<snip>

>
>Naturally this situation rapidly starts including signs of low 
>supply in the mother too, regardless of how normal her breasts may 
>be.
>
>I've wondered at times whether it would be useful to send a note to 
>the facility in question.  Dear colleague, I had occasion to see M 
>and her baby, G, today when they sought our help for a breastfeeding 
>problem. The baby had not begun to gain weight yet and when I saw 
>them she had lost x percent of her birth weight and had not stooled 
>for three days.  M could not recall the details of the plan you and 
>she agreed upon when she was seen by you, and she did not have a 
>written copy of it.  I hope the plan we made when I saw them is not 
>too different from yours. It consists of (some way of ensuring the 
>baby gets fed) and (some way of protecting the milk supply). M and G 
>are coming back here in a couple of days to see how the plan is 
>working, but it is more appropriate for her to continue her care 
>with you since you are in the facility in the community where she 
>gets the rest of her care.  M looks forward to the resolution of the 
>problem and plans to continue breastfeeding for at least six months.'


Great letter :)

>
>That way, they are not cornered into defending some garbled version 
>of a possibly great plan forgotten by the mother, and if there has 
>been no real plan, they will see that I at least (pretended to) 
>respect them so much that I assumed there was a plan but the mother 
>had forgotten what it was and forgotten to bring her copy along to 
>the visit at our clinic.  If they did have a plan, perhaps they will 
>consider the importance of writing it down next time so the mother 
>doesn't have to remember it by heart.


Yep - no one needs to feel criticised. And *of* *course* mothers do 
not always remember accurately what they hear. I think it is 
essential to write stuff down, even as a lay counsellor. On the 
phone, I often suggest the mother writes down what we agree. It is, I 
think, part of the practitioner's job to make sure the mother has 
some way of remembering accurately what she hears, and that includes 
clear communication of what you say.

<snip>
>If daily visits while you wait are not an option, I would not 
>criticize anyone erring on the side of feeding the baby.


Important, I agree. Here in the UK, I am regularly dismayed by the 
fact that staff shortages in some areas (especially London) mean that 
mothers cannot expect even the option of daily visits from their 
midwife - something that was routine everywhere, including Holidays, 
including weekends, several years ago. Mothers are entitled to 
statutory midwifery care at home and most places can do daily (or 
even more frequently)  home visits when they're required - though we 
sometimes find that mothers are left for a weekend with a massive 
problem, and part of our role is to support the parents in 
*insisting* on a home visit or at the very least phone contact.

Heather Welford Neil
NCT bfc, tutor, UK


-- 
http://www.heatherwelford.co.uk

http://heatherwelford.posterous.com

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