Libby writes about a mother who engages in "non-essential, social
conversation" while not responding to her newborn's hunger cues. I have
several thoughts and many questions. I hope something here is helpful.
1. Rule number one: feed the baby. If the mother, for whatever reason,
appears to be consistently unable to breastfeed her child, the baby must
receive nourishment. Formula need not be presented as the first or only
option. For example, would the mother be able to be more responsive if she
could exclusively feed her expressed milk?
2. Rule number two: protect the mother's milk supply. As long as she
expresses the desire to breastfeed, she needs to be offered help to protect
her milk supply. This will give her time to work through whatever it is
that she needs to work through while keeping breastfeeding a possibility.
3. How many hours had passed since the birth of the baby when you saw the
mother and baby, Libby?
4. The mother's "scoffing" about the "help" she received from the nurses
warrants evaluation. What was that experience like for the mother? For the
nurse? For the baby? What could be done differently next time to address
anything problematic in the mother's and baby's experience of receiving
that help and the nurse's experience giving that help?
5. As long as the mother expresses a desire to breastfeed, she should be
afforded the assistance she needs, whether that assistance is practical,
medical, or psychological. What is the mother's definition of
breastfeeding? Is she psychologically uncomfortable with breastfeeding (and
she may not know or be able to express that she is, if she is)? Again,
would the exclusive feeding of her expressed milk meet an acceptable (and,
perhaps, more acceptable) definition of breastfeeding for her?
6. Your referral to a social worker seems appropriate to me, Libby. Women
do not breastfeed in a social, historical, economic, political, etc.
vacuum. And something sure seems to be getting in her way. Does this mother
believe that newborns must be breastfed at strict intervals? That hunger
cues are attempts to manipulate? That she will spoil the baby if she
responds when he cries? Was this baby planned? Wanted? Does she know that
it's common and all right to feel ambivalent about becoming and being a
mother? How was the birth? How did she experience it physically?
Emotionally? Did her experience match with her expectations of birth? Does
she have a supportive partner? Does she have social support beyond that
partner? What does it mean to her to have a boy when she expected a girl?
(It seems notable that you say the mother refers to the baby as "it" even
though she knows now that he is a boy.) What does it mean to her partner
and others around her that the baby is actually a boy? Is she grieving the
loss of an expected girl baby? Does she need this loss validated? Does she
need help grieving the loss of an expected girl baby so she can adjust to
the surprise or shock or dismay... of having a boy baby? What was her life
like before the baby was born? Before she was pregnant? What has her life
been like since the baby was born? How has she experienced these hours/days
physically? Emotionally? Does her experience so far match with her
expectations of early mothering? How does she feel about her body? Her
breasts? Breastfeeding? How does she feel when she breastfeeds her infant?
Physically? Emotionally? Is that experience what she expected? Is her busy,
happy phone chatter her way of saying, "I cannot handle what has happened
to me here. I need help but I cannot say that I need help. It would be
socially unacceptable to say that I (fill in an infinite list of
possibilities here: am grieving the loss of a girl that I deeply wanted;
was traumatized by my birth experience; am experience flashbacks to my
sexual abuse when I breastfeed; do not like men or boys because of my
experiences with them in my life and society and I don't know what to do
with these feelings and these experiences now that I am suddenly the mother
of a baby boy; watched my mother abuse my baby brother and am afraid I will
do the same to my baby boy; didn't want to be a mother; don't feel ready to
be a mother; don't know how to be a mother; etc., etc. etc.). So, instead I
will engage in things (like trivial conversation on the phone) that make me
feel like I'm happy and in control."
7. People find their way in their own way in their own time. Through no
fault of hers or yours, the mother may not have been in a "teachable
moment" when you were there, Libby. This mother's "teachable moment"--or
even "therapeutic moment"--may come in four more hours, at three in the
morning tomorrow, or five days after she gets home from the hospital...
Therefore, it is appropriate for her health care providers--from you or
other LC to the nurses to the social worker to her physician--to maintain
contact and convey availability, acceptance, safety, and respect. This
mother may be in high need of close, frequent follow-up after discharge, if
her apparent lack of responsiveness to her infant continues throughout her
hospital stay. The environment she goes home to certainly needs assessment.
Who will be watching out for her and the baby? Do they and the mother know
the signs of jaundice, dehydration, and failure to thrive? Do they and the
mother know the signs of a baby gaining and developing well?
8. We can only do what we can do. Whether we are mothers struggling with
being mothers or LCs struggling to help those mothers, we can only do what
we can do. Some breastfeeding problems are far from straightforward and do
not have solutions that can be easily identified and rapidly implemented.
The referral you made to the social worker may have been the best thing you
could have done at that moment. It may have been the only thing you could
have done at that moment. Yet things rarely stay the same for any length of
time. The mother might have a teachable moment coming up just waiting for
you--or a therapeutic moment just waiting for the social worker... And no
matter how breastfeeding works out for this mother and baby at this point
in time, your, the nursing staff's and the social worker's gentle,
respectful treatment of the mother now can lay the foundation for her being
more able to seek help with breastfeeding a subsequent child.
Best wishes to this mother, baby and those who care for them,
Cynthia
Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC
Ammawell
Email: [log in to unmask]
Web site: http://home.attbi.com/~ammawell
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