car, I ended up alone with my mom and I had to tell her. I blurted out the whole story. I could trust her. I had to have someone help me. She reinforced what I already knew that of course I couldn’t tell.  I felt better just letting it out to someone.

The funeral home was packed. We bypassed the rows of picture and long lines, gave nods to the family up front and found some seats. I sat there with my husband all teary eyed.  I saw a lot of people I knew. There were also a lot of children running about.  I saw what looked like a set of adorable triplets impeccably dressed in their identical brown suits.  One of the triplets climbed up in the chair across from me and got snuggled in towards his mother, and then he popped right back down running after his brothers.

I slowly became more aware of this mother sitting across from me. The boy climbed back up in her lap as she looked up and met my gaze. 

I could not believe what I was seeing! It was Dr. E.!

She said confused “What are you doing here?”

I said crying “Sarah was the daughter of one of my best friends– Karen…..”

She said “I didn’t know you knew her….. all this time… well–this is JOEY!  Oh –that’s why you wanted a picture! Oh Sweetie.”

I fell to my knees in front of her, my hands on her lap sobbing, I could not control my emotions….

Me sobbing “I didn’t know they knew where he was..I didn’t know, I didn’t know..”

By now she was up and leading me down the hall, holding Joey’s hand…..I’m crying:”did Sarah get to see him? Did Karen? Oh –he’s just so precious….”

She realized I didn’t know about any contact at all so she quietly explained that Sarah had opened up the line of communication when she realized the treatments weren’t working and that she and Justin had wanted to see Joey– spend a little time with him. Then she said ..“Come here, I want you to see something.”

She took me into another room, filled with people I didn’t know. She announced to everyone. “This is the nurse I was telling you about who took such good care of Joey in the nursery as a baby!”  I was sobbing still as she introduced me to her brother and his wife the adoptive parents, Joey, and the other 2 boys (I thought were triplets) who were brothers. I had said earlier in the story that Dr. E’s brother and wife (also both physicians) had gotten pregnant after getting Joey but I never knew they also had the good fortune of adopting another child a few months after Joey. The 3 boys were very close in age. The room was filled with Dr.E’s family who had all made the trip from Georgia! There were grandmas, grandpas, aunts, uncles.. all coming to pay their respects to Joey’s birth mother. What a wonderful openminded loving family! They were mostly staying in a room off to the side out of respect to Sarah’s family. What a gift… for Joey, for Karen and her family and what a gift for me.

Only a few people in Sarah’s family knew she had ever had a baby… …that was more than I thought. Those that knew only found out with-in the last few months. They were all very private about it. I found out later that Karen had still not come to terms with Sarah’s adoption choice. Karen was hoping to help her raise the baby when first finding out Sarah was pregnant. She herself hadn’t really visited with Joey It was very hard for her that Joey was even there… There were pictures on the wall of Sarah, Justin and Joey.. but I had bypassed that when we came in…and had not seen them.

 

Before the service started, my sisters were standing next to me on some steps, and Dr. E walked past with Joey saying he wanted to say hi to everyone again.

The sister who had been Sarah’s friend said: “Who’s that? Is that one of Sarah’s cousins?”       

I hesitated not know what to say at first… and Karen’s mom looked at me–clearly understanding that I knew.    She said: “It’s OK, you can tell her.” Once again, crying, I told my sister the secret I had kept all these years.

 At the end of the service, people went outside to release flower petals or balloons in the wind and say a final goodbye to Sarah.

I stood next to Joey as he released a balloon. Dr E said “Would you like to say something Joey?”

Joey: “I say goodbye to my birth mother and I am happy my birth father is still alive!”