In a message dated 11/10/2003 8:01:37 AM Pacific Standard Time,
[log in to unmask] writes:

> Put a mom and baby together (after educating the mom a little) and see if
> they don't figure it out on their own!

I feel that many times moms and babies don't figure it out on their own and
here are the reasons:  1.) Medicated births with interventions disturbs the
natural ability for babies to figure it out and know what to do. 2.) Moms lack
knowledgeable support persons who can assist effectively with breastfeeding
because we've got a generation or two of women who didn't breastfeed themselves.
Here are my recent case examples to support my opinion:
1.) Mom's mom had 3 children in 1970's and breastfed all 3 for 2 years and
attended area LLL. This mom attends LLL prior to delivery.  Delivery results in
epidural and on hindsight, mom states she realizes the baby was never latched
onto the breast at the hospital despite being told the baby had a proper
latch.  Mom takes baby home and bili = 17 on day 4 of life.  Jaundice probably
partially result of poor hydration as a result of improper latch.  Bili causes
baby to be more sleepy and further inability to latch properly.  Mom and grandma
have reflected on this situation on hindsight and their perceptions are that
baby would never have gotten it at breast without the consult with appropriate
interventions to resolve bili issue in 24 hours, resulting in a baby waking up
and able to participate in learning how to suckle, which requires
suck-training, and even a nipple shield in this case to sustain a latch.  Again, I repeat
what mom states "baby would not be breastfeeding without the necessary steps
we've had to take".  Meanwhile, mom's milk supply is maintained with the use
of a pump.  Necessary?  Shouldn't have been, but going back to a medicated
birth, and mom's unstable medical condition, and yes insurance pumping is now
necessary to sustain her supply.  Oh, by the way, did I fail to mention that this
is an IVF baby and the twin died in utero....hmmm, perhaps mom failed to
mention that during the short hospital stay....does this complicate matters?
Perhaps.....maybe even enough to require ongoing lactation support to overcome
emotional factors experienced by this mom as she perceives her body to function
"naturally" to breastfeed.  As this mom stated to me, "had she been left to
naturally breastfeed her baby, she would not be breastfeeding by this point"...end
of story.  2.) Mom works as a peds. psych. nurse and has her first baby.  She
calls the hospital where she delivers and asks questions over the phone.  She
tells me she's told it sounds like she's doing fine, offered reassurance, and
this is because baby continues to have 6-8 wet diapers.  But, her concerns
persist, and she calls the hospital LC again.  She requests the name of an LC
for a consult.  She contacts me and she tells me her story; she feels she had to
demand a referral name in order to get one.  She tells me she doesn't
understand why the seemingly unwillingness to provide this type of follow-up.  She
tells me the consult has been invaluable.  She's learned a lot, and we've fixed
a shallow latch, and also dealings for overzealous let-down and some
foremilk/hindmilk imbalance issues....oh, by the way, case example #1 also had
foremilk/hindmilk issues.

I'm not trying to blame anyone for causing any oversight, and I'm not trying
to say all new moms need to be referred to a lactation consultant.  I'm saying
that I feel as a profession we are underutilized and we could make a bigger
impact on these mothers if we all agreed that ongoing support is necessary.
I've had a few moms lately tell me they don't understand why the LCs seemed to
hesitate to provide resources for follow-up.  Can someone try to explain to me
the rationale behind hesitating to offer community resources?  (And politics
don't count....putting patients first is what matters most.)

Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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