Skip to content

Posts tagged ‘advocacy’

Jun 21

29 Comments

Little Old Men… & Nursing in Public

Welcome Readers…to my first Carnival of Breastfeeding post!
This month’s topic is “Nursing in Public”.
Links to all the Carnival Posts are listed @ the bottom. I’ll update this as more are posted.

Keep checking back and Enjoy!!

My first baby was born in sunny Florida during a particularly hot stretch in May 1979.  Although I was an OB nurse, I knew very little about breastfeeding other than what my older co-workers had taught me—which was not all that correct or very helpful information. Luckily, I had a great friend who was nursing her 3 month old at the time my son was born. She really showed me the ropes. It just so happened that she was the one who took me home from the hospital. We had to stop at the store for a few items so we went in to a “Publix” supermarket with both babies in our arms.  My newborn son began fussing to nurse soon after we hit the air conditioning.

I said.. “I’m going to have to go back out to the car and nurse him.”

My friend says “Oh..You’ll do no such thing.. You’ll die in that heat.. Just hook him up and keep shopping so we can get finished and out of here!”

Me- “Nurse him in here?”

Friend- “Well if he’s hungry.. yeah!.. (after looking at my face) Oh stop worrying about it..go over to a deserted aisle, get him hooked on and put your receiving blanket up near his face… nobody will know!”

Me- timidly…above the louder howls.. “Alright, be right back..”

I found the most private place I could. I started cursing that complicated “wonderful nursing bra” I just had to have. (Remember..this is 30 years ago… this bra is now an antique!) My skills handling newborns allowed me some grace as I attempted to multitask by stooping down, prop my loudly crying baby on my partial lap, use 2 hands to fiddle with the damn nursing bra, then get him back up near my finally free boob and latched on.

Ahhhh~ quiet, happy, drinking baby!

Still stooped down, I peered slowly behind me — expecting that a large crowd must have assembled. Somewhat surprisingly, everybody was just going about their business and I happily realized that noone was looking at me! I stood up, made sure I wasn’t showing anything, and walked off with my happily nursing baby to find my friend.

It’s amazing how many people want to see a quiet baby as opposed to a screaming infant!

A sweet little old man stopped me first and asked me how old my baby was….”3 days”, I replied. He peeked in for a closer look and he actually didn’t get it right away.. “I can’t really see his face.”.. I said “Well- he’s feeding right now.”.. He just said..”OOPS….sorry about that! Well he’s a cute one!” then walked off.

The next person who stopped me was again.. a sweet little old man. He was very smiley and jolly. He asked all about the baby but didn’t lean over to look like the other man. I quickly said he’s nursing now and then answered all the small talk.  He never seemed uncomfortable about it at all! That probably gave me a lot more confidence. We parted ways and I finally found my friend. She gave me an approving thumbs up, asked me to hold a basket with my other hand and said we were almost done.

Another little old man stopped us by the register to ask about both babies. We gave him all the small talk answers and let him know my son was nursing. This guy was a real sweetie, commenting on how lucky kids were that moms were starting to “nurse their young” again and ‘good for you.”  He never tried to look in at my son. He didn’t seem embarrassed by the process at all. He was the coolest guy!

I left the Publix Supermarket on my way home to begin my life as a mommy…. with a little public education bonus.  Encountering those sweet little old men while feeding my baby and receiving their positive type feedback was the gentle support I needed. I went on to feel empowered to nurse in public for all three of my babies…  Those little old men were just so supportive! ~ When my baby was hungry, he needed to feed and it really didn’t matter where I was at the time.  Thank goodness for my friend’s wisdom and support to go for it!

I became a lactation professional while nursing my last baby. It was then, only after I really became more aware of issues surrounding nursing in public that I actually took any kind of public action to empower other moms.  I’ve done lots of different little things as the years have gone by. I want to mention one fun way that I thought I could help gently re-educate some of the “new” sweet little old men of this day and age.  Our local paper has a lot of little retired guys commenting back and forth on various local articles. I’m guessing their age and status by all the things they say. I took this opportunity to possibly educate some of these forum readers about breastfeeding rights in public.  Every once in a while, on the forum, I put out a little snippet on nursing in public… and sit back and watch what they have to say in reply! It’s quite fun!

Here’s an example I wrote on a long forum discussion a couple years ago on a breastfeeding article:

On another note, regarding a reader reaction in the forum, a skimpy bikini or the bathing-suit issue of a favorite sports magazine show more skin in a provocative, sexy way than any mom breast-feeding. Even the movie stars in their gowns with plunging necklines are showing almost the entire breast! Somehow, that is OK. It is sad that the public opinion of a baby breast-feeding (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 breast-feeding her baby. August 1-7 is always World Breast Feeding Week. The theme this year is “Welcome Baby Softly,” focusing on the importance of the first hour or two after birth. Learn more about it. I would love to see the paper do an article on that.

This one provoked a few responses in both directions and sometimes there were a few people who actually thought out loud that …gosh maybe I was right… never thought about it that way…etc..

Here’s an example I wrote on a recent article about the appropriate % amount for tipping :

I have never left an establishment without tipping– however, I also tip according to service up to 20%. If there are unkind reactions to small children in a FAMILY establishment, they will be getting a bare minimal tip for sure!! I do my best to keep my children behaved with table manners AND respect other patrons… but fact remains, they are children! I cannot possibly be prepared for every behavior or an accidental spill. In addition, my breastfeeding baby may be hungry.. By PA law, I have the right to nurse my baby in a public place wherever he and I are allowed to be. I am discreet.. I am protected by law… I don’t need an unkind comment from servers. They do not get a 15-20% tip if nasty, unkind or disrespectful comments have been made about my children or my breastfeeding baby!

This provoked a foray of comments ranging from ‘good for you’ to ‘you should be in the back booth…controlling kids etc..’  Sometimes the opportunities to educate others come at unexpected times but produce amazing results!

On a few occasions, other readers were supporting my comments and

helping to educate those sweet little old guys with me!

😉

Carnival of Breastfeeding Post Links (Check back for updates)

Jun 16

9 Comments

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

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

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

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

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

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

~25 Week gestation walk-in~

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

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

~Twins!~

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

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

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

Jun 3

52 Comments

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.

Read more

May 28

21 Comments

OB Docs and Nurses Scoff at Homebirth

My community hospital’s views have never been in favor of any type of home-birth… whether it’s with a skilled professional  practitioner or a skilled lay midwife. There could have been some free unassisted births going on but we were not aware….  As I grew-up in this profession, I learned first from my experienced counterparts…then I began to educate myself and learned a lot from mothers and babies.  The doctors and nurses I worked with were all stagnant in their knowledge in my early years. They were satisfied with how things were.  I was young, I had an open-minded philosophy and an eager quest for knowledge.

In the later 70’s, just when we began to have mothers speak out and request a more natural childbirth, I had a few friends who enlisted the aid of some lay midwife in the region and arranged for homebirths. They all had a really nice birth experience without a single complication. Perhaps that was why I was open to the idea even though I was not personally involved. Besides some of the truly prepared couples who came in and had incredibly beautiful births….. that had been my first exposure as an alternative option to the knock’em out–pull’em out births I had been working with on the job. I knew my friends were very low-risk and had done their homework. 

   However, the hospital’s exposure to a homebirth in those days was only if the homebirth went awry for some reason or another and they came in our doors seeking help…  here’s what the docs and nurses would say to one another :

  • “Can you believe she planned to deliver at home???”
  • “How could she take take a chance like that with her baby?”
  • “The reason people started coming to hospitals to give birth was because mothers and babies were dieing at home….she must be crazy or totally insane!!”

   We’ve had planned homebirths come in for various reasons, as I am sure other facilities did…. (keep in mind that in my area, the usual birth attendant was a lay midwife). The situations bringing the mother to the hospital were often scary and upsetting for her. The most common were:

  • Fetal heart rate decels with or without meconium stained fluid 
  • Lack of progress with pushing mostly after many hours..
  • Higher than normal bloody show or bleeding–possibly abrupting
  • Breech, brow or face presentation
  • Retained placenta

Often the OB’s didn’t handle themselves well.. certainly not professionally. We had this one OB who would call for the OR to be opened before he even examined the patient or evaluated the situation…..regardless of why they came in.  And he often actually yelled at the mother, in the middle of her scary situation.

“Your baby will die if we don’t do an emergency C/S right now, why did you let this happen!”

Most often the backlash was directed at the midwife who cowered in the hallway- uninvited by the staff, left alone detached from her patient. She never left the unit though until she was afforded the opportunity to visit and speak to her patient. 

The two significant situations I remember which would fall in to statistical data for morbidity were:

  1.  An abruption which resulted in a crash C/S upon admission and a neonatal resuscitation with good response….(final apgars 3@one min then 7@ five min) positive overall outcome, no long term sequelae.
  2. A birth where the father (a chiropractor) was the birth attendant for his wife, a multip, encountered a shoulder dystocia and the baby ended up with a displaced fractured left humerus. That baby was in a crib with traction to realign the bone. The child went on to be an honor student at a local university after homeschool.

I feel that instead of the midwife or mother receiving hostility (or even the mother being wisked away to the OR without a trial of something if the baby was deemed stable..)~ the staff should have behaved in a compassionate professional manner, acting on any urgent situation with consideration that this mother is now experiencing not only labor but fear and grief over the loss of her beautiful planned birth.

Despite all the negativity from the staff, we never had a seriously bad outcome from attempted homebirths arriving on our doorstep.  We still have attitude problems, probably always will~ just as we do with breastfeeding.  I wish they could  look at it from my perspective. Those who choose homebirth today have better information to hopefully make an educated informed decision about their birth options and choose wisely. I really like Ricki Lake’s “The Business of being Born” among other’s. I hope those choosing homebirth are truly investigating all these options, deciding what is best for them and not making any decisions out of “anger at the system” or any sort of revolutionary zeal.  

  There is so much out there for medical professionals to be aware of other than what goes on in their tiny little realm, their little part of the world. My co-workers and doctors need to be better informed.  

Any one bad outcome (which most certainly happens in the hospital)  does not mean that every homebirth is a bad idea.

May 21

15 Comments

Cesarean Delivery of the Second Twin… Why? 

029I was talking to one of my on-line Twitter friends @onefinebreeder about twin delivery. I was telling her about how things used to be.. how vertex-nonvertex twin gestation’s were always delivered vaginally ….. and she commented on how it was sad that some of the old OB skills have been totally lost to surgery… So Very True!

I got to thinking about the first combination Twin delivery I had witnessed back in the very early 80’s. This was actually one of our own (hospital employee) nurses .  She was a multip…. around 37-38 weeks and healthy…no complications during pregnancy. Twin A delivered spontaneously, vaginally with a generous episiotomy as they often performed at that time… The baby , a girl, was about 6 pounds, vigorous and had no problems. We were all marveling at the first baby, checked fetal hearts on the second twin and started waiting for him to get in position.  Still before consistent ultrasound, we were not worried. However, we had a newer doctor who was attending this birth. He began to get concerned after 5- 10 min when contractions slowed and he was worried that if this baby was breech, he would have difficulty with the “after-coming” head. Up to this point, all I had learned was this can be a real concern if the smaller feet or buttocks present through a cervix which is not fully dilated. Much research was done later on but at the time, I did not know about it. He began to ask us to call the OR for a C/S. This was unheard of in my limited experience at the time…. my 70’s world. I thought.. how can they do a C/S now when one baby was already born??? I tried to be an advocate… (my early days… )”We have Piper forceps…”  I said meekly… “Have you tried to grab a large part and help bring the baby down… ?” This was my limited knowledge… all I knew to suggest. I kept wishing one of the other doctors was on duty that day.. or maybe we could call them???

In front of the mother, he said to me “I’m not going to have a bad outcome here!” By now it was 20 minutes or so. There was no cord prolapse, no drop in fetal hearts, no evidence of immediate trouble… the baby was seeming to work itself into breech position…. To the mother he said “Your baby is in serious danger and the best thing to save him is to take you for a Cesarean now!” “I’ll sew your episiotomy together while we are in the OR.”

I was in shock. She signed, scared to death of course. So we prepped her for the OR. She went up for a C/S of her second twin and repair of her generous episiotomy. Her second baby was delivered frank breech…  a beautiful boy about the same size and was also vigorous and healthy. I remember I felt as though she was almost assaulted. I remember feeling that this was a true rare event if it every happened before. There was no immediate access to information like today.

Luckily mom and babies did fairly well in the postpartum period even though healing from both the episiotomy and the C/S was difficult for her.

"How can I get out if I'm not head 1st ??"

" Psst-- How can I get out if I'm not head 1st ??"

I wanted to see how much research I could find on this topic. I had gone to the green journal (OB & GYN) website but then it locked me out. (You can only look at abstracts anyway unless you want to purchase the article. You are on your own for that.) I had some luck with the abstracts at PubMed so I have put a few here.

I decided to take a look across time…….

This first one is from 1981. . Quoted abstract from the PubMed site:

Cesarean Section for Delivery of the Second Twin

Evrard,JohnR.; Gold, Edwin M.
Obstetrics & Gynecology. 57(5):581-583, May 1981.

Four cases of combined vaginal-abdominal delivery of twins are presented, and an additional 5 cases from the recent literature are discussed. Malposition, malpresentation, and contracted cervix were the main indications for cesarean section for the birth of twin B. In the 9 cases presented, there were 2 perinatal deaths.

Interesting that this research was done during the same time frame as my experience above. I’d like to know more about those poor outcomes 😦

The next interesting article I found was researched over a 10 yr period, somewhat close to here in a larger facility, published 1997. THIS study examines the delivery of the second twin by utilizing external version vs breech extraction . 😉 The results are showing in favor of breech delivery vs version (those meeting exclusionary criteria ).. Versions were associated with higher a incidence of Cesarean and fetal distress. Neonatal outcomes no different and are stated below:

Method of delivery of the nonvertex second twin: a community hospital experience.

 Smith SJ, Zebrowitz J, Latta RA.   J Matern Fetal Med. 1997 May-Jun;6(3):146-50

Abington Memorial Hospital, Pennsylvania, USA.

The purpose of this study is to examine the incidence of cesarean section and fetal distress complicating the delivery of the second twin in vertex-nonvertex twin gestations in which the second twin underwent either breech extraction or external version. The intrapartum courses of 510 twin gestations delivered at a community hospital over a 10-year period were retrospectively analyzed. All vertex-nonvertex twin gestations were identified in which the second twin underwent attempted breech extraction or external version. Exclusion criteria included birthweight < or = 1,500 g, fetal anomaly, intrauterine demise, and monoamniotic twins. Of the 76 twin sets that met inclusion criteria, 33 underwent external version and 43 underwent primary breech extraction. The two groups had similar demographic characteristics. External version compared to breech extraction was associated with a significantly greater incidence of cesarean section (8/33 vs. 1/43, P = .008) and fetal distress (8/33 vs. 1/43, P = .008). There was no difference between groups in neonatal outcome for the second twin as measured by length of stay, 5-minute Apgar < 7, intensive care unit admissions, hyaline membrane disease, intraventricular hemorrhage, and traumatic birth injury. In conclusion, the increased incidence of cesarean section and fetal distress in patients undergoing attempted external version suggests that breech extraction may be the preferable route of delivery for the nonvertex second twin weighing more than 1,500 g

The next study was published a little later in 2001 and covered a 20 year span of time… during the 80’s and 90’s at a larger center in Nova Scotia, Canada. They noted an increase in their combination vaginal/cesarean twin births and documented some statistical data, looked at reasons for an operative second twin birth. I wish to read this study further some day to see if there is mention pertaining to mother/baby outcomes other than statistics outlined (even though that wasn’t their objective) in this abstract:

Combined Vaginal-Cesarean Delivery of Twin Pregnancies

Persad, Vidia L.; Baskett, Thomas F.; O’Connell, Colleen M.; Scott, Heather M.

Obstetrics & Gynecology . 98(6):1032-1037, December 2001.

Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada.

OBJECTIVE: To estimate the incidence and factors associated with combined vaginal-cesarean delivery in twin pregnancies. METHODS: We studied all twin births weighing 500 g or more during a 20-year period (1980-1999) at a tertiary care center. Major anomalies, monoamniotic and conjoined twins, and antepartum fetal deaths were excluded.

RESULTS: During this 20-year period, 105,987 women delivered, of whom 1565 (1.5%) had twins. Of these, 1151 twin sets fulfilled the study criteria. The mode of delivery was vaginal in 653 (56.8%), cesarean in 448 (38.9%), and vaginal-cesarean in 50 (4.3%). During the 20 years there was a statistically significant increase in combined vaginal-cesarean and elective cesarean deliveries, with a decrease in vaginal deliveries. Parity, gestational age, and birth weight discordance (>25%) were not associated with combined delivery. Compared with vaginal delivery, the nonvertex second twin was associated with a twofold higher risk of cesarean delivery (relative risk [RR] 2.3; 95% confidence interval [CI] 1.3, 3.8; P =.002); and an interdelivery interval of over 60 minutes with an eightfold higher risk (RR 8.2; CI 4.6,14.6; P <.001). Vaginal-cesarean delivery had a 22-fold higher use of general anesthesia compared with vaginal delivery (RR 21.8; CI 5.4, 88.5; P <.001). CONCLUSION: There has been a significant increase in combined vaginal-cesarean and elective cesarean deliveries among twin gestations, with a decrease in vaginal births. Vaginal-cesarean delivery is associated with nonvertex second twin and a prolonged interdelivery interval.

Now we come to 2008!  There is a study here from Texas. This study looked a twins born by C/S after labor and twins who had cesarean birth of the second twin. they campared outcomes to see if the twin of a combined delivery had more problems. The most important pieces of information I gather from this abstract of results…. (again, having NOT read the entire study):

“Combined twin delivery may be associated with endometritis and neonatal sepsis when compared with a twin delivery where both are delivered by cesarean in twin pregnancies experiencing labor. More serious neonatal sequelae, including hypoxic ischemic encephalopathy and death, were not affected by the route of delivery of the second twin.”  Hmmm 

Cesarean Delivery for the Second Twin

Alexander, James M.; Leveno, Kenneth J.; ….et al:for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU)   Obstetrics & Gynecology . 112(4):748-752, October 2008.

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235-9032, USA. james.alexander@utsouthwestern.edu

OBJECTIVE: To examine maternal and infant outcomes after a vaginal delivery of twin A and a cesarean delivery of twin B, and to identify whether the second twin experienced increased short-term morbidity as part of a combined route of delivery. METHODS: Between January 1, 1999, and December 31, 2000, a prospective cohort study of all cesarean deliveries was conducted at 13 university centers. This secondary analysis was limited to women with twin gestations who experienced labor and underwent cesarean delivery. We compared outcomes of the second twin in women who had vaginal delivery of the first twin and a cesarean delivery of the second twin to those who had cesarean delivery of both twins. RESULTS: One thousand twenty-eight twin pregnancies experienced labor and underwent cesarean delivery; 179 (17%) had a combined vaginal/cesarean delivery. Gestational age at delivery was 34.6 weeks in both groups (P=.97). The rupture of membranes to delivery interval was longer in the combined group (3.2 compared with 2.3 hours, P<.001). Endometritis and culture-proven sepsis in the second twin were more common in the combined group, respectively (n=24, odds ratio 1.6, 95% confidence interval, 1.0-2.7; n=15, odds ratio 1.8, 95% confidence interval, 1.0-3.4). These differences were not significant after logistic regression analysis. There were no statistically significant differences in an arterial cord pH of less than 7.0, Apgar score less than or equal to 3 at 5 minutes, seizures, grade III or IV intraventricular hemorrhage, hypoxic ischemic encephalopathy, or neonatal death. CONCLUSION: Combined twin delivery may be associated with endometritis and neonatal sepsis when compared with a twin delivery where both are delivered by cesarean in twin pregnancies experiencing labor. More serious neonatal sequelae, including hypoxic ischemic encephalopathy and death, were not affected by the route of delivery of the second twin.

I gather from these studies that a combined delivery route leads to more problems.. however…there are probably more problems than breech presentation alone to lead the provider to make that choice. I believe that many newer providers of obstetrics in a hospital setting are more apt to do a scheduled C/S for any vertex-nonvertex twins they encounter. That is what is done in my facility today. The same for all breech presentation singleton gestation.

Where is that old-fashioned nurse when you need her?? How ’bout the old fashoined doc??? 😉

I am very interested in anyone’s story or experience either in healthcare or your personal birth. Please let me know if you know anything about this!

Thanks for reading!

May 20

1 Comment

Watch Wednesday ~ WAIT to Clamp Cord!

Watch the video Wednesday

Just read an awesome Post about Delayed Cord Clamping by a fellow Labor and Delivery Nurse who has an excellent blog you should all read. I have a link to it on the right hand side… “nursingbirth”.

She did tremendous research and has supplied fabulous information. 

Here’s a shout out to you nursingbirth!!

Watch this video..

 

 

May 19

16 Comments

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?

 

 

May 15

12 Comments

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!”

May 8

64 Comments

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?

Newer Entries »