Robin, I hear your frustration. You're in a place that has a lot of
"Hammer-itis".

Let me explain.

Hammers are a great tool - for driving nails. But they are not the tool of
choice for screws or thumb tacks. Yes, you can use one on a screw, it
"works", but it causes a lot of unnecessary damage to the screw and the
wood - and the screw is never quite right again. A thumb tack can be put in
by a hammer, but again you're apt to damage the thumb tack and the wood.

Wielding a hammer is a "powerful" act. It's "important and decisive". Using
a screwdriver is a "skillful" act. It takes more skill to use a screwdriver
than a hammer (think of children's toys - they can use a hammer at a year -
they have to be about two years to begin to use a screwdriver properly).
Thumbtacks just need a gentle touch. It actually takes a bit of maturity not
to use your hammer on them (just give a 5 year old a box of thumb tacks and
a hammer and you'll see what I mean).

So what does this have to do with birth and breastfeeding? Plenty.

The majority of situations are in the thumb tack category. What mom needs is
simply "encouragement and opportunity". Mom can birth a baby without
intervention -  a doula for encouragement and support - and the chance to
labor without induction or augmentation or some other intervention to "hurry
the baby out". Mom needs the opportunity to hold the baby skin to skin after
birth and the encouragement to keep the baby with her. She needs to be made
aware of what to watch for (feeding cues, poopy diapers, etc.) so she can be
reassured that things are going well and be able to recognize if things
aren't.

Some situations are in the screwdriver category. Mom may need some
assistance with labor and the baby's birth - whether its medications or
hands-on help. Some moms have problems with sore nipples or yeast or milk
supply. Some babies are tongue tied or "almost term" or have some minor
problem that needs special attention.

Fortunately, few situations are in the hammer category.  This is the "baby
or mom is in trouble" situation with prolapsed cord or
pre-eclampsia/eclampsia or some other such problem. This is the time to be
decisive. A baby may have severe cleft palate and need to get his breastmilk
by haberman feeder.  He could be only 25 weeks gestation and need to get his
breastmilk a few cc's at a time by an OG tube because he's on a ventilator.
Or there really may be not enough milk and a dehydrated or failure-to-thrive
baby who needs to get formula by cup feeding because donor milk is not
available. Sometimes you need the hammer.

There's "Hammer-itis" when hammers are being used where a screwdriver is
more appropriate or the gentle push on a thumb tack is due. As in any
disease, the key to the treatment is understanding the cause. If a hammer is
the only tool someone has, that's the one they'll use. In terms of
breastfeeding, they don't know you can have mom pump to increase milk
supply, that free access to the breast and effective nursing are all a baby
needs, that donor milk is available, how to find out if a medication or
illness is compatable with breastfeeding, etc. If the only "fix" they know
is formula in a bottle - that's the one they'll use. Other times people have
a whole set of tools but don't know when or if it's appropriate to use each
one.

So as you go about battling "Hammer-itis" you might be overheard saying:

"Here's the reference for AAP approval of the use of that drug in
breastfeeding moms. By the way, I keep this book (Hale's Medications and
Mother's Milk) right over there if you ever want to use it for a quick
reference."

"Some babies have difficulty going back to the breast after receiving
bottles, would you like me to show you how to cup feed the baby?"

"This looks like a situation where mom can pump to increase/maintain her
supply while this 35 weeker gets a few weeks older and more skilled at
nursing."

"That was great how you did XYZ. It really worked well for mom/baby."

You get the picture...it's not "Hammertime". Hang in there.

Gail S. Hertz, MD, IBCLC
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