Hi Hoda,

If I were seeing this mother, I would probably suggest a homemade nursing
supplementer to feed at the breast as much as possible. I would recommend
that she discontinue any pacifier use if possible, and to feed at any and
every cue. If something simple and inexpensive could be used as a
galactagogue, maybe a nice herbal tea then, but the evidence on
galactagogues is really not very promising. I would ask her to express
after feeds when she felt she had the time and energy. The point I would be
trying to make would be to enjoy the breastfeeding and the baby and not
really worry about the exact amounts of breastmilk the baby is getting.

Now this next part you ask about is the really hard part and the MOST
DIFFICULT part of my job. You said "one other thing. I have numerous
mothers, ... have needed to supplement.  With each one, I could identify
the reasons due to choices that they made or the particular circumstances,
but I did not jump in and push them because I was trying to honor their
level of commitment and willingness to follow my recommendations.  Any
advice on balancing the respect for a parent's readiness and own pace
versus advising them much more seriously as their consultant?"

Well, Hoda, I have even had complaints 2x in 9 yrs for making a mother feel
bad 1. for not making enough milk (this was a mother I was helping even by
phone on my off days a premie baby if I recall and she wanted to make more
milk) or 2. being "negative and pessimistic" from a mom also mainly formula
feeding and pumping 1 or 2x per day and not wanting to latch but just
provide ebm. Believe me when I say I did not think I was being negative or
pessimistic in any way nor uncaring nor unfeeling in any way. However,
these 2 mothers perceived it that way.

Believe me also when I say that EVERY DAY I struggle with being honest
(expressing 8 to 10 x per day if you are not wanting to latch the baby but
you want to provide a full supply) or mostly validating what mother is
already doing (even though we know it's not gonna work) and HOW do I give
the information w/o alienating the mom or getting a lousy patient
satisfaction score. To get the best score one has to just really say "keep
doing what you are doing, it's all going to work out fine." I've  had a mom
come in around Day8 mostly formula feeding and pumping 2 or 3x a day and
saying "I am just going to keep waiting for my milk to come in". Now, how
do I tell her it's not going to just come in under those circumstances? So
really this is a very difficult dilemma for me. I think I am a nice and
caring person, validating what struggles the mother is going through, but
maybe I'm not??? I have lately taken to saying something like this, "to
kick into gear, our breasts need to have milk removed about 8 to 12 x per
day." Or "our breasts require x amount of minutes of use per day". Instead
of something like "express milk ideally 8 or 10 times per day." The former
puts the responsibility on the breast and not on the mom??? I would also
appreciate any feedback on this topic, and I marvel at the fact that I have
not perfected this counseling skill yet!

Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA

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