Barbara Wilson-Clay's posts about abandoning running a pump depot and doing
home visits struck a chord with me.

Since I have been working in a hospital for over a year as an LC I have come
to compare my experiences there wityh helpiong a mother in her home.  I have
felt  frustrated by the contrast of the hospital environment to the home.  Our
hospital's birthing center has rooms that look more like a cozy hotel room;
wonderful wallpaper, private bath.  Mothers who come feel at home in  many
ways and feel an ownership of the space.  BUT it is not home. And there are
many gadgets available there.

At home you see where the mother is choosing to nurse.  How it effects her
breastfeeding - positioning and latch-on.  You can help with suggestions for
making it work for her where is counts - at home.  And I don't go there with a
lot of gadgets.  I had one Mom whose baby would wake up and immediately become
frantic.  She'd been struggling for a few days with this behavior.  [I've seen
a lot of babies and this was an extreme reaction.  The penetrating cry, the
disorganization!]  She was so hungry or wanting so desperately to be on the
breast the moment she woke up that when latch-on didn't occur perfecting the
first time, she lost it.  All we did was find a tablespoon, hand express some
milk onto it and feed it to the baby.  It was enough to calm her down and get
her onto the breast.   A few mintues later she lost her hold on the breast,
backed off - maybe due to a strong let-down and again, was frantic.  Out came
the spoon, down settled the baby, and she continued to feed beautifully.

It's times like those that I'm glad I can see them at home.  And use simple
tools found in the home.  If she would have travelled to the hosptial in the
early evening to see me, would this have happened then?   Would the
circumstances been recreated?  I don't know.

Another mom was sitting cross-legged in bed leaning against the backboard,
round-shouldered, hunched over with her 3 week old baby in her lap.  If she
had come into the hospital and sat in a chair would this have shown up?  The
minute I saw her I knew why she'd had sore nipples for three weeks.  Her baby
was hanging off the end of her breast and she was trying to insert her
pendulous breast into the baby's mouth.  So simple.   Even if I had helped her
with bringing the baby onto the breast at the hospital she might have gone
home and habit might have kicked in  her position might have remained the same
in the bed.  It took both her husband and I coaxing her to change her posture
and teach her to lift the baby onto her breast.  A few minutes later she lose
it and start the old habit.  So working with her at home made an difference, I
think.

Just some thoughts.....

Mardrey Swenson