Those of you who remember how awful 1997 was for me and my hip will be happy
that I'm finally back to work.  I am now working 3 days a week in a new
discharge follow-up clinic plus I still have office hours at our lactation
clinic.  I feel very fortunate that this new clinic was started just as I was
ready to come back after nearly a year and was offered to me.  It is working
well with my disability.  It has also been a great lactation teaching
opportunity for the Peds and OB departments in my hospital.
I am really enjoying this and the parents are raving about how helpful the
clinic is.  Second time parents are asking why we didn't do this sooner.  The
clinic visit comes at a time when they really need the help.
We schedule appointments in groups of 6 one hour apart at 3-5 days after
discharge.  The clinic runs from 8:30 to 12:00, so we see about 18 moms per
day.  All of them so far are also bringing a support person, usually the dad.
The new moms and babies are seen by Peds, OB and an LC.  The baby gets a full
ped exam, mom is asked about her postpartum state (we caught a few with really
high blood pressure) and they receive breastfeeding counseling and I try to
fix whatever the problem is.  They are told before they arrive that a feeding
will be observed.
Unfortunately most of the breastfeeding moms have big problems.  Mostly bad
latch on.  But I think those xxxx discharge packs also have a major role.  One
mom said "It wasn't going well and that formula from the hospital was sitting
there.  It was SO easy compared to worrying and struggling over the
breastfeeding.  So I gave it to her.  But I REALLY want to breastfeed."  I
have seen several Hispanic moms engorged to their collar bones who tell me
they have no milk (The translator already knows my next question "Well, what
do you think is in there?") Given the numbers of women with problems I am left
wondering what happened to them before this?  We weren't seeing this many in
the lactation clinic.
I was shocked that we have had  complaints about exposed breasts but NOT from
the parents--from the staff who peak their heads in and gasp.  Part of my job
is to teach these moms how to nurse without showing everything, so at the
most, the complainers saw an inch or two of skin.  Yesterday, the supervisor
came by and relayed some of the complaints.  I had it with the comments and
announced (Loudly I might add)  "That is exactly why California had to pass a
law to protect breastfeeding.  Thank you Hugh Heifner!" It got a laugh but I
think I got my point across.  I refuse to even think about asking these women
to turn their backs or hide them in a corner.  If the mom is uncomfortable
nursing with others around I make a suggestion and they are glad for the
advice.  I guess if someone had a real problem I would figure out a way to
shield her.  Anyway, I told the supervisor that there is absolutely no shame
in breastfeeding and I wasn't going to perpetuate other people's ignorance.
She agreed but I am not sure she was very happy with me.
I desperately need some solid info on drying up milk for our non-nursers.  Our
policy is not to use any of the traditional drugs for drying milk because of
the side effects.
I do recommend cabbage compresses and sage tea (1/4 teaspoon powdered sage to
1 cup of hot water sweetened to hide the taste 3-4 times per day).  The
powdered sage is easier for them to get than sage tea from a health food
store.
Are there any other methods I've missed?  Some of these gals are so
uncomfortable I feel I need to give them something to help.  I also worry
about breast damage and mastitis in these horrificly engorged non-nursing
women.
TIA
Marie Davis, RN, IBCLC