Monday, November 2, 2009

If you have a problem when you breastfeed, then you have a breastfeeding problem!

Recently I went to visit with former doula clients. (It was so nice to see them. They are such wonderful people and have such a cute baby. And I got to hold the baby for a long time! I know not all doulas/midwives/other birth professionals are baby fans, but I am definitely a huge sucker for an itty bitty baby. But I digress.) Their baby breastfed beautifully all through the hospital stay - frequently, happily, no concerns whatsoever.

Apparently when they got home the baby went in for a check-up. Due to weight concerns, the pediatrician told them to supplement with 1 oz of formula after each feeding, and they did, reluctantly. Fortunately baby soon became more wakeful and interested in eating (my guess is, the baby just got a few days older and grew out of the sleepiest phase). They weaned off the supplementation rapidly and are back to exclusive breastfeeding.

But ack! That was the first line of a tale too often told...weight problems, doctor recommends supplementation, leads to supply problems, leads to more supplementation, more supply problems, and now we're in the downward spiral.

I say to all my clients at our immediate postpartum visit, "Just call me if you have any problems or questions about breastfeeding." But this has happened more than once: I find out weeks or months later that the doctor recommended supplementation, and I don't hear about it until long after the fact. Mulling it over, I decided that maybe not everyone perceives the need to supplement as a breastfeeding problem. And I think it reveals the norm in our culture of: "It's good to breastfeed, but when it's not working supplementation is the answer". When instead, the norm should be "Women make enough milk and babies transfer it effectively, and if this does not happen there is a problem that needs to be solved".

If I had talked to them when they got that recommendation, I would have recommended they make an appointment with an LC to make sure baby was transferring milk effectively and that mom's supply was OK and being maintained. I would also have talked to them about ways to avoid confusion while supplementing with the bottle, and/or alternative supplementation methods to prevent nipple confusion. Am I glad that they didn't need this help? Yes, but it's that dodged-a-bullet feeling.

I asked one of the LCs about how she gets people to call when they get the order to supplement, and she said she tells parents, "If the doctor tells you to supplement, please call me so I can show you how to supplement without using a bottle." I think that's a good way to 1) avoid nipple/flow confusion and 2) get in to assess what other problems are contributing to the situation. I'm going to try that line in the future.

And pediatricians: Hello. You have a mother in front of you who wants to exclusively breastfeed. Her baby is not gaining enough weight on exclusive breastfeeding. Obviously, the first thing to do is always "FEED THE BABY" (as a page in my breastfeeding educator manual says in huge bolded letters). So now you have fixed ONE problem by ensuring the baby is eating enough. Take another step to get to problem number TWO: what is going on with breastfeeding and how can it be fixed? Yes, this is your responsibility, particularly since your fix to problem one is likely to make problem two even worse. It is so discouraging when pediatricians talk a great line on breastfeeding but don't do much to support it.

I'm not hating on all peds; there are great, supportive, knowledgeable pediatricians out there, and they can and do give excellent advice and refer to lactation consultants when needed. It just sucks when you run into the ones who do NOT.

4 comments:

Sheridan said...

Thanks for this post! I was wondering how to encourage moms to call if things like this happen. I often have moms mention at a post partum visit and sometimes it is too late to help!

Rebecca said...

Caveat is that I don't know yet how well it works! But let me know if it does work well for you.

Dou-la-la said...

Hoo, boy, girl, you know I feel you on this. It's so frustrating to be dealing with a problem that you might have been much more effective in helping - two weeks ago.

I have mixed feelings about this: "I asked one of the LCs about how she gets people to call when they get the order to supplement, and she said she tells parents, "If the doctor tells you to supplement, please call me so I can show you how to supplement without using a bottle." I think that's a good way to 1) avoid nipple/flow confusion and 2) get in to assess what other problems are contributing to the situation."

While I agree with the latter two points you make re: confusion and assessment, I worry about saying that in the first place - is it possible that this would plant the seed of feeling inadequate about milk supply right off the bat? Like, what if it never occurred to the new mom that she might have to supplement, and now she may be thinking deep down, Oh, maybe I won't be able to do this.

Do you know what I mean? But then, what's the alternative? To not say anything and continue getting calls two weeks into the damage? I sure don't have the answers. I think the LC' suggestion above IS a step in the right direction, I just wonder if there's any way to phrase it so it conveys the same info but doesn't potentially introduce supply insecurity.

Let's brainstorm . . .

Rebecca said...

I know! It's so hard to do anticipatory guidance (I am discovering) without introducing any insecurity. How can you tell people how to deal with engorgement without making them nervous their breasts MIGHT become hard, painful, and so full of milk that the baby might have trouble nursing? Let's brainstorm indeed...