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Posts tagged ‘emotional’

Oct 16

30 Comments

**ROAR** on Breastfeeding Guilt

10_Lioness-with-Cub-Feeding

(Image found at Google Images)

**ROAR**

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

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

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

There are STILL moms out there confusing the issue.

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

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

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

“She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know.  She needs to come to terms with that herself,  and not punish herself and or publicly criticize the advocates saying they are causing the guilt.  Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty. I read a comment from a mom somewhere that said something like… “perhaps if moms knew it wasn’t all or nothing, maybe more would try breastfeeding.”  My first thought was..why do they even think that..are there really mom’s who feel it has to be all or nothing? Is this causing the guilt because they don’t think they can breastfeed exclusively for the first 6 months as the experts recommend??”

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

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

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

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

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

Because it is

Important.

Don’t be guilty

Stop it

*ROAR*


Oct 16

4 Comments

Repost~ The Guilt trip~ Breastfeeding, Bottle-Feeding and…. Somewhere In-between…. Why the Guilt?

There has been so much discussion circulating in the blogosphere right now about breastfeeding.  I thought I’d add my 2 cents because….I have an opinion and….. I have just a little experience in this field both in study (2 year Lactation course, IBCLC for 10 years, current CLC) and in practice (35 years).

I thought I knew so much in 1988 after nursing 3 babies and assisting others for nearly 15 years. I actually thought I could just take the IBLCE exam based on my experience!

I was so ignorant and naïve!

I started to talk to some IBCLC’s and my eyes were opened wide to the real world. Up to that point, at that time, (I sadly and guiltily admit) I had no idea about the volume of study and research in the field of lactation. I had NO idea just how wrong we were doing things at my hospital.

I launched into a lactation course, soaking up all I could, 3 years of study preparing for certification. I set out to change the world… at least my world. I wrote big proposals for the hospital. I applied for grants to fund a lactation program. I developed education competencies for the staff. I started breastfeeding classes. I thought everybody shared my passion, that they too would want to learn …. because I was right!!

Instead I was the target of all the boob jokes you could think of and I had almost no support. My ideas were rejected left and right.

Long story short…it took me a long time to come to terms with accepting small changes, taking baby steps…..continuing to do the best job I could with each mother-baby couple and to keep a positive outlook. I needed to remain realistic about how much I could actually accomplish one step at a time. Slowly I began to have people under my wing trying to learn. Yeah!

I learned a lot about how to approach physicians, co-workers, managers and most of all …. mothers.

I am not an expert in journalism or critical analysis so this is my opinion of what is going on right now.

There have been some irresponsible journalists, those who have a bigger platform than most of us, writing negatively about something they have not studied or truly researched. They are expressing their opinion and including an emotional component which has, in my opinion, gotten the reaction they hoped for from breastfeeding advocates as well as those who concur with the authors. More hits, more readers. I feel they have twisted the facts to benefit or support a point they want to make. I read some of them.. other’s I really just scanned then brushed off so I don’t know everything that’s been said. On the positive side, these articles possibly give us a larger platform to provide correct information to a larger public in reply.

I read a lot of blogs and I really respect and admire all the research that many breastfeeding advocates put into their fabulous posts. These are educated women who are trying to provide current accurate information! (@phdinparenting, @bfmom, @MommyNews , @JakeAryehMarcus, @blacktating ,@AmberStrocel, and so many more). I applaud their passion and breastfeeding advocacy. They are doing a very important job. Breastfeeding IS very important and deserves advocacy, protection and support! There are still large scores of women out there making choices with only tiny bits of information, who really do not know the important benefits of breastfeeding. It is because of this, and because we still haven’t met the US Dept HHS Healthy People Goals for 2010, that breastfeeding advocacy needs to continue. I have been there, advocating in a time where I faced great adversity and a lot of negativity. I am bothered that it still exists…and exists now in so many new ways.

I am more disturbed that some mother’s out there are upset. I always try to understand just WHY a mom feels guilty if she chooses to formula feed or do some combination of formula and breastfeeding. I always hope she’s made her choice with good information and that it is her own true choice. Then good for her! I am not to judge. She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know.  She needs to come to terms with that herself,  and not punish herself and or publicly criticize the advocates saying they are causing the guilt.  Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty. I read a comment from a mom somewhere that said something like… “perhaps if moms knew it wasn’t all or nothing, maybe more would try breastfeeding.”  My first thought was..why do they even think that..are there really mom’s who feel it has to be all or nothing? Is this causing the guilt because they don’t think they can breastfeed exclusively for the first 6 months as the experts recommend??

Over the years, I have learned this:

  • It is inappropriate for a health care professional to indicate to a mother directly or indirectly that formula feeding and breastfeeding are equal. Human breast milk is the superior food for human infants. Properly prepared infant formula is an acceptable substitute for those who cannot or choose not to breastfeed.
  • The first approach is probably the number one factor in gaining a mother’s interest in what you have to say.
  • The education process to a mother needs to be in small doses, sensitive to her unique learning abilities, her cultural beliefs and practices and most importantly, her choices and individual breastfeeding goals.
  • With that in mind, try to provide her with the information she needs to make her decision.
  • Never overestimate a mother’s desire to breastfeed her infant.
  • Never underestimate a mother’s desire to breastfeed her infant.
  • Listen to the mother; help her define her true desires and goals.
  • Many times, the first question she asks may not be what she really wants to ask.
  • The mother’s individual breastfeeding goals, how she defines them, how important they are to her and how she relates them to her actual breastfeeding experience all help define how she measures success.
  • Support the mother, support the mother, and support the mother.

Here are the top 3 responses to the feeding choice question pertaining to breastfeeding at my facility on admission:

  • “Breast and Bottle”
  • “I’m going to do both”
  • “I’m going to ‘try’ to breastfeed”

To each of these I respond very positively with something like… “Great! Tell me what you’ve learned about breastfeeding.”     I will then ask the mom a few questions to somehow find out her true wishes.

Then I say  “We will support and honor however you wish to feed your baby.  I’d like to give you some information so you can really understand and then tell us what you’d like to do.”

I explain some things,  i.e.: how the milk production works, the importance of early feeds etc.. and how formula introduced at that time could  interfere with the process of production, the baby’s ability to latch properly and so on… I usually end with..”We usually recommend to  focus on breastfeeding for now and then offer bottles later after milk supply is established if that is how you’d still like to manage feeding”. ETC…ETC….  Here’s what I then see:

  • There have been so many mom’s who — after a little  bit of information decide they would like to focus on breastfeeding. There have been many who totally fell in love with it.
  • There have also been many who really didn’t want to breastfeed after one single feeding.
  • There are many many still that like to breastfeed and bottle feed in combination right from the start. If they have the right info and understand how things may progress… I still say “Good for you!”
  • I have seen many continue that way for months and they are very happy with that.
  • I’ve seen many mom’s “partially” ( I don’t like to say it that way) breastfeed and feel very proud. I say “good for you!”  They don’t think of it in terms of “exclusive” or “partial”… It’s more like any breast at all…. is breastfeeding vs. no breastfeeding at all.
  • There have been many who also never wanted to try until all of a sudden they see milk leaking!
  • I’ve worked with mom’s where I can see tremendous improvement in her situation, I think she’s going to keep going…but she decides to totally quit. I simply praise her for all her efforts and help her feel proud of herself.
  • I’ve worked with mom’s who have hardly put forth any effort to overcome small obstacles, I think they will probably quit outright… Then..I find out they are the ones exclusively breastfeeding down the road.

I got a comment from a breastfeeding mom @TheFeministBreeder that I absolutely have to share. She describes her own experience in the full comment and on her new blog post.  She comments:

“Yes, I think that’s the most important part – informing a mother of any and ALL benefits/risks to supplementing, and helping them work through the option they choose.  But to tell a mother to supplement without explaining that it could undermine her efforts is just plain mean.  And too many medpros are doing it.  I’m glad there are more nurses like you who will give out the real information to empower a woman to make her own choice.  My smart friend always says ‘It’s not really a choice if you don’t have all the information.’ “

For those mom’s really trying to breastfeed and struggling, there’s more than I can say right here to cover that. I’m sorry for your struggles and hope it gets easier for you. It is important to have a skilled competent support person assisting you who listens thoughtfully and helps you get to the root of your problem… and helps you define and realize your goals. If you are experiencing guilt from your struggles or from not being able to fulfill your goals, desires to breastfeed….I think that kind of guilt is different from what I’m trying to discuss here. I am not a an expert on that. It is valuable to get the best help out there that you can as soon as possible.

I’m adding this after reading some comments on other blogs.. When approaching a mom to observe or assist with the latch process…. Permission is a must! I ALWAYS ask the mother if she would like any assistance with the latch or if  I may observe how well her baby is latching….. If that answer is yes… The next question is ALWAYS.. May I touch your breast? (if that needs to part of the process). I prefer to help moms by having the mom and BABY do the latch. I try to keep my hands out of it.  All nurses and LC’s should practice this. I am sorry for the mom’s who aren’t asked permission to be helped or touched.  😦

One of my favorite things I like to say to any breastfeeding mom is:

“Try not to make any final decision when it’s dark outside”.

On another note, regarding some reader comments on various blogs about public breastfeeding, a skimpy bikini or the bathing-suit issue of a favorite sports magazine show more skin in a provocative, sexy way than any mom breastfeeding. Even the movie stars in their gowns with plunging necklines are showing almost the entire breast! Somehow, that is OK. There are volumes of video footage and photos all over the place… even on billboards. It is sad that the public opinion of a baby breastfeeding (the most natural way for him to eat) is something that should be done in private … yet young girls are encouraged by media to bare more and more skin. Of course being discreet while feeding is important, but I can assure you, most girls in a tiny bikini are thinking more about “tacky exhibitionist behavior” than a mother breastfeeding her baby. Why aren’t law-makers focusing on any of that?

Sep 22

21 Comments

My Breast Pump and I didn’t get Along 

Can I Pump my MILK?  Should I? …

or  Not.  Even.  Bother.


My Own Struggles with Pumping and Working

and doing what worked for me

Welcome to September’s Carnival of Breastfeeding!!!

I have this post AND an additional post All about Pumping including choosing a pump and how to Practice Pumping before going back. After you read this, check out the other posts on this month’s theme of “Breastfeeding and Work” linked at the bottom of this post. All links will be added as I get them hopefully by the end of the day Monday, so be sure to check back for the full list!

breast pump

A little history

As far back as I can remember, the only breast pump we had around in nursing school or when I first started working on the maternity unit was this thing that looked like a bicycle horn. This picture above is for an old “Breast Reliever”. It is glass with a rubber bulb to squeeze for suction. This particular antique is from the earlier half of the 20th century. We actually had a similar type glass model in Nursing school and on my 1st OB unit in 1974.   Historical use of breast pumps shows the first patent was issued in the 1800’s and a patent for a mechanical version was issued in the 1920’s. Information was scarce then. Not too many nurses knew much about it.  Mother’s were instructed to use it if they got engorged. I can’t believe it would have been very helpful.

pump70sold horn pump

We got a newer plastic version of this pump in the 70’s but still didn’t have any clear instructions for use. I was never taught by instructors or fellow nurses, so all I could do for the patients in my care was review the instructions on the box with them! I don’t even remember what that said. Those old horn pumps were trouble. They were traumatizing to the breast and the rubber bulb was just a trap for bacteria.

I remember one mother in particular in 1975 had been readmitted with bleeding, gone to the OR for retained placental fragments at 2 weeks postpartum. She was breastfeeding and having trouble. I took care of her postop. She said “I can’t believe how much milk I have, what can I do?”  I promptly went for the only pump we had and went over the directions with her. She was saying it hurt but felt better at the same time because it did help to drain some of the milk.  I didn’t much know then about how the retained placenta can delay hormonal shifts and your milk coming in. She and I both thought at the time it was because of being separated from her baby!

ANYWAY—

By the time I had my first baby in 1979, (YES- 30 years ago) I had become more familiar with pumps because I had a friend pumping and now I was very personally interested. I wanted to pump just like her! I want to store milk for my baby when I went back to work. Her baby was 3 months old and she had gone back to work. She pumped in front of me once to show me how easy it was. She used a cylinder style hand pump similar to this picture. She got 8 ounces of milk in about 10 min!

70s pumpIt had one chamber inside the other. To pump, you would place the cone over your breast and pull the outer chamber up and down. This was a very popular style pump at the time. Easy right? I promptly went and bought one! I can do this!

My son was born weighing 6 lbs 9 1/2 oz. Breastfeeding got off to a great start, there were no problems at all. I was very confident about that and had great support from my best friend. My son weighed 7lbs 2oz at 2 weeks and nearly 10 lbs by 6 weeks.

I had plenty of milk!

None of which hit the bottom of the chamber when I first tried to pump….  no matter what I did! I knew nothing about the technique of pumping. I worked and worked at it.  I could playfully squirt milk across the room. I had squirting contests with my sister. We cracked up laughing! I could not get any milk with the pump.

I had never practiced. I thought that once I was away from my baby, I would just pump… thought the milk would just come out like my friend. I went to work, let myself get a full feeling and tried. Nothing.  I woke him up when I got home and made him eat!  The next day… same thing.. Nothing.  Luckily I only worked 2 days a week so I nursed him all the rest of the time. I kept trying- week after week– I thought I just had to get used to it. I am sure I was very stressed each time, never using any of the tricks I teach moms today.  I still never thought to practice when I was home with the baby. The most I EVER got after 45 min of pumping was one ounce.  I gave up and only fed formula while at work. My body adjusted and I was happy doing what I was doing.

I wrote a guest post over at Breastfeeding Moms Unite on pumping including choosing a pump for you and practicing to pump. All moms are so different and many have no trouble at all expressing their milk. Others have  trouble releasing their milk to this plastic “thing” on them that doesn’t feel like their baby. It’s just not the same! In that post I say:

I have found it’s important for mothers to understand that pumping is a substitute for the real thing and that it takes practice for lots of moms. I always say to expect hardly anything the first time you try then whatever milk you may get is wonderful! One very important point to realize is that whatever you see come out with a pump or hand expression is NOT a reflection of how much a baby gets in a feeding when he is well latched and effectively feeding.  What you see come out with the pump is what your body released at that moment in time. Even women with a great supply and healthy growing babies can have trouble learning to pump. The baby is the master … you are merely trying to imitate him! The type of pump used and when you pump in relation to the age of the baby as well as the time of day, frequency etc. can have a big impact on your results.

My second baby was born in 1985 . Another 6 pounder at birth with rapid weight gain, a great milk supply for me.  I had some improved pumping results with him partly because of better pumps and mostly by sheer determination to help him heal through major surgery at  3 months. The Children’s Hospital had a hospital grade electric pump, a pumping room and directions on what to do. Because I was able to provide milk for him in the hospital, I had renewed faith in myself that I could pump once I went back to work.

pump 80s

There were different pumps, better pumps available. I tried my old pump and some piston style pump like above. I don’t remember the name of that either. I tried many…still waiting to pump again till I had eventually gone back to work. There were some battery/ AC adapter electric ones to buy. I had one, but don’t even remember the name.  I had to push a button to make the suction go on and off –>  otherwise there was constant suction on your breast and no control on the degree or amont of suction. Some people told me to keep the suction on till it started to flow then push that button on/off.

Well it didn’t flow, it hurt. I never released any substantial milk for any of these pumps. I wasn’t able to keep it up. I ended up doing the same as I had with my first son. I made a routine which worked for me of nursing all the time at home and formula when I was at work. We didn’t have any hospital grade mechanical pump until the 1990’s at my hospital, long after my third baby and after I became a Lactation Professional.

I had dealt with so many other issues after my third baby that pumping was never much of a thought in my head. I simply fell back into the routine that had worked for me with the first two babies. She is the baby that nursed the longest even after I went back to work!

Looking back, I think if I had access to the information I know now, and the availability of today’s high quality pumps…I might have, possibly would have had better success pumping. The most important point is that I still felt successful  and was happy with my breastfeeding relationship for all my children!

After all, I could squirt my milk the farthest!!

😉

More Carnival Posts:

Aug 12

9 Comments

Initial Low Milk Supply: A Breastfeeding Story – Case Study

034     The History:

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

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

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

I went in and introduced myself to Meg*, Brad* and their son Mikey* (*names changed). They had indeed been waiting for me.  Breakfast was underway and Mikey was asleep in his crib. I asked her a few general questions in a relaxed manner about breastfeeding first to try to establish some background: Mikey’s energy level, drinking pattern, feeding frequency, and diaper checks.  It is important to gather information and observe the feeding  in the process of  a full evaluation to determine adequacy of feedings.  The information I got was concerning.  He spends a lot of time at the breast, falls asleep quickly, not very energetic with every feed, not much change in her breasts at this point and no stool since yesterday. I did not tell her I was concerned at this point, nor did I mention the weight yet. I asked if I could check him now and if  it would be alright if I observed the next feeding.. We determined that should be with in the next hour. I talked about feeding cues and asked her to get me if  Mikey seemed ready to eat before I came back.  His vital signs were normal, jaundice not too significant for his age, diaper contained a small amt concentrated urine, and Mikey went immediately back to sleep.  I felt he was OK at the moment and needed to go do a few other  things with other patients.
 
At this point I am feeling pulled in different directions because Meg’s situation could easily take hours of my already busy morning. I am upset that this has possibly been going on the last 3 days and hasn’t been evaluated properly, now it’s day of discharge! How do you do the proper evaluation, give the needed gentle support, make possible feeding plan arrangements in fragments of time? This is what I am trying to change…in my opinion, we the hospital, helped contribute to this situation of possible inadequate feeding and supply… we need to help her! I talk to the charge nurse and it’s cleared to keep my coverage the rest of the morning.. good thing L&D was quiet!
 
Mikey’s doctor comes in and thankfully it is a partner who is very pro breastfeeding and open minded to try options a mom may choose. I gave her report on his physical status, VS, weight, earlier glucoses, and the Bilirubin. I summed up my plan to evaluate feeding quality but suspected he has been ineffective at the breast & milk supply/production may be delayed. I added that I was going to check his glucose if he had low energy level, and encourage pumping or expression for the mom and get that milk into the baby as well as encouraging her to stay for a few feedings to work with me. The MD was happy with these ideas but requested he be supplemented (complemented) with formula at all feedings now until his weight came up. She supports the theory (as I do) that the birth weight can be somewhat inflated with all the pre-birth IV fluids mom rec’d and some of what he lost may be fluid.  The MD said that if things were better by afternoon, he could go home. She went out to examine him at mom’s bedside.
 
I went in for my feeding observation a little while later. Meg now knows his total weight loss and feels very upset. I give her a lot of support and agree with the doctor that some of that could be fluid. I then find out..Meg is an RN here at my hospital on another floor! It had not come up in conversation! So now I know she is even more worried because we nurses always think the worst! I do my best to think simple and encourage her to do the same… it is very early and we can turn this around quickly with a strong approach.
 
My Evaluation:
  • Good independent maternal positioning, holding and offering of the breast
  • Nipples erectile, breast tissue soft, pliable, small amts colostrum expressed–> mom reports her breasts were “swollen first 2 days”
  • Latch fairly adequate but not optimal-> improved greatly with football position and instruction on asymmetrical latch approach (I’d like to say here that I have a” if it’s not broke don’t fix it” attitude. I don’t correct a latch for a mom who has no pain and good milk transfer, we talk about it in case it may come up for though)
  • Mikey very sleepy at breast, difficult to maintain latch, no milk transfer observed–>breast massage during feed tried without improvement
  • Due to continued low energy level (suspected caloric deprived state causing sleepy ineffective feeding behaviors) a bedside glucose was checked. Result was 49.
  • Diaper dry–> the previous concentrated void was only his 2nd in last 24 hrs No stool last 20 hrs and that one was dark.
The mother’s feeding plan:
Many options and teaching points discussed with Meg including the need to boost caloric intake –>starting right now, methods to get her milk or formula into the baby avoiding bottles, a vigorous pumping plan to augment breast stimulation, alternate breast massage, how to observe for swallowing and milk transfer at the breast etc.. I also discussed with her how in my experience, sometimes it is like magic once the baby regains up to birth weight… they just take off!
She chose:
  • Cup feed formula now while she pumped –>Mikey would not cup feed so we used a syringe, 18 cc, repeat glucose 62
  • Pumping round the clock, double pumping –> Meg rented a hospital grade pump for home use
  • Keep close eye on feeding cues, put Mikey to breast in football w/ latch process discussed earlier
  • Closely watch signs for milk transfer, correct feeding activity while at breast, sucking rythym 1 or 2 sucks /swallow ( Brad was very involved in this process of learning the observation techniques)
  • Use breast massage/ compression while baby @ breast through feed to increase milk transfer
  • Goal of min 8 effective feeds in 24 hr..wanted to try for 10 –>agreed to feed expressed milk or formula 1/2 to 1 oz after each feed first 24 hrs until re-weighed next day
  • Have as 1st 24 hr goal:  to see 3 -4 increasingly wet/clearer diapers and at least 2-3 good sized stools
  • Return to MD for F/U bili and wgt check next day
  • Call IBCLC for eval in next few days if weight not adequate and not independently breastfeeding/output  within safe parameters for age

The follow up reports:

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

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

Every mother and baby deserve our best!

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 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 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!”