To all my Lactnet friends: My granddaughter Jenni has given me permission
to post. It is so easy to get one's feelings "enmeshed" in the
breastfeeding experience of a loved one, and so hard to separate them
again! One month of partial breastfeeding is good. Much better than no
breastfeeding at all. My head knows that. I trust my heart will one day get
the message. It is 4 times more than any one of my first three children
received, and I told her so when I was "giving her (my) permission" to stop
her efforts. (She reminded me that none of her girlfriends had ever even
tried, and that unless she had accompanied me to the ILCA convention in
D.C. at age 16, and heard so much breast feeding talk among my friends, she
never would have thought to try breastfeeding either! (And she
says "Besides, the fee for her base nursery covers the cost of formula!"
Argh-h-h! Even the mention of antibodies, exposure to illness from other
children at the nursery, more time off for doctor's visits, more rest at
night when she is the sole caregiver, and the prospect of her first Montana
winter, didn't make a dent!) A cascade of events eventually overwhelmed the
support of the milk supply, till the experience was so far "down the tubes"
that both she and the baby were obviously dreading/fighting each nursing.
I realize that a grandchild's purpose in life is not to fulfill the
expectations and dreams of their grandparents and parents. So I take
responsibility for my feelings, and reflect on how to continue to be
supportive as she learns motherhood, and where to divert my energies to
help improve the healthcare system so that others might have a better
experience. (That's why I'm ventilating here.) My original motivation, left
over from my own experiences as a mother, is that far too many mothers are
saddled with unnecessary feelings of inadequacy, when it is our health care
system that is often inadequate!
She is in the US Air Force, stationed in Great Falls, Montana, and her
husband, (Daddy Reuben) stationed in Korea, had exactly 28 days to travel
home and be with her, to help her finish "feathering their nest" and to
experience the birth of their son. I arrived there a week after he did,
squeezed in a little vacation sightseeing to let them have their privacy
before the due date and did "doula" duty. I was privileged to support them
both and help out grocery shopping, cooking, washing dishes, sewing
curtains (my outlet for "perfectionism"), etc., wherever I saw a need as
they transitioned to their new roles as parents. So many adjustments for
them to make, in such a short time!
I was never able to persuade her to go to a LLL meeting prenatally, and I
think seeing how casually other women could nurse would have helped her
form her feeding ideas in a more relaxed way, instead of making it "a
project" every time she put him to breast, and breaking suction and
declaring "He's done!" every time suckling effort tired him momentarily. I
did take her to a weekend childbirth class when she was home on leave about
mid-pregnancy, and all along, I had provided some of my favorite parenting
books, (alas, I saw them gathering dust on her shelf) and several of
Diane's sheets, including "He Can't be Hungry, He Just Ate", but they went
mostly unread because of her resistance to "TMI" (too much information).
She was also curiously resistant to learning to nurse lying down, stating
she just couldn't relax that way. (This has been reinforced, I believe, by
the recent newspaper articles on AAP recommendations on how to avoid SIDS!)
Nevertheless, I started with "where she was at" and my goal was to be
the "wind beneath her wings" to help her. She had to overcome numerous
hurdles, including an elective CS for breech presentation and a 41-week
g.a. 5# 7 oz. baby with IUGR (intrauterine growth restriction from a small
placenta. Fortunately, the IV fluids did not overhydrate her, and RPS was
unnecessary.) Even though I have been a maternal-child nurse with
experience in every phase, from infertility clinic on, through years in
every area of hospital maternity care, plus public health, and now WIC,
this is the first time in 24 years (since my daughter came to stay with me
for a week after her first child), that I have spent virtually 24 hours a
day with a new mother, and did so for over 2 weeks! I stayed all night
after her CS, and even though it was 2 1/2 hours after surgery when Baby R.
came out to her to begin skin to skin contact, I sat and listened in awe as
she cooed and talked to him off and on for hours while they literally fell
in love with each other that night. That just wasn't done back in my days
in the hospital, and I encourage everyone to put it into practice!
The IUGR resulted in Baby Reuben having very unstable blood sugars, and I
must compliment the hospital staff (especially the four dedicated CLC's,
two about to sit the exam in 2006) on their efforts. They were in no hurry
re: the first day's feedings, very sparing on early blood sugars, and
no "threats". Despite the eventual need for IV's to maintain his lab-
confirmed blood sugars, they fingerfed him formula when absolutely
necessary, and faithfully returned him to her room, IV and all, to let her
have as many hours of time to learn nursing, and skin to skin contact as
she and Daddy desired. Baby R. had to stay after she went home, for an
extra 36 hours of IV's and a bili lamp for a bili of 16. They supplied the
pump in her home till he was discharged.
One thing was definitely not so fortunate. As ably as the pediatrician
managed the blood sugar issues, she was definitely not informed on the
latest professional literature on tongue-tie, and unwilling to entertain
the idea of newborn frenectomy, stating unequivocally (in front of the
medical student accompanying her on rounds) that it might even cause
complications and could be addressed IF AND WHEN there were ever any speech
impediments! (Not shouting-just emphasizing! But I did really feel like
shouting!!) I had been determined from early pregnancy that Jenni's
somewhat unusual nipples would not be turned into hamburger. But with this
extra complication, I had to turn to a nipple shield, a long pacifier
for "tug of war", football hold, breast compression, some pumping and some
supplemental EBM and/or formula bottle feeding as per Dee Kassing's
article, to get us through till we could get home for a frenectomy at 17
days. (I think finger-feeding, at that moment in time, might well have
caused her to "throw in the towel" right then and there! In retrospect,
since tongue-tie interferes with efficient milk transfer, if I could do
just one thing over, I would have insisted they start her on the pumping
earlier, paid the rental fee for her and would definitely have had
her "insurance pumping" till we flew home, in order to build an oversupply
early on, instead of fearing the problems of oversupply. Handpumping just
didn't fill the bill. One of several definite learning experiences for me.)
Five days after Daddy Reuben's return to Korea, she (at 16 days post-op,
but in excellent physical condition from her Air Force experiences) and I
flew home to Dayton, Ohio, so she could spend the last 4 weeks of her
maternity leave with her parents. (I will never forget her valiant efforts,
wearing a sling, nursing exclusively, with shield, on the plane, and even
in the middle of the main lobby of Minneapolis-St. Paul airport! She really
gave it the "college try"!) Back home in Dayton, we immediately had the
tongue clipped by my friend Greg Notestine DDS (Ankyloglossia, JHL 1990).
Sadly, even at 6.5 #, the baby still has a tiny mouth and had developed
habits that were hard to break [humping, clamping, etc.] and at 5 weeks, is
still slow to form boluses even with carefully paced bottle-feeding.
Even though the shield seemed to transfer milk nicely, as in Meier's premi
research, eventually, after the first few (still painful) nursings after
the clipping, she was just too overwhelmed with all of new motherhood,
unrealistic expectations of herself, especially the effects of sleep
deprivation and how often newborns wake in the night, and the fear of still-
acute nipple pain, to put the baby to breast, even with the shield. Since
she will always mainly see me in my grandmother hat, I fed info to my
daughter (G2,L1), to ration out as she saw fit after we returned to Dayton,
in order not to overstep my bounds and crush her ego with my approach. I
enlisted other relatives to buoy up her ego, re-emphasize the importance of
turning off the TV and sleeping when the baby sleeps, to help her be more
patient with herself learning Motherhood 101. And just as important,
perhaps moreso, I asked my good friend Geneva to step into the LC role, and
I withdrew to my own home to tackle the stack of mail. Via phone contact, I
continued to dole out praise and support, but waited to be asked for
further help.
Fortunately, prenatally, I had been able to get her to accept a limited
amount of vital info, including Rule 1, 2 and 3. Rule 1 has never been
broken (thanks to the formula company and the diaper bag stash of formula.
Galls me to admit it, but I am glad it was there when I thought it was
needed. Of course, I suppose I could have gone out and bought it when it
was needed.) We worked (mimimally, per her efforts) on Rule 2 with a
Lactina back home in Dayton, but I don't think she ever got past the idea
that pumping was mainly for obtaining milk, and the reverse logic kept
taking over, so that she only pumped "when she felt full enough" despite
numerous simple explanations that "you must keep removing the milk to
maintain your supply, and to re-build your supply higher, short, frequent
pumpings are more important now, even if you don't get much out at a time".
She confided to her mom that she felt like "she was disappointing me". I
tried not to let that show, for I knew, of course, that was my own problem.
I tried to keep "accentuating all the positives" of her accomplishments,
help facilitate any (possible) grieving on her part and manage and reframe
my goals and expectations as needed. I would be glad to give her two purple
hearts, one for each nipple, if I could! I zealously helped her avoid skin
breakage, but some pictures show much peaking, slight bruising, and the
pain eventually became excruciating. But amazingly, about 6 days after the
clipping, when all internal bruising had resolved, her mom walked in one
morning and found her nursing, without shield. She asked Jenni "Does it
still hurt?" "No, it just feels a little bit funny. Is it supposed to feel
that way??" After her mom's assurance that that was exactly the way it was
supposed to feel now that the tongue was no longer tied down, she smiled
and said "I can do this!" But the pumping became even less after that.
I think the final crack in the dike came the day she went to see the
pediatrician at our local air base. (We had kept the weight gain adequate,
by following Rule # 1, with EBM, and with formula, but just when
necessary.) He did tell her that they clip frenulums all the time here in
Dayton, but when he found out the amount she was getting per pumping, he of
course, took that to be indicative of the amount Baby R. was obtaining at
breast, and told her to supplement with formula after each feeding. (She
had not informed me that her own base had called her and told her to go to
our local base for a check-up, or I certainly would have accompanied her to
the visit and added my $.02 about the pumping at that time. Of course,
maybe she didn't want me along, or felt that getting a base pass for me was
too much hassle.) Supplementation after absolutely every feeding made him
sleep longer, which pleased her. And you know the rest of the story. This
became a self-fulfilling prophecy. She felt confirmed in her
fears/discouraged about the amount being pumped, and soon there was no more
pumping, less and less milk, slower and slower MER and less and less
immediate reward from the breast. He began to clamp, struggle and cry at
the breast, and of course, she refused to be "clamped on", and I could see
impatience mounting so that between the two of them, the breast was turning
into a battleground.
And I saw great relief on her face when I acknowledged that it didn't look
like either one of them was enjoying nursing the least bit, and how would
she rather proceed from here on? "Permission" had been granted-to me to
cease and desist all but appreciation of her efforts and how fortunate her
baby was to get such a good start. And permission for her, to return the
pump, buy more bottles and more formula and "get on with her life". She
declares "It seems so much easier."
I am trying to maintain professionality by supplying the name and address
of the Great Falls pediatrician to Dr. Notestine so that he can send
pictures and a report on the frenectomy, but I can't decide whether to
chance sending along anything myself as far as events after the baby left
the hospital. I don't want to go overboard, but I can't help feeling that
if that large stumbling block had been taken care of in the beginning,
things would have been different from there on out, and her motivation,
tenuous as it may have been to start, would subsequently have been rewarded
and strengthened, rather than spiraling downward to complete weanng at one
month. I am particularly interested in suggestions from physicians on the
list as to how best to handle this. My main goal is to improve the
healthcare system, not ventilate my own strong feelings that remain. And
what about the physican at the local base who recommended formula after
every feeding, based on Jenni's report of the amount she had been getting
at pumping? Since I did not meet him, is there any professional way for me
to improve his information?
Jean
***********************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|