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Posts tagged ‘support’

Breastfeeding- Yeah- It’s Not Exact or Precise

Cartoon by Neil

Cartoon by Neil

The truth of the matter is that doctors, physicians assistants, med students, interns, yes and many midwives plus many nurses working in the mother/baby environment SIMPLY DO NOT have enough education about Lactation and Lactation Management to adequately guide new mothers. It is sad and pathetic. The vast majority of these individuals would rather work with precise numbers and are actually happier if a mom is pumping and feeding her milk in a container to baby.

It is no wonder this has transferred to the vulnerable new mother. WE have done this to her. There is actually a new trend to pump and feed expressed breast milk instead of ever putting baby to breast. I can help you with that.  Please know that a large number of these infants do get some formula until milk supply is established. Make an informed choice. These breastmilk-fed babies are not usually exclusively fed expressed milk thru out the first few months. It is a hard job to pump and feed and pump and feed. It is a damn hard job to build and keep up a full supply long term exclusively pumping!! It has been done. You can do it. Mommas are very powerful and they can do it SO if that’s the choice you make then GO FOR IT!!! Give it all you have got. But CONSIDER putting baby to breast and feeding the way nature designed your body. Work with an IBCLC. We need good lactation programs at EVERY facility that provides childbirth services. We need IBCLC’s in the hospital. We need prenatal education about the benefits of breastfeeding so mothers make a true informed choice.

The more I speak with and counsel new mothers, the more I get asked for exact numbers when it comes to feeding instruction. It is no surprise that the number one question on the mind of a brand new first time breastfeeding mom is “HOW do I know my baby is getting enough milk?”

Babies were born to breastfeed

WATCH the baby, Listen to the baby. Look for feeding cues or little things the baby does which tell you he is getting hungry.

Lets make it EASY with very little “rules”. Think of these as TOOLS– not RULES

First:  Attachment to breast should be DEEP and COMFORTABLE

Second: Baby needs to do the RIGHT JOB of effective drinking

Third: Baby needs to do this OFTEN ENOUGH each 24 hours…. about 8 for most moms – more is very common- feed on cue

Fourth: By the fourth day ( give or take a day), and EACH 24 HOURS thereafter Baby should be having around 6 ”good” wet diapers and about 3 -4 poops that are starting to turn yellow.

Please KEEP your baby with you at a times!! Just.Say.NO.

 

Bottom lineWeight Gain. Baby should be at birth weight by Day 10 (or at least on a proven good upward trend) and be gaining about an ounce every day thereafter.

After the first 4-6 weeks. This little chart comes in handy:

Copyright Nancy Mohrbacher used with permission

Copyright Nancy Mohrbacher used with permission

If a doctor or  nurses first suggestion is to give formula to your breastfed baby—for whatever reason— ask to see a Lactation Consultant, an IBCLC.

These are the only numbers to remember. TRY to stop stressing out.

This blog post is not a replacement for medical advice should you or your baby have an issue. This is applicable to healthy full term infants.

Copyright 2014 StorkStories RN IBCLC RLC

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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.

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

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

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

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

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

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

Then Sadie got pregnant.

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

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

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

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

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

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

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

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

Thanked me for being such a good grandma!  ;-

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

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

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

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

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

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

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

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

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

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

Breastfeeding Evolution amidst the NICU Technology

 

 

Powerful Skin to Skin

Evolution

I love babies. I love being a nurse.

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

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

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

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

Evolution

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

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

 

NG tube

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

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

Breastfeeding is NOT an exact science!

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

into the feeding plan for each individual baby!

We Deliver? How about we make it a better delivery?

permission from CartoonStock

permission from CartoonStock

Our Maternity Services

Need Help!

The Maternal Child care delivery system in this country as a whole needs vast improvement. All of these 10 steps as well as the 10 steps to ensure optimal successful  breastfeeding are very important.

These items are sadly grossly misconstrued or ignored by many facilities offering maternity services in this country. I have been having the same discussions and occasional arguments with co-workers  lately on this battle of the newborn baby staying in the moms room overnight!!! I know~ it is a no brainer to those of you who read, research and understand. Many of my co-workers still defend their philosophy that the baby needs to come into the nursery at night so the mom can sleep!!  Many argue with me about labor positions and inductions!! AARRGGHH! I won’t get into our details right now…….

What I have here for you today is NOT new info but I recently reviewed it again as I was searching for evidence to back my discussions with staff. If you haven’t placed this information in your workplace to nudge some resistant peers, I urge you to do so!

This document : THE COALITION FOR IMPROVING MATERNITY SERVICES:
EVIDENCE BASIS FOR THE TEN STEPS OF MOTHER-FRIENDLY CARE
can show you research studies or data which support the ten steps below.

The 10 steps for Mother-Friendly Care from CIMS {Coalition for Improving Maternity Services} taken from their website…..are:

Ten Steps of the Mother-Friendly Childbirth Initiative
For Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care.

A mother-friendly hospital, birth center, or home birth service:

  1. Offers all birthing mothers:
    • Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
    • Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
    • Access to professional midwifery care.
  2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
  3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
  4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
  5. Has clearly defined policies and procedures for:
    • collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
    • linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
  6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
    • shaving;
    • enemas;
    • IVs (intravenous drip);
    • withholding nourishment or water;
    • early rupture of membranes*;
    • electronic fetal monitoring;
    • Has an induction* rate of 10% or less;†
    • Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
    • Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
    • Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
  7. other interventions are limited as follows:

  8. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
  9. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
  10. Discourages non-religious circumcision of the newborn.
  11. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
    1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
    2. Train all health care staff in skills necessary to implement this policy;
    3. Inform all pregnant women about the benefits and management of breastfeeding;
    4. Help mothers initiate breastfeeding within a half-hour of birth;
    5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
    6. Give newborn infants no food or drink other than breast milk unless medically indicated;
    7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
    8. Encourage breastfeeding on demand;
    9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
    10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

I endorse these steps. You can visit their website to also endorse.

Kathy from Woman to Woman Childbirth Education wrote about the CIMS press release on the Need for Transparency regarding the rising C/S rates. Excellent information is discussed here by the CIMS and I enjoyed the discussion between Kathy and RealityRounds.

I also would urge you all to visit and give information to The Birth Survey.

How is your birth place measuring up to these initiatives?

Let’s all continue to make this a better world

in which to give birth!!

**ROAR** on Breastfeeding Guilt

10_Lioness-with-Cub-Feeding

(Image found at Google Images)

**ROAR**

The Mommy Wars over feeding babies continue..I guess it won’t ever be truly over. I’ve been following a discussion over at NursingBirth on  “Why Educating Our patients is a Professional Responsibility and Not about Guilt.”

I thank her for quoting me and including thoughts I wrote on what I have learned over the years talking to, educating and helping mothers.

I have re-posted this earlier segment  “Breastfeeding, Bottle-feeding and Somewhere In-between… Why the Guilt?” This post is about what I have learned speaking from a professional point of view. As a professional, it is inappropriate for any of us to imply directly or indirectly to any mother trying to make feeding choices that breastfeeding and formula feeding are equal.  They are not. Human milk is the superior species-specific food for Human infants. The recommended feeding hierarchy from the experts (AAP,CDC, WHO) is Breastfeeding, expressed mother’s milk, expressed donor milk then properly prepared infant formula. That’s why NursingBirth’s post is so important to understand. Reading the comments……

There are STILL moms out there confusing the issue.

All or most of this discussion is NOT directed at any mother who tried to breastfeed under any circumstance and wasn’t able to at all or wasn’t able to fulfill her individual goals. I applaud all your efforts for trying to give your baby the best food you could. I am so sorry that you experienced the difficulties you have. Your situation is not what this discussion is about. I think it’s very possible that advocates and some professionals lack sufficient skills to help you deal with the loss of a breastfeeding relationship. If breastfeeding is important to you then you would truly go through a grieving process and guilt would most likely come into play somewhere along the line. We do that to ourselves a lot as women anyway. I did personally experience that guilt. I had wanted to breastfeed my last baby for a full year and was unable to because of personal health problems. I had a lot of guilt. This discussion is NOT about these situations. Let’s stop making it about that. Please!

This mommy war guilt discussion as I see it is one where a mother who chooses to formula feed defends her choice and lays claim that those who are promoting or advocating breastfeeding make her feel guilty.

Guilt comes from within an individual if they feel they haven’t done what they “should” or wanted to. Guilt is a very strong emotion. NursingBirth has a great description of guilt as does The Feminist Breeder in “Mommy Guilt- Its all about Perspective.” It would be a good idea for guilt-ridden moms to read these articles. Those professionals or advocates who I have mentioned here or in my re-post are trying to do a good job of making sure people have the information to make educated decisions about health care issues.  Any professional who intentionally tries to make a mother feel guilty isn’t being very professional. If there is an advocate out there continually finding moms feeling guilty, perhaps you should change how you deliver the message. I said in this earlier post about how one single word can make a difference:

“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??”

None of this changes the facts. Like it or not, breastfeeding is and will continue to be a major Public health Issue to the point of a public health crisis! As professionals and advocates, our work is not finished. I think sometimes that those speaking out against advocates get in the way of facts and put their personal opinions or views out in front and totally distort the issue. I read on someones blog this week (TFB) a great quote by Daniel P. Moynihan: “You are entitled to your own opinion, but not your own facts.” and I loved it!

According to this article from the American Journal of Public Health:

“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.”

I am still going to promote breastfeeding. I am still going to provide appropriate factual information to the mothers in my care and support whatever feeding decision they make. I will never be pushy. I will gently encourage those on the fence to give breastfeeding a try. I always support the mother.

But more people need to talk about the importance of breastfeeding.

Because it is

Important.

Don’t be guilty

Stop it

*ROAR*


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?