I suppose I shouldn't complain because I can make a descent living due to
these problems, but I can't help but feel that something is going terribly
wrong when I visit a mother who has seen several lactation specialists and nurses
in the hospital, the pediatrician, and sometimes even another private LC,
and it appears that no one knows that the baby has a frenum issue, sucking
problem, or mom has the wrong sized breastshield.
First, let me add that I know firsthand how frustrating it can be working
with a mother and baby who are early postpartum and drugged from an epidural
and painkillers. However, lots of things go by the wayside. For example,
hospital grade pumps and kits are given out like candy. Mother's are rarely
fitted for the correct breastshield--and rarely are they shown how to attach the
kits. So many mothers use the wrong sized parts, sometimes to the extent of
losing their milk supplies, particularly when the baby is in NICU or the
mother starts working full-time. Some don't have their parts attached correctly.
Ever work with a mom whose nipple doesn't even make it into the shield well
enough for doesn't pumping because it is either too small, flat or inverted?
Also, I find so many people who were told to get a pump, but someone said
pump 3 times per day? Then there are the pediatric recommendations for what I
call "2 oz. bottle chasers" As we are aware, this usually signals the
beginning of the end of a supply if the mom keeps this up.
Doorway nursing bugs me to death. You know when the nurse just walks by the
mother's room, and tells that mom how beautifully latched that baby is. Of
course that mom could be getting a breast hickey because the baby isn't even
latched on to the nipple!
Then there is all the conflicting advice. Many moms report that every nurse
told them something different or that they saw 3 different lactation
specialists in the hospital, and they all said something different.
There is also a lot of what I call "a half consult". Lots of working on
latch with relatively little regard to mother or infant anatomy or feelings. I
have seen mothers with short or flat nipples sent home with tongue tied
babies told to nurse on demand with no pump. Is it any wonder that mom's nipples
are practically severed by day 5 or that the infant is back in the hospital
for dehydration?
Then there is the whole "breast aversion" experience. This occurs when
there is a constant attempt to latch a baby when there is an anatomical reason
the baby cannot currently latch. The baby is forced unto the breast
repeatedly-- a lot like frantically pressing the elevator buttons when the elevator
won't work. Is it any wonder that the baby cries the moment the breast is
exposed? Any wonder why some babies pull the "let's sleep routine"? And--why are
we continuously trying to latch a mother and infant that are shutting off
emotionally from the experience? Isn't there a point where we can tell that it
is just not working?
Again, to the hospital's credit, you often do not get a chance to see these
moms more than one to three days. You may tell a mom doped up on percocet
the correct information, but she doesn't remember, but on many occasions (too
many for me to recount here), I am following up on situations that were never
correctly evaluated in the first place. I suppose that I shouldn't complain
because I have a thriving private practice as a result, but I am very tired of
seeing crises that could have been prevented.
Debbie Albert, RN, Ph.D., LMHC, IBCLC, RLC
Tampa Lactation Counseling
Tampa, FL
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