I have been mulling over a message I read quite a while ago...and thought
I'd "walk you through" my thoughts so that we can get some dialogue - I
don't have answers, by the way, so skip this if you want a "solution"....

The first trigger was a statement that someone (I'm sorry, can't remember
who) said about how some moms hear what we have to say and our suggestions,
then go home, and we're sure nothing was understood - but then later on we
get a call or contact by someone else and hear that she is doing what we
said ... or she calls back with more questions, and we realize we HAVE been
heard, just not at the pace we expected.

My first reaction (sorry, it was judgmental, but that's why I'm walking you
through this) was:
"Yes, that's just like some teen agers - you tell them something and you
think they don't hear, but they do..."

THEN I realized that it was MY learning style (and I'm WAY past
teenager-status).  I figured that out last week when I found myself
listening to the tapes I make during our choir rehearsal that I use to
practice at home - when no one is there to hear all my flat notes - or in
the car while I commute to work.  I need to make lots of mistakes - believe
me LOTS - then slowly, with MANY repetitions, and often by taping myself
and hearing it then practicing it, or playing it on the piano and again
hearing it as a solo (I sing alto), I can THEN practice the harmony with
the soprano and finally, by the next week, I've got "most" of it right.

Yet I expect a mom to learn how to position her body, her baby's body, her
hand, pillows, folded towels (my favorite - much better in my estimation
than pillows), wait until baby opens WIDE then move the WHOLE baby (not
push the back of the head, now) toward herself then sustain these positions
or gradually change them for comfort...and learn it during my visit while
often being distracted by mother-in-law or mother, father, siblings, and
her own stress etc.

I'm trying to figure out how to use this "brainstorm" to help me pace my
education and support.  I think that will be the key: "Pacing".  When I
teach "Keys to Caregiving" we talk about following the baby's "pace" and
responding to their cries, using measures to comfort, then taking the time
to observe the baby's response to our attempts before trying other comfort
measures.  Too many different comfort measures can be as ineffective as
trying none at all ( I remember a nervous mom at an airport trying to rock
her baby, then put him up in the air, then patting his back, then sitting
him up...poor kid just couldn't settle down.)  Too many corrections and
options brought up to a mom who is ready to try ONE thing can also be
totally ineffective.

Lately I've tried even more than before to observe, suggest, observe some
more, and only offer a different suggestion after the first one has proven
to be ineffective.  I've explained to mom that she should try what I
suggested but that I have many more tricks "up my sleeve" and she should
also try something if she thinks it might work.  I find that moms may think
of something I wouldn't necessarily have thought of at the time as a
solution (the mom that is feeding her baby only at one breast because of
the discomfort she felt when her other breast, which had a pierced nipple,
leaked too much comes to mind).  But if it works for her....

Hopefully during my visit I've given her enough reasons to NOT do
ineffective (don't push the back of the baby's head, they don't like it),
painful (if you push at your breast so the baby can breathe, you often move
your nipple in a position that will cause the tongue to flatten it against
the hard palate and hurt it) or dangerous (we need to count diapers and
watch your baby, he may be unable to wake himself up as often as he needs
to eat, so you may need to wake him up) alternatives.

Giving mom my phone number, calling her back the next day or so allows her
time to try the things I've suggested.  During the follow-up phone calls
(and at times this is done by the Public Health Nurse or the Health Worker
who went out with me) we often learn of alternatives mom has decided to
try, she gets feedback from us, and additional suggestions.  The stress is
much less at this time, and she feels we are working WITH her.

Does this make sense?

Now, the problem comes in when baby's health is in danger and we need to do
something NOW...we may not be able to allow mom her "learning style".  In
this case, I'm afraid I've become "pump or hand expression dependent"...

As long as I can get the milk supply going - often learning (it may be Dad
who learns) how to run the pump - may be the only accomplishment of the
first visit.

Mom AND baby may not be able to "get" all the steps:
Increase the milk supply by frequent feeds, hand expression or pumping
Feed the baby using SNS, cup, syringe, spoon
Follow baby's cues
Follow these steps to get baby at the breast
Don't limit feeds - but
Don't let the baby oversleep
Count diapers
Have weight checks
Etc.

But if I can protect the milk supply, and baby is fed, then we have time to
get things going...at mom's pace.

Jeanette Panchula, BSW, RN, PHN, IBCLC
NEW e-mail address: [log in to unmask]

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