To all my Lactnet friends: My granddaughter Jenni has given me permission 
to post. It is so easy to get one's feelings "enmeshed" in the 
breastfeeding experience of a loved one, and so hard to separate them 
again! One month of partial breastfeeding is good. Much better than no 
breastfeeding at all. My head knows that. I trust my heart will one day get 
the message. It is 4 times more than any one of my first three children 
received, and I told her so when I was "giving her (my) permission" to stop 
her efforts. (She reminded me that none of her girlfriends had ever even 
tried, and that unless she had accompanied me to the ILCA convention in 
D.C. at age 16, and heard so much breast feeding talk among my friends, she 
never would have thought to try breastfeeding either! (And she 
says "Besides, the fee for her base nursery covers the cost of formula!" 
Argh-h-h! Even the mention of antibodies, exposure to illness from other 
children at the nursery, more time off for doctor's visits, more rest at 
night when she is the sole caregiver, and the prospect of her first Montana 
winter, didn't make a dent!) A cascade of events eventually overwhelmed the 
support of the milk supply, till the experience was so far "down the tubes" 
that both she and the baby were obviously dreading/fighting each nursing.
 
 
I realize that a grandchild's purpose in life is not to fulfill the 
expectations and dreams of their grandparents and parents. So I take 
responsibility for my feelings, and reflect on how to continue to be 
supportive as she learns motherhood, and where to divert my energies to 
help improve the healthcare system so that others might have a better 
experience. (That's why I'm ventilating here.) My original motivation, left 
over from my own experiences as a mother, is that far too many mothers are 
saddled with unnecessary feelings of inadequacy, when it is our health care 
system that is often inadequate!
 
 
She is in the US Air Force, stationed in Great Falls, Montana, and her 
husband, (Daddy Reuben) stationed in Korea, had exactly 28 days to travel 
home and be with her, to help her finish "feathering their nest" and to 
experience the birth of their son. I arrived there a week after he did, 
squeezed in a little vacation sightseeing to let them have their privacy 
before the due date and did "doula" duty. I was privileged to support them 
both and help out grocery shopping, cooking, washing dishes, sewing 
curtains (my outlet for "perfectionism"), etc., wherever I saw a need as 
they transitioned to their new roles as parents. So many adjustments for 
them to make, in such a short time! 
 
 
 
I was never able to persuade her to go to a LLL meeting prenatally, and I 
think seeing how casually other women could nurse would have helped her 
form her feeding ideas in a more relaxed way, instead of making it "a 
project" every time she put him to breast, and breaking suction and 
declaring "He's done!" every time suckling effort tired him momentarily. I 
did take her to a weekend childbirth class when she was home on leave about 
mid-pregnancy, and all along, I had provided some of my favorite parenting 
books, (alas, I saw them gathering dust on her shelf) and several of 
Diane's sheets, including "He Can't be Hungry, He Just Ate", but they went 
mostly unread because of her resistance to "TMI" (too much information). 
She was also curiously resistant to learning to nurse lying down, stating 
she just couldn't relax that way. (This has been reinforced, I believe, by 
the recent newspaper articles on AAP recommendations on how to avoid SIDS!) 
 
 
Nevertheless, I started with "where she was at" and my goal was to be 
the "wind beneath her wings" to help her. She had to overcome numerous 
hurdles, including an elective CS for breech presentation and a 41-week 
g.a. 5# 7 oz. baby with IUGR (intrauterine growth restriction from a small 
placenta. Fortunately, the IV fluids did not overhydrate her, and RPS was 
unnecessary.) Even though I have been a maternal-child nurse with 
experience in every phase, from infertility clinic on, through years in 
every area of hospital maternity care, plus public health, and now WIC, 
this is the first time in 24 years (since my daughter came to stay with me 
for a week after her first child), that I have spent virtually 24 hours a 
day with a new mother, and did so for over 2 weeks! I stayed all night 
after her CS, and even though it was 2 1/2 hours after surgery when Baby R. 
came out to her to begin skin to skin contact, I sat and listened in awe as 
she cooed and talked to him off and on for hours while they literally fell 
in love with each other that night. That just wasn't done back in my days 
in the hospital, and I encourage everyone to put it into practice!
 
 
The IUGR resulted in Baby Reuben having very unstable blood sugars, and I 
must compliment the hospital staff (especially the four dedicated CLC's, 
two about to sit the exam in 2006) on their efforts. They were in no hurry 
re: the first day's feedings, very sparing on early blood sugars, and 
no "threats". Despite the eventual need for IV's to maintain his lab-
confirmed blood sugars, they fingerfed him formula when absolutely 
necessary, and faithfully returned him to her room, IV and all, to let her 
have as many hours of time to learn nursing, and skin to skin contact as 
she and Daddy desired. Baby R. had to stay after she went home, for an 
extra 36 hours of IV's and a bili lamp for a bili of 16. They supplied the 
pump in her home till he was discharged.  
 
 
 
One thing was definitely not so fortunate. As ably as the pediatrician 
managed the blood sugar issues, she was definitely not informed on the 
latest professional literature on tongue-tie, and unwilling to entertain 
the idea of newborn frenectomy, stating unequivocally (in front of the 
medical student accompanying her on rounds) that it might even cause 
complications and could be addressed IF AND WHEN there were ever any speech 
impediments!  (Not shouting-just emphasizing! But I did really feel like 
shouting!!) I had been determined from early pregnancy that Jenni's 
somewhat unusual nipples would not be turned into hamburger. But with this 
extra complication, I had to turn to a nipple shield, a long pacifier 
for "tug of war", football hold, breast compression, some pumping and some 
supplemental EBM and/or formula bottle feeding as per Dee Kassing's 
article, to get us through till we could get home for a frenectomy at 17 
days. (I think finger-feeding, at that moment in time, might well have 
caused her to "throw in the towel" right then and there! In retrospect, 
since tongue-tie interferes with efficient milk transfer, if I could do 
just one thing over, I would have insisted they start her on the pumping 
earlier, paid the rental fee for her and would definitely have had 
her "insurance pumping" till we flew home, in order to build an oversupply 
early on, instead of fearing the problems of oversupply. Handpumping just 
didn't fill the bill. One of several definite learning experiences for me.) 
 
 
 
Five days after Daddy Reuben's return to Korea, she (at 16 days post-op, 
but in excellent physical condition from her Air Force experiences) and I 
flew home to Dayton, Ohio, so she could spend the last 4 weeks of her 
maternity leave with her parents. (I will never forget her valiant efforts, 
wearing a sling, nursing exclusively, with shield, on the plane, and even 
in the middle of the main lobby of Minneapolis-St. Paul airport! She really 
gave it the "college try"!) Back home in Dayton, we immediately had the 
tongue clipped by my friend Greg Notestine DDS (Ankyloglossia, JHL 1990). 
Sadly, even at 6.5 #, the baby still has a tiny mouth and had developed 
habits that were hard to break [humping, clamping, etc.] and at 5 weeks, is 
still slow to form boluses even with carefully paced bottle-feeding. 
 
 
Even though the shield seemed to transfer milk nicely, as in Meier's premi 
research, eventually, after the first few (still painful) nursings after 
the clipping, she was just too overwhelmed with all of new motherhood, 
unrealistic expectations of herself, especially the effects of sleep 
deprivation and how often newborns wake in the night, and the fear of still-
acute nipple pain, to put the baby to breast, even with the shield. Since 
she will always mainly see me in my grandmother hat, I fed info to my 
daughter (G2,L1), to ration out as she saw fit after we returned to Dayton, 
in order not to overstep my bounds and crush her ego with my approach. I 
enlisted other relatives to buoy up her ego, re-emphasize the importance of 
turning off the TV and sleeping when the baby sleeps, to help her be more 
patient with herself learning Motherhood 101. And just as important, 
perhaps moreso, I asked my good friend Geneva to step into the LC role, and 
I withdrew to my own home to tackle the stack of mail. Via phone contact, I 
continued to dole out praise and support, but waited to be asked for 
further help.
 
 
Fortunately, prenatally, I had been able to get her to accept a limited 
amount of vital info, including Rule 1, 2 and 3. Rule 1 has never been 
broken (thanks to the formula company and the diaper bag stash of formula. 
Galls me to admit it, but I am glad it was there when I thought it was 
needed. Of course, I suppose I could have gone out and bought it when it 
was needed.) We worked (mimimally, per her efforts) on Rule 2 with a 
Lactina back home in Dayton, but I don't think she ever got past the idea 
that pumping was mainly for obtaining milk, and the reverse logic kept 
taking over, so that she only pumped "when she felt full enough" despite 
numerous simple explanations that "you must keep removing the milk to 
maintain your supply, and to re-build your supply higher, short, frequent 
pumpings are more important now, even if you don't get much out at a time". 
 
 
She confided to her mom that she felt like "she was disappointing me". I 
tried not to let that show, for I knew, of course, that was my own problem. 
I tried to keep "accentuating all the positives" of her accomplishments, 
help facilitate any (possible) grieving on her part and manage and reframe 
my goals and expectations as needed. I would be glad to give her two purple 
hearts, one for each nipple, if I could!  I zealously helped her avoid skin 
breakage, but some pictures show much peaking, slight bruising, and the 
pain eventually became excruciating. But amazingly, about 6 days after the 
clipping, when all internal bruising had resolved, her mom walked in one 
morning and found her nursing, without shield. She asked Jenni "Does it 
still hurt?" "No, it just feels a little bit funny. Is it supposed to feel 
that way??" After her mom's assurance that that was exactly the way it was 
supposed to feel now that the tongue was no longer tied down, she smiled 
and said "I can do this!" But the pumping became even less after that.
 
 
I think the final crack in the dike came the day she went to see the 
pediatrician at our local air base. (We had kept the weight gain adequate, 
by following Rule # 1, with EBM, and with formula, but just when 
necessary.) He did tell her that they clip frenulums all the time here in 
Dayton, but when he found out the amount she was getting per pumping, he of 
course, took that to be indicative of the amount Baby R. was obtaining at 
breast, and told her to supplement with formula after each feeding.  (She 
had not informed me that her own base had called her and told her to go to 
our local base for a check-up, or I certainly would have accompanied her to 
the visit and added my $.02 about the pumping at that time. Of course, 
maybe she didn't want me along, or felt that getting a base pass for me was 
too much hassle.) Supplementation after absolutely every feeding made him 
sleep longer, which pleased her. And you know the rest of the story. This 
became a self-fulfilling prophecy. She felt confirmed in her 
fears/discouraged about the amount being pumped, and soon there was no more 
pumping, less and less milk, slower and slower MER and less and less 
immediate reward from the breast. He began to clamp, struggle and cry at 
the breast, and of course, she refused to be "clamped on", and I could see 
impatience mounting so that between the two of them, the breast was turning 
into a battleground. 
 
And I saw great relief on her face when I acknowledged that it didn't look 
like either one of them was enjoying nursing the least bit, and how would 
she rather proceed from here on? "Permission" had been granted-to me to 
cease and desist all but appreciation of her efforts and how fortunate her 
baby was to get such a good start. And permission for her, to return the 
pump, buy more bottles and more formula and "get on with her life".   She 
declares "It seems so much easier."
 
I am trying to maintain professionality by supplying the name and address 
of the Great Falls pediatrician to Dr. Notestine so that he can send 
pictures and a report on the frenectomy, but I can't decide whether to 
chance sending along anything myself as far as events after the baby left 
the hospital. I don't want to go overboard, but I can't help feeling that 
if that large stumbling block had been taken care of in the beginning, 
things would have been different from there on out, and her motivation, 
tenuous as it may have been to start, would subsequently have been rewarded 
and strengthened, rather than spiraling downward to complete weanng at one 
month. I am particularly interested in suggestions from physicians on the 
list as to how best to handle this. My main goal is to improve the 
healthcare system, not ventilate my own strong feelings that remain. And 
what about the physican at the local base who recommended formula after 
every feeding, based on Jenni's report of the amount she had been getting 
at pumping? Since I did not meet him, is there any professional way for me 
to improve his information?
 
Jean
***********************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
 
 
 
 

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