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From:
"Karen Kerkhoff Gromada, MSN, RN, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 8 Jan 2000 11:02:42 EST
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I don't recall ever reading Reva Rubin's writings, or writings about her
writings, in which a term such as "fogginess" was used to describe what she
called the "taking in" phase. My impression was that this phase was a time
during which the mother was "regrouping" and integrating the birth experience
in to her psyche. While some may appear physically foggy or flaky, we
generally don't know if this new mom's approach to life tends toward foggy or
flaky! (I give someone with a PCA pump or postpartum IV MgSO4 the benefit of
the doubt!).

In my experience, every new job includes "taking in," "taking on," and
"taking hold" phases, so why wouldn't parenthood? And most other jobs don't
begin immediately after so many profound physical and emotional changes, such
as birth and the expulsion of the hormone-producing placenta.

There already is some evidence in nursing research re: postpartum cognitive
deficits--at least one of which was cited earlier. (I wonder if the
preoccupation of reintegration appears as cognitive deficit? In either case,
there seems to be a period of maternal "regrouping" in the immediate period
after birth.) There also was a research report in JOGNN within the last
couple of years re: the effect maternal comfort level has on
absorption/preoccupation with self vs. high interest in infant or learning
about infant care. (I don't have time to search for the citation just now.) I
think this period of time is a specialty of Maryanne Locklin, PhD, RN,
IBCLC--would love her input on this discussion.

No one has mentioned as a variable the number of first-time mothers in
Western cultures that come to birth today without ever having held a younger
infant, much less a newborn. If they haven't helped care for an infant,
chances are they haven't seen much in the way of real babies breastfeeding.
My impression is that in "less-developed" cultures (a subjective term if ever
there was one) there are few women giving birth that have grown up without
having cared for newborns and young infants or provided "services" for the
resting, recently delivered new mother. Most also would have grown up seeing
babies breastfeed. This experience certainly could affect the "taking in"
reintegration phase!

Anecdotally, I find most new mothers very receptive to info, especially info
that can be physically demonstrated, if they basically feel OK and any
medication has cleared their systems. However, I don't believe they'll retain
all that much, especially if verbal or written. I worked too long as an early
OB discharge home health nurse during which I witnessed all the postpartum
hopital instruction fly out the window after a night or two home alone with a
newborn. And I saw similar maternal responses whether I was visiting someone
in an affluent suburb or an inner-city ghetto area.

Mothers in our area go home from the hospital with piles of crap--some
useful/most useless. Once home, many of the moms or dads don't know how to
find or remember where in the huge piles they put that nice packet or booklet
with all that wonderful breastfeeding info they received from that the
wonderful LC or postpartum nurse. When the home visit nurse asks, they tend
to point to a pile of bags in a corner and say "it's in there somewhere."
Having asked if they were given such info in the hospital when working LLL
phones or a LC "warmline," I'd bet it will be a good 4-6 weeks--if
ever--before many/most of them get to those piles to find that booklet or
packet (often painstakingly compiled by LCs or nurses). Even those that know
where the booklet or packet is often say they didn't have time to go through
it to find the info they needed.

I'd love to see more instruction provided prenatally, in care providers'
offices with "captive" audiences waiting for check-ups. I'd like to see all
prenatal providers and CE instructors encouraging expectant mothers to mother
support group meetings, such as LLL so they can actually see babies
breastfeed and also see how normal babies can demonstrate a range of feeding
patterns. I'd like to see expectant moms make this a priority.

Since I'm not counting on any of that happening any time soon, I support
those who've recommended giving the mother 1-2 sheets of vital breastfeeding
info that is printed in large type-font with lots of white space. A checklist
chart for marking feedings (intake) or pumpings and pees/poops (output) with
info about how many of each to expect daily and the number of a support
personal to call printed at the top in bold print is ideal. If the hospital
has a booklet, I'd suggest putting basic intake and output info and a contact
number somewhere on the cover--inside front or back or outside back. I'd
further recommend that the importance of the 1-2 sheets be emphasized and the
new mother asked where it should be left so she will be able to easily find
it when she gets home. Book recs--I think Bestfeeding: Getting Breastfeeding
Right for You by Renfrew, Fisher and Arms is about the best for those first
few, but crucial to breastfeeding, weeks--large print, clear illustrations,
easy to follow. (I'm hoping Gotsch's revision of Breastfeeding Pure and
Simple for LLLI will be as clear. Some photos in the original were hard to
decipher.)

Sorry to go on so long...

Karen

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