Dear Lactnet Friends:

I am not sure what I want from you all; maybe just listening while I
describe what happened will be enough, although suggestions are welcomed.

Yesterday, the 22nd, a Korean gentleman, called me for a consult for his
6-day old baby. His wife wanted to breastfeed; they had been bottle-feeding
formula.But now, she "has milk" and their baby would not latch on.

I gave some suggestions before our visit, scheduled for 8 hours later.  I
told him she had to take milk out to make milk. They had a Medela pump. I
suggested going to Youtube to look at videos of hand expression and to
either hand express or pump at least 4 times before our visit later that
day.  I advised putting the baby skin to skin for 15 minutes before taking
out milk.

He met me at the door, and I came in, removing my shoes. The baby was in
another room with the maternal grandmother. The mother and he and I sat
together and chatted.

I spoke about my personal and positive knowledge of South Korea; I have a
wonderful figure skating coach who is from South Korea and has competed at
the Olympics. I admire Yu Na Kim, the Olympic gold medalist in ladies'. They
smiled and nodded, as Ms Kim in the leading celebrity in South Korea,
singing and modeling as well as skating. I enjoy Korean food. That is all I
know. I asked him to help me do the right things to show respect to the new
mother; in some cultures, it isn't right to praise a new baby. He indicated
that it is alright to praise his baby. He is a doctoral student, studying
chemistry and plans to do a post-doctoral fellowship and then determine
where would be the best place to find work, the US or South Korea.

She did not speak English. She had a vaginal birth. They had breastfed only
a few times in the hospital because the pain of her 3rd degree episiotomy
took all her energy; mostly the baby had been bottle-fed formula. She had
been breastfed herself. I showed my happiness about that, as her mother is
here with her. In South Korea, mothers eat a special soup to make good milk.
Her mother, the baby's grandmother, was making her this soup.

She had taken out some milk, but could get only a little. They didn't have
time to do any s2s, because of a pediatric visit earlier that day. I said
that her breasts were full of milk and that milk can't be pulled out of the
breast. Her breast would have to let it go and that we have to help the
breasts to feel comfortable to let the milk flow.

After all this conversation, I asked them where they would put a guest who
was invited over for dinner. They considered the question thoughtfully, and
he said, "At the table." I agreed and said that the baby had to be at the
table too, indicating her chest. I then described skin to skin care, which
they had done once or twice, and suggested that the baby spend as much time
at the table, in skin to skin, as possible. This was a way to help the baby
to breastfeed.

I suggested the mother get into a position for breastfeeding. While he
undressed his son, a beautiful baby boy, I demonstrated that I wanted her to
find a comfortable reclining position. I slouched in my chair  to
illustrate. She chose to use that chair rather than recline in their bed. So
I got up and she sat down, and opened her pajama jacket. I mentioned to him
that her breasts were perfect for her baby.....they were.

He was handling the baby so gently and gingerly while he undressed him, as
if he was afraid the baby would break, the classic first-time parent. So
sweet and tender.

Once the baby was s2s, she closed her pajama jacket over him and cuddled
him. The baby instantly unfolded and snuggled into her. I pointed out how
her baby loved this and asked how she felt. She gave me a huge smile in
return. I was sitting near hear, and did not touch her or her baby.

After a few minutes, the baby made a beeline for her breast and attached!
Yay!!  Meanwhile I was talking to her husband about how babies are like
kittens and puppies and can attach themselves. I asked him to tell her to
let the baby do what it wanted, and just snuggle the baby close while the
baby sought the breast. He translated for her.

As soon as the baby started to suckle, the mother sat bolt upright and
starting repositioning him the way she'd been taught in the hospital. The
breast instantly fell out of the baby's mouth and he started wailing. The
mother became alarmed and started patting and hugging the baby and
repositioned him again on her chest, leaning back. There was a moment of
calm and then he again attached and started suckling. Again she sat upright
and worked to "fix" the positioning and again the breast fell out of the
baby's mouth and he started screaming. I repeated my message about letting
the baby do what he wanted to her husband, but now my voice was being
drowned out by the furious baby.

I suggested giving the baby her pinky to suck, to calm him. She put her
pinky sideways, across, his lips. I suggested putting her finger on his
tongue but she couldn't/wouldn't/ didn't do that; instead she stood up,
turned her back to me and cuddled her wailing son close.

I suggested she give some formula in the bottle to calm him and I would
explain more and show them (I brought a great s2s DVD with me) what I meant.
The husband went to her and spoke and she shook her head. Again the husband
spoke, and again she shook her head.

The husband told me that she did not want to continue with our visit.

I felt so helpless.

The baby had latched on twice and started suckling. The baby was mad because
he was being interrupted. The husband said that he could see this too and
said that he had to defer to his wife. I asked what I could have done
differently. He said he didn't know, that I was the one with the expertise.
(Ouch!)

I then encouraged safe bed-sharing, saying that the baby very well could
find the breast while the mother was sleeping. I suggested some video search
topics on Youtube for delivery self-attachment and skin to skin care. I
suggested that if she used her breast instead of a pacifier, and if she
spent lots of time in skin to skin, they might find each other and discover
how to breastfeed.

He said that the mother was still in great pain from the episiotomy, taking
Ibuprofen and some Percocet (a synthetic narcotic analgesic mixed with
acetominophen). So he and her mother were taking care of the baby because
she didn't have the energy to do so.

No way I could accept any money for this visit. He wasn't comfortable with
that, and said that I had spent some time, so we agreed to a small amount of
money. I said that I was very sorry, and had obviously made things worse.

I thought about them all night and called this morning. I spoke with him
about her episiotomy. At nearly a week out, she should be a little better
each day. If she isn't, she should be seen by her OB. It shouldn't be
hurting so much after 6, now 7 days. He thanked my for that thought and said
he would explore it with her.

Does anyone have any ideas for how this could have gone better?

warmly,

Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

             ***********************************************

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