Thank you for this Lisa.  I was planning on doing this very thing when
I returned from LLLI's conference in Chicago. I think MOBI is such a
great support place and I send moms there for the extra support from
mothers who have been there done that.  I found the information to be
very good, and the women to be extremely supportive of each other.

 I know that every single time I inform a mom of 'why' it may be
happening to her she is so relieved!  So many mothers blame a behavior
they are doing wrong that knowing this is outside their control gives
them immense relief.  I am absolutely in favor of sharing complete
information once I know for sure there is a problem.I rarely have the
chance to share information prenatally since I only see moms pre baby
in arms if I am working with them as a doula.  I always ask the
questions I need to know to see if there may be a difficulty, and
address the issues they share...implants, reduction, inverted nipples,
fertility issues, etc. This mom I wrote about is the first one that I
noticed a problem in the recovery room...but she did not share
complete information with me prenatally.  I still think based on this
mother's situation it was better to not have shared the information
with her at less than an hour postpartum. It would have been
inappropriate.  I still think informing the nurse manager that there
may be a problem and why was the appropriate choice.) I have since
seen her and have informed her of what I see, feel, and what she needs
to do, etc.  She told me I was being defeatist...she believes her milk
will be enough for twins and I need to believe it too....miracles do
happen though. And she is agreeing to feed with the supplementer at
the breast so they are not starving.

I think we have to consider the timing and the way we share
information.  It may be one thing to explain and comfort  and validate
the mother who is struggling and another thing to create a traumatic
experience so close to the birth. What we say to a mom during labor
and for some time after is not always heard the way we say it, and it
can alter her mental state more than I want to be responsible for.
Looking back, I still think I should not have told her at that time
what I suspected.  She did need to be told, but not in the early hours
after the birth of her babies.

 I still wonder about the prenatal informing and balancing that with
the self fulfilling prophecy theory. Even those moms who say yes, I
would have wanted to know prenatally say that now with knowledge of
their struggle....what if knowing meant they never tried at all?  What
if someone says "you may not be able to make enough milk" is heard as
"you can't make milk" which in turn means why bother using breasts to
feed your baby at all?  We have spent so much energy on the milk, we
lost sight of the delivery system.  Maybe I am not optimistic.  I work
in a community where doctors say "your pelvis may be to small to
deliver your baby who may be over 8 lbs." and mothers opt quickly for
a c section at 38 weeks rather than risk a labor that may not 'work'.

I appreciate this exchange of ideas and will consider how to handle
this in the future. Unfortunately, I am sure it will continue to be an
issue.


Best,
Pam MazzellaDiBosco, IBCLC, RLC

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