I had a really lousy day at work yesterday.  Apart from the fact that I was
unwell and should have been home in bed (which is where i was today), and
that I was anticipating a nice quiet day and it wasn't I had several quite
disturbing consults.
The one i would like your input on is a woman who delivered at another
hospital and first saw me at 6 weeks postpartum.  Her attachment was
atrocious and she had a reducing supply, a skinny baby and damaged nipples
and had just started to give formula.  I assisted her with attachment 'Wow
that doesn't hurt to feed' and during the hx taking discovered she still had
a bright lochial loss.  She was also quite 'deadpan' in her attitude. (I
hope you people of other cultures know what I mean) - she lacks any social
supports (partner OK, but works long hours, exhausted when he gets home).  I
discussed postnatal depression with her, which she felt she may have and
referred her to the Social Worker and all the community support groups out
there.  Also she ended up having a D&C for retained products.  OK so she's
had a pretty bad start and as to whether I told her of the benefits of
breastfeeding (which i should have if i didn't) or she read them somewhere I
don't remember.
Yesterday the baby was 12 weeks old and she'd been coming to see me weekly
and we were reducing the amount she had been comping with.  Weight gains had
been 160g per week for last 3 weeks (about 5+ oz, I think) which is all
right by my standards. So we were down to 'only comp if you really feel he
needs it'.  Anyway yesterday he lost weight and she was devastated, put the
baby to the breast and her attachment was lousy again and i ever so gently
suggested some improvements.
Well that was it!  She was in tears, felt she was spending all her time with
a boob out, was resenting the baby for the effect he has had on her life and
why couldn't she bottle feed?  People tell her about cancer and risk of
heart attack for her baby if she doesn't breastfeed, so she's not game not
to. (I'm paraphrasing here)
I know she was under particular strss right then, but i'd say most of those
feelings she'd had for some time. I did my best to reassure her that things
would be different next week, that if she wanted to wean I'd still be there
for her, that she'd given him a great start, discussed different plans for
the coming week, etc - none of which she committed to.  She's still looking
very postnatally depressed and has got no treatment from anyone.
Anyway I was taken back when she mentioned the benefits and how she didn't
want to breastfeed but would feel so guilty if she didn't.  I did talk about
love being more important than breastfeeding, but don't know that that was
all that appropriate as she looked rather blankly at the baby when i said that.
I guess my problem is that I felt really guilty that I had told this woman
about benefits of breastfeeding which she feels she must do now, even though
she's desperately unhappy doing it, but would feel worse because she wasn't
doing the best for her baby.
I need some wise counselling from those have have resolved this dilemma.
Thanks
Denise

Denise Fisher,
Brisbane, Australia
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Caution:  Never drive faster than your guardian angel can fly.
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