Thanks to Lea for clarifying and answering Ellen's questions in more detail. I read this with interest because I believe, like many lactation support people do, that mothers often don't ask the questions they really want answered, but dance around the issue and sometimes go from person to person looking for what they want or need to hear. This isn't necessarily a negative behavior; we all require different types of support from various people in our lives, and we all look for answers that make sense to us. I know that because at our facility lactation support functions as a team, our patients get better, more well-rounded care. How do I know? Because I measured it! (Thank you Dr. Wight, for reminding us at ILCA last year that if you can't measure it, it doesn't count!) I track the consults we have with our NICU mommies and without exception, even with confounding factors, the mommies who have contact with at least 3 of our 6 lactation staff during their baby's stay pump for more days, bring more milk for their babies, and make more progress toward breastfeeding than those who do not. This type of informal, simple statistical tracking may not be fancy, but it takes so little time and it informs our decisions immediately.
Returning to Lea's question, I tend to agree with Ellen. If we look at the first layer of this mother's questions, her main concern is that her baby eats ok in the morning but gets fussier as the day progresses (a massive oversimplification, but it will take us down a logical road.) From a support group or mom-to-mom type perspective, the answer is that many babies do that. This mom might not mention, and perhaps no one would notice in that setting, a shallow latch since she does not complain of pain. At the next level, a more trained eye can see the shallow latch and wonders if it is affecting milk transfer; therefore the question is about weight gain. We have that answer, too - baby is gaining weight overall. The red flag to me is the scale. Why is she using a scale? What, who, or what website has so undermined this mother's confidence in breastfeeding that she is weighing her baby every time? If this is a healthy newborn gaining weight with evening fussiness, a scale will not help. The scale to me represents that the mother has sought "lactation support" from a source which is not personalized or individualized enough, perhaps a website or magazine article (but more likely a website.) Assuming (because it wasn't mentioned, not because I wouldn't ask) that the mom didn't begin hormonal birth control or any type of medication, nothing has really changed for this mom and baby except that the mom starting doubting herself. Who is fueling those doubts?
This mother, like many of those who now call us concerned that their baby is not getting enough foremilk or hindmilk, has lost sight of the beauty and simplicity of breastfeeding the healthy, normal newborn: feed on demand without pain, baby wets and stools and gains weight. Seek mother-to-mother support when questions arise. The confusion for us in lactation support arises from the fact that while we are trained to help the true high-acuity breastfeeding dyad, our culture and society have also left us holding the bag on providing basic breastfeeding management skills to normal, healthy dyads. We have to go back and forth all day and it's exhausting!
To be clear, I am neither anti-website nor anti-scale. However, these are tools which like any other can be overused and cause confusion when not used properly. Both have a legitimate place in breastfeeding support.
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