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Posts tagged ‘Breastfeeding’

Aug 11

12 Comments

Not your Usual Birth Plan

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

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

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

Her Birth Plan requested:

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

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

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

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

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

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

Aug 7

10 Comments

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

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

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

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

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

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

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

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

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

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

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

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

Hope all had a great WBW 2009!!

Hope all had a great WBW 2009!!

Aug 2

6 Comments

WBW~ Breastfeeding in a Personal Disaster…. C.Michael’s Story

SendPicture14 August 2nd…..Today is my son’s 24th birthday. Yeah…I’m old 😉 This is not really the theme of WBW but I will take this opportunity to tell his breastfeeding story on his birthday.

In 1985, I gave birth to my second son. C. Michael. He was 37 weeks and behaved like many     near term babies… Breastfeeding got off to a slightly delayed start but then was awesome and without problems! Yay!

I wish C. Michael’s physical health was the same way.

C.M. was born with craniosynostosis.  Specifically, saggital craniosynostosis. Infants skull bones are purposely NOT fused together at the time of birth so the head can mold as baby makes his way down the birth canal and into the world. The different skull bones will overlap easily along the suture line so as to fit thru the pelvis. These bones then gradually reshape and the sutures eventually fuse.

My son’s saggital suture line was prematurely fused…causing a misshappen head. When there is a premature fusion, the growth can only occur parallel to the fusion. The saggital suture goes from the anterior fontanel along the top of the head to the posterior fontanel. Parallel growth would cause his head to be really oblong, or football shaped.

We took him to 5 doctors to decide if we would have corrective surgery… Yes that’s right…. it had to be OUR decision. Although this is a birth defect and causes a visual deformity, it does NOT affect healthy brain function UNLESS there is fusion of more than one suture and growth is impeded. So it is cosmetic surgery.

We decided to go ahead with the surgery at age 3 months and had everything arranged at CHOP (Children’s Hospital of Philadelphia). The craniofacial team was amazingly supportive. I was so very scared. My husband and I could not sleep. I hadn’t been able to sleep well since he was diagnosed. How many new mom’s tell you the baby is sleeping but they can’t sleep??? I’m not going to get into the whole surgical procedure… but the  main point of this story is how breastfeeding not only provided C.M. with the best nutrition and immune system protection, it also saved me thru my son’s ordeal.  My husband was able to pre-donate blood so we both felt like we were doing everything physically possible as his parents to help him tolerate and recover from this major surgery.

I was so pleased to be able to sleep right next to him in the hospital. We had to go in the night before and the he was not allowed anything after 4 am… he could nurse up to that point. I woke him to nurse around 3 am. It was very bittersweet. I was crying and he was happily nursing, not know what was coming next. It was difficult just to see the IV placed, let alone the actual surgery.  I was so grateful and happy they had done alot of pre-op procedures the night before when I could nurse him after each study. Now , when they wheeled him off to the OR, I was almost happy he had been slightly sedated because as hard as it was, I could never have handled him screaming at that point.

While he had the surgery, I headed first to the pumping room to try and get as much milk stored as possible. I had not been able to pump well before this so I had limited expectations. It was the first time I had used a hospital grade pump so I had much better volume than I expected. I stored a couple bottles and was feeling actively involved in his recovery already!

They called us to meet him outside of recovery a couple hours later. It was very difficult to see his head swollen and heavily bandaged. He had had a blood transfusion once already in the OR and they expected he would need more. Apparently the bone edges ooze when cut.  We took turns with him until he wasn’t groggy any more, then, once awake…. I rarely left him.  I was told he had to have a little bit of an electrolyte solution in a bottle first before I could nurse him, just to make sure he didn’t vomit.  He was ready to nurse in about another hour. They took him out of the crib, with his massive head bandage, black and blue eyes and 2 IV lines….place him in my arms and we gently rocked and nursed.SendPicture12

I felt completely lost, even as a nurse or especially as a nurse…. because seeing your child like that is very difficult. I kept thinking all the worst possible complications would happen to him. I wanted to keep him safe, protect him. I struggled with tremendous guilt, thinking I must have done something to cause this to happen… It must have been my fault.  Many parents go thru that, I’m sure. Breastfeeding him thru the hospitalization, two more blood transfusions and recovery period helped me feel like I was actively healing him. My husband felt similar thoughts because they used his blood for the first 2 transfusions. It was an empowering feeling.

I’ll close by saying that finally being finished with the decision process, the surgery completed (sucessfully I’m happy to say) and on the recovery road also cured my sleeplessness.

The night nurses at CHOP laughed at me! There I was, sleeping right next to my precious brave 3 month old post-op son…and they had to wake me up to tell me he was crying to feed in the night.  😉

What a handsome guy now!

What a handsome guy now!

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Aug 1

6 Comments

August is here! World Breastfeeding Week Aug 1-7

World Breastfeeding Week

WBW Theme Logo 2009

WBW Theme Logo 2009

WBW Theme for 2009
Breastfeeding: A Vital Emergency Response
Are you ready?

OBJECTIVES OF WORLD BREASTFEEDING WEEK 2009

  • To draw attention to the vital role that breastfeeding plays in emergencies worldwide.
  • To stress the need for active protection and support of breastfeeding before and during emergencies.
  • To inform mothers, breastfeeding advocates, communities, health professionals, governments, aid agencies, donors, and the media on how they can actively support breastfeeding before and during an emergency.
  • To mobilie action and nurture networking and collaboration between those with breastfeeding skills and those involved in emergency response.

RATIONALE

  • Children are the most vulnerable in emergencies – child mortality can soar from 2 to 70 times higher than average due to diarrhoea, respiratory illness and malnutrition.
  • Breastfeeding is a life saving intervention and protection is greatest for the youngest infants. Even in non-emergency settings, non-breastfed babies under 2 months of age are six times more likely to die.
  • Emergencies can happen anywhere in the world. Emergencies destroy what is ‘normal,’ leaving caregivers struggling to cope and infants vulnerable to disease and death.
  • During emergencies, mothers need active support to continue or re-establish breastfeeding.
  • Emergency preparedness is vital. Supporting breastfeeding in non-emergency settings will strengthen mothers’ capacity to cope in an emergency.

Source: http://worldbreastfeedingweek.org/

What we are doing…….

At my facility we are working on action plans to include breastfeeding support in our exisiting disaster response plans. We are never immune to disaster…. we just had a tornado here on July 29th with a lot of damage, small flooding and many homes with loss of power and clean water.

We are promoting WBW with staff and physician education as well as small gifts to new moms congratulating them on their decision to breastfeed!

WHAT ARE YOU DOING???? I really would love to hear your stories and your efforts so that we can share ideas.

Jul 28

7 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

BUT

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

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

Jul 19

16 Comments

HomeBirth Transfer~ Doc says NO to C/S~

I wrote a few stories a few weeks ago because I was proud of my hospital that week– sorry I didn’t finish the stories until now……

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~She lived about 8 -10 miles outside of town. “Ellie” was having her first baby at age 32.  First baby, first pregnancy, no risk factors…. an easy uncomplicated pregnancy. She had done some research, not extensively, judging from some of my conversations with her and her husband…but she knew what she wanted. She had made a beautiful plan with a CPM for a water tub home birth. This particular midwife has been doing home-births in my area for a long time.. (She was the one cowering in the L&D hallway in this story…). The story of how things progressed up to transfer to the hospital was told to us by both the mother, father and midwife. 

~Her labor started with regular contractions at 39 weeks. They progressed from early labor which lasted around 6 hours to a more active labor with contractions about every 2- 3 minutes.  Her cervix had dilated to 6-7 cm. This pattern of contractions continued for hours. Ellie was in and out of the tub, walking, dozing, in and out of the shower, squatting, doing many different position changes throughout the next 6 to 8 hours. When she was re-examined by her midwife, she had made no cervical change in all that time. This can happen sometimes, things can stall out and pick back up again. Ellie reported that the contractions may not have been as strong at that, so she wanted to wait it out, maybe nap. The baby’s heart rate checks were all good.

~Everyone rested about 2 hours … Ellie’s water broke (clear fluid)  about 1 am and her contractions got more intense. The CPM checked her cervix about 3 am and felt no change. She still was 6 -7 cm dilated and the head was at about -2 station. The midwife then brought up the idea of possibly transferring to the hospital. Ellie said NO! Is my baby alright? “Yes….” said her midwife.. “Then No..I’m staying here, — I can do this.”

~Back to the tub… In and out of the shower, total body massages.. contraction pattern the same with increased intensity…next cervix check at 730 am… still 6-7 cm. Now Ellie was tired. Really tired. Exhausted! The baby was great on all checks. Her midwife again brought up the transfer to hospital idea, talked to her about the possibilities of pitocin, epidural etc… Ellie was now wanting anything, agreeing with anything–to get this over with.

~She arrived at the hospital around 8- 830 am very upset. Her husband and midwife were with her and her CPM had all her prenatal care info. Some of the first words out of Ellie’s mouth were that she wanted an epidural and a Cesarean! The nurses on duty this morning were awesome! They calmed her down, had her hooked up to the fetal monitor and observed her contraction pattern and the fetal heart rate pattern response. The baby looked excellent! The midwife and hubby coached her through the contractions while the nurses gathered their admission data.  The doctor checked her and she was still about 6-7,  swelling of the cervix noted, about -1 station. Ellie asked him if he would please do a C/S and he said no… (yeah!).  He said that he felt the best option at this time was to do the epidural she was asking for and observe her contraction pattern… possibly add Pitocin. He talked to her so nicely and non-judgmentally. Many of the other docs would have taken her right into the OR with very little discussion of options. She had been 6-7 cm dilated for some approximate 16 hours.

~After the epidural, Ellie and her husband and midwife all slept. The doc did NOT start pitocin right away, he said that she may need to rest and the contraction pattern couldstart to become of better quality once she rested and was better relaxed. WOW! Where did this guy come from? I’m so amazed and happy and quite frankly, shocked. This was a newer OB here.. I wanted to ask him where he’d been all my life! I went in to talk to Ellie and introduced myself. I told her I was so sorry thingsweren’t progressing the way she had hoped and sorry she didn’t get to stay home. She thanked me and said at this point, she was ready for it to be over! I told her she was really quite fortunate to have this particular doctor on duty today. Except for one bad apple from the night shift just leaving when Ellie arrived, everyone was wonderfully supportive and accommodating. Ellie’s contractions indeed did start up in a better intensity pattern on their own….. however their continued to be a lack of progress.  Once again, she asked the doctor to get it over with now and please do a C/S. 

~The doctor said NO again! He explained that her uterus was probably tired and the quality/intensity of contractions just may not be what was needed for the job to get done. He explained that the fetal heart rate tracing was beautiful and her membranes had been ruptured less than 12 hours. No baby risks…  He felt it possible the baby merely needed to get in better position and the contraction quality needed to improve.. and then he would re-evaluate. Ellie agreed with renewed optimism. The pitocin drip was started. She didn’t need much before the contraction pattern got much stronger, longer and better quality.  He came to re-evaluate her only after these better contractions had been consistent for 2 hours. The vaginal exam revealed the cervix was the same ..still the same and possibly more swollen.  He said he felt the head was not as well applied to the cervix as it had been.. but still at -1 station. He examined her with and without a contraction. Same in his opinion. Ellie lost all her fight. Her support people rallied to help her, but she was now insistent.

~This time the doctor  said she certainly had reason to feel this way, had given this a great try. He told her he still felt she could try longer… that we could alter positions with the pitocin, keep her comfortable with the epidural and keep going… the baby was handling all this just fine. He did say that there was a possibility the baby had his head in a tilted position making it difficult to descend the birth canal. He then let it up to her and told her if she wanted the C/S, he would do it at this point.

~YES I want a C/S! Ellie exclaimed. We did the C/S about 3 pm… some 7 hours after transfer and approximatelyclose to 24 hours of being 6-7cm dilated. Her gorgeous 7 lb baby boy was delivered operatively with apgar scores of 9 and 9. Pink and vigorous! Beautiful. I was able to get him skin to skin in the OR.. that was one of the first times all the players didn’t object and I went with it! (It won’t be the last….and next I’m trying for breastfeeding on the OR table!) Upon delivery, the OB noted the baby had been acynclitic . This is when the head is tilted to the side, ear towards the shoulder.  It is probably responsible for her long stall in labor. The OB still felt she could have delivered vaginally given time and good management. I am just so happy he was there.  I am proud of this mom, her partner and midwife and of our whole team! This mom was able to make good educated choices about her care despite dealing with the stress of a transfer.. and was able to feel so very very proud of how hard she tried.

In the end it was her…… who gave in to the C/S … not her doctor. 

Of that we can be proud

🙂

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.

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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..

 

 

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