Tamara writes:
So please, stop passing judgment and making mothers feels bad. She does
not have to be experiencing what you read in a breastfeeding text book. If
you are that concerned and upset about what you are hearing, offer your
services for free and come help her out with every feeding.
This sounds like it is directed at one or a few specific IBCLCs. It might
be better to ask them privately and individually, or provide a forum to get
a discussion going in person at a chapter meeting perhaps. I don't know
anyone that would arbitrarily tell a woman to ignore the information she is
getting from HCPs in the hospital without having a clue whether it is
actually appropriate or not but there may be local people who do this. I don't
actually do "phone consults" meaning I asked to be paid, and give advice
blind, in situations like this. If mothers call me, first time on the phone,
they need support to make sure their baby is well-fed and hydrated, get that
baby home and then have an IBCLC come and evaluate them as an individual
dyad. I will give them information they can use til they get home, and I don't
care if the IBCLC who sees them is me or not. If they are getting awful
advice, like "your 24 hr old baby needs 2 ounces of formula every 3 hours" or
" your 4 day old with a bilirubin of 12 needs 3 oz of formula at each
feeding and you should stop breastfeeding", then I give them the information
about norms and how babies usually behave and what they need, and they can
apply to what they are seeing with their own baby. A baby that cannot
self-regulate, is drugged or disorganized, is often not able to do what a normal
baby should be able to do. A baby whose mother's fluid balance is out of
whack for days, may not have the supply he/she needs even if he is able to
latch and feed. These days I make no assumptions. There are simply so few
active, self-regulating, undrugged, unseparated babies with mothers whose
bodies have not been manipulated or augmented or whatever, that I like to make
sure a baby proves they can "be normal" under such abnormal circumstances.
That's why I will provide good information, but not give advice in these
situations. They need to know that without seeing the baby there is a lot we
can't know and therefore have to be open to things going on we know nothing
about. And I suggest that when they get home, they should consult an
IBCLC and make sure they have the #s of several IBCLCs who serve where they
live. Sometimes it seems better to just support a mother by telling her that
as long as her breasts are being stimulated appropriately as needed and she
is protecting her supply, whatever happens in the hospital can be dealt
with when she gets home. Sometimes a mother has to do what the hospital
suggests so they will "allow"
her to leave and take the baby home - sometimes we do what we have to do
as mothers. Mothers can always go back to the "default setting" of true
skin-to-skin, protect her supply, feed her baby in whatever way seems best at
the time, and move forward in time. Yes, I guess these things happen though
since I know you are sincere in your concern for these moms in these
situations. I was out for a while and this was typed before I read Jaye's
response and then yours. Now, I guess I would say that I believe that the people
you want to reach are not reading LN regularly, and so will not be reached
by your post. So... how to proceed? I go back to the idea of providing a
forum for discussion, like a round table at a chapter meeting or something so
people can talk openly about this and hear from the IBCLC who is being
discussed. Unless I am the guilty one, (gasp!) and another idea is if someone
had an issue about how I help families, they would call me up, have lunch
with me, and discuss it.
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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