Kirsten writes of a woman who has had recurrent problems with yeast, seems
ambivalent about nursing (talks about giving up, then says she wants to
continue), is seeking second opinions from healthcare providers in Spain
(her homeland), is losing weight, has frequently expressed concerns about
her son's health (e.g., stuffy nose), has been diagnosed with hypoglycemia,
and was referred to Kirsten because of the thrush/sore nipples and to
reassure the mother that her son was "doing well," etc.
Others have already addressed the yeast issue (e.g., treatment of the
entire household and family--including husband). I have a few questions and
comments:
1. What support does this mother have? Has she been in the US (or wherever
Kirsten is writing from) for very long? Immigration tends to break social
ties in a sudden and profound way. What support "should" she have according
to her cultural background? Is she lacking that support and missing it
greatly?
2. A mother is the first line of defense for her child. As such, others
should be very, very careful about dismissing the concerns a mother
expresses about her child. Mothers of children born with special needs are
often the first and only people for a very long time to realize that
"something is wrong with the baby." These mothers are often labeled
"overprotective" by family, friends and health care providers, discouraged
from seeking further medical evaluation, and delayed in finding the
treatments that their children, in fact, needed. The physician that saw the
baby appears not to have found anything he/she found concerning (other than
the yeast). So, the mother may feel concerned about her child because she
simply doesn't have the social support around her that she needs (e.g.,
lots of family oooing and ahhhing over how well and wonderful her baby is;
people that she can count on to not let a health problem slip by her
unrecognized; ...). In theory, there could be a psychological issue
involved. [For example, does she show anxiety about lots of other things?
Or has she had reason to come to see her son as fragile (e.g., born
prematurely, treated for jaundice, delivered by c-section), even though he
may no longer be medically vulnerable now?] However, she may feel concerned
about her child because there is, in fact, something to be concerned about
that the physician does not recognize.
3. How significant is the weight loss and how well managed is the
hypoglycemia? Hypoglycemia itself can alter one's mood negatively. Might
she need more help getting her hypoglycemia under better control?
4. Chronic health problems can result in depression. She's been struggling
with yeast for quite a while. She is distressed enough by it to
periodically consider stopping breastfeeding. If she can get the yeast
situation resolved, her mood may, understandably, improve greatly.
5. Do you have a colleague who is a mental health professional whom you can
consult with regarding your concerns about postpartum depression? Such a
conversation can help you decide whether and to whom to refer the mother.
Here's an excerpt from my chapter "Congenital Disorders in the Nursling" on
the symptoms of clinical depression:
"Feelings of depression are a common experience of the constructive process
of grieving a significant loss. However, this understanding should not
prevent the lactation consultant from referring a mother to a mental health
professional if she shows signs of clinical depression; that is, whenever a
mother persistently and regularly (most of the day, nearly every day) shows
symptoms such as:
* Depressed mood,
* Lowered interest or pleasure in all or almost all activities,
* Significant changes in weight and/or appetite,
* Insomnia or hypersomnia,
* Observable restlessness or sluggishness
* Fatigue or loss of energy,
* Feelings of worthlessness or excessive or inappropriate guilt,
* Observably diminished ability to think or concentrate, or indecisiveness,
* Or if the mother has recurrent thoughts of death, experiences, recurrent
suicidal ideation without a plan, has a specific plan for committing
suicide, or attempts suicide."
Good Mojab, C. Congenital disorders in the nursling. Unit 5. Lactation
Consultant Series II. Schaumburg, IL: La Leche League International, 2002.
Best wishes to this mother, baby, and those involved in their care,
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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