Dear Jo-Anne,

I knew there would be a reply like yours to my post.  You are right that telephone/email help can be effective.  After 20+ years as a LLLL I have done my share.  Much of it used to be quite straightforward (once you get the mom to tell you what is really going on) and fairly easily handled with a couple of contacts, sometimes even just one would do the trick (or at least we like to think that it did.) What I am seeing now, for whatever reason, is that moms are presenting with more serious and complicated problems.  It is extremely time-consuming to try to figure these out when there is no face-to-face involved.  And you never know for sure if you are on the right track.  I found this out the hard way many years ago with a multiple-contact case which didn't sound that bad over the phone, based on moms responses to my many questions.  However, I was a little uneasy and finally arranged a home visit.  What I found was an extremely lethargic baby with large cephalohematomas who had no suck and was dehydrated.  I drove them to the doctor who then admitted the baby to the hospital.  The baby eventually recovered after she was rehydrated and the swelling finally abated.  After that experience, I became less willing to drag things out over the phone if breastfeeding was really not going very well.  You mention that this mom may be struggling with PPD.  If this were truly the case, then she needs more than a little hand-holding over the phone - she needs immediate medical evaluation and possibly medication.

As an APL I continue to help Leaders hone their phone counseling skills which I think are extremely important.   But I also help them to know when this may not be enough and how to network with others in the community to get moms the kind of help they need.  Luckily we have a nice mix here of very experienced LLLLs and very competent IBCLCs, so there are a lot of resources to choose from.  Long-term contacts involving mostly hand-holding are fine to do over the phone and in LLL meetings.  When breastfeeding is not working and several phone contacts do not bring progress, then I think it is time for a sit-down with the mom and baby.  Whatever the original problem was in the case of Trish's mom, this is now a baby with an aversion to the breast.  I don't think this mom has PPD, she is just devastated that breastfeeding is no longer enjoyable for her or her baby.  It is unfortunate that she hooked up with a less-than-helpful LC the first time around.  The difficulty with these cases is that you really need to start at square one and go over a lot of old ground, which the mom is often not willing to do at this point.  She just wants the problem fixed, now, or she is going to wean.  There are avenues that Trish can pursue at this point and she may yet get a resolution.  If mom is unwilling to see anyone else, then this is really all that is left.  A really thorough history is needed at this point and then some time to evaluate the information and provide suggestions which may prove helpful.

And a final observation.  It is not normal for a healthy 6 week old to suddenly start having trouble nursing.  Somebody did miss something, especially the LC that said that this is a normal part of learning how to breastfeed.  Unless this mom is giving Trish totally bogus information, this baby did and does have problem serious enough for the mom to be considering weaning.

Too much time on the computer today. Time to go to bed.  My hat is off to all of you who do mostly phone or email helping - it is a tough job to do well.  Peace to all and to all a good night.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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