Dear Friends:
The following case study shows the value of follow-up telephone support. I
saw this mother in the hospital, and made 2 follow-up calls to her after she
got home.
At first, everything sounded wonderful. 10-day old baby is gaining, nursing
is easy, nipples and breasts are comfortable. She was nursing while conversing
with me. (Clinically, this is called a 'positive telephone sign'.)
I was happy to hear it. Then she mentioned, almost as an afterthought, that
she was nursing 10 minutes each side then giving formula, "but not even a
whole ounce". Her pediatrician had told her to do that, because the baby was
nursing "all the time" because she "didn't have enough milk."
I took a deep breath.
Then I asked her, "Would you like a lactation consultant's evidenced-based
and clinically-supported opinion about that practice?"
She thought a few seconds, then said, "yes."
I asked her if she wanted to wean. She said "No." I said that the practice
recommended would send her down a road that might surprise and sadden her, the
road to no milk.
I told her about the delicate balance that is the work of the postpartum
period, that between milk production and milk removal. As she is a thoroughly
educated, highly-placed academic professional, I used a more technical analogy.
Our blood volume stays pretty much the same, in the closed system of our
body. If more fluid comes in, we pee more to get back to balance. If we loose a
lot of fluid, we pee less to get back to balance. In the first few weeks
after birth, the breasts and the baby have to reach a fluid balance. (A few
months from now, she might be able to do what the pediatrician
suggested,,,,,,,,,but not now!) This balance adjusts on a minute-to-minute basis, whether for
milk or for blood volume.
(An aside here, the more I learn, the more impressed I am with the Koran
that calls milk "white blood." A lovely and accurate definition!!)
Disrupting the construction of the milk set point with timed feeds
(insufficent removal) and formula supplementation (insufficent suckling frequency) was
putting her on the road to a complete loss of supply. Is that what she
wanted?
An hour and a half is a common pattern for a newborn weaning off placental
continuous feeds. She didn't know that either.
I suggested she follow the baby's lead for the next few days, reminding her
that the baby might want to nurse more frequently to catch-up. I also said
I'd check up on her, if she wanted.
I said that her pediatrician loved her, that the advice was meant only to be
helpful and was based in a lack of knowledge about lactation (my area of
specialisation).
She told me she'd think about everything, and looked forward to my next
telephone call in 2-3 days. She also has my telephone number, I encouraged her
to use it by asking where it was.
I wonder what will happen? I feel that I was professional in my
disagreement. I am sick of saying nothing when this happens.
warmly,
Nikki Lee RN, BSN, MS, Mother of 2, IBCLC, CCE, CIMI
craniosacral therapy practitioner, Elkins Park, Pennsylvania USA
_www.myspace.com/adonicalee_ (http://www.myspace/adonicalee)
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