Kika,

From the outcome you describe - despite your feelings, you did the right thing for that mother/baby!  

It is really scary when we feel so sure babies need to be supplemented.  In a recent situation a mother - and  father too -  were in denial and felt it was an exaggeration that their baby needed more than mom was giving even though:
 - baby was at the breast for HOURS on the breast
 - mom was exhausted
 - weight had gone down from birth - and was now just flat - for 10 days!

Some of the problems we are having, I fear, are caused by our own messaging - in trying to promote exclusive breastfeeding, we are using phrases that imply that the absolutely worst thing to give a baby is formula.  In some cases parents choose homemade mixtures or milk from a variety of other mammals...or refuse to give their baby anything other than the drops of milk mom is able to pump or baby is able to transfer.  

I believe that formula, like any other tool we use in breastfeeding support, has its place.  (After other options, such as mothers' own milk and banked human milk are not available).  I now use the term "crutch or wheelchair" to describe it.  The Academy of Breastfeeding Medicine, in their Supplementation Protocol #3,  recommends protein hydrolysate formulas for that very reason.  The message to mother is that this is "medicine" to help a baby get stronger while other solutions are explored.  

It seems that you DID communicate in a way that informed the mother that "there is a problem that needs to be fixed".  She got the message and went to her doctor.  

Clearly you also did not stop communicating - you called her and followed up quickly, that night.  This had allowed her time to process what you had said and allowed her to make choices that were safe for her baby.  That proved that you had communicated correctly....and you also were taking steps to check on the baby's safety as well.  

In most cases, mothers DO want what is best for their babies - and we have to be able to communicate concern without phrasing it in such a way that she feels we are criticizing her.  This gives her time to listen and process.  That is why the first step after asking open ended questions is to "validate and affirm" so she knows we believe she IS a good mother and WILL make the right choices for her baby.  (Even though we don't agree with her choices, we can usually agree that the choices she made were never meant to put her baby in danger.)   We still have to provide appropriate information - but that can be done in a positive or a negative way - you obviously provided her with the information that led her to make the right choice.  

If she had NOT chosen this route, you would probably have needed to follow up with the MD directly.  As you are a physician in Spain, it may be different than for us who have only one "hat" as IBCLCs...  We must get a consent from the mother to provide information to both her doctor and her baby's doctor.  Often this is a short summary of what was seen and what next steps were planned, but in this case more details may have been necessary.  

For example one mother kept coming to me after being "told" by her pediatrician to supplement.  We evaluated breastfeeding, milk transfer and observe that transfer was small, she would agree to supplement - along with improving milk transfer with different positions, use of breast compressions and not having baby 'hand out' at the breast.  Her breasts and nipples were HUGE, baby was very small, and latch was often ineffective, with few swallows.  Then she would return a week later telling me she had NOT supplemented, she thought it was getting better - and again we observed that baby was not transferring or gaining adequately.  This happened x 3 weeks (baby was alert, not dehydrated, with normal output but no gain).  As the doctor has assumed all he had to do was to "tell" the mother to supplement, and she would do it, he was not following up in a way I felt was safe, even though I sent notes that described each visit (which I wonder if were ever read).  So I used the free WHO Anthro program, and created a growth chart with the baby's weights and called his office then faxed this to him along with a note.  Mom got called that day, baby was seen again by the MD and mother started supplementing.  In this case, I did lose her, as she stopped coming to me - but her baby grew and many, many months later she came back to me to thank me. 

It is so important to be aware about our own feelings...and how they affect how we communicate, speak in a way that shows respect for the mother, while also not "dropping the ball" after they are out of our office.  Good job!  


Jeanette Panchula, BSW, RN, PHN,IBCLC
Vacaville, CA


 

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