> I've done counseling by email, but I don't like it much unless it is a
> simple question or problem.  Otherwise, if I can't see them, I don't feel
> that I can ethically try to help.  Same thing with stuff over the phone.
>
Maybe it's a difference in learning / communication style, maybe a
difference in training, but I have had and heard about wonderful results
through e-mail and phone helping. One thing that is harder by e-mail
than by phone is that it is isn't as easy to ask a lot of questions and
let the conversation lead you in a different direction. When I read the
mother's post, however, my first thought was that she was struggling
with ppd and could probably use some telephone help, active listening
etc. even more than help with the technical aspects of her situation. I
would refer her to some local support -- an LLLL (she has been to
meetings, but perhaps needs some one-on-one telephone helping), public
health or other community support.

As far as the technical stuff goes, you could e-mail her and ask her
questions about the baby's weight gain, whether she has had the baby
assessed by a physician, etc. I would also ask her if it is coughing or
sputtering (just as spitting up can be construed as vomiting), if it
always starts after a few minutes into the feed (in which case it may be
when the milk lets down strongly again) etc. A couple of mothers I have
worked with have found that breast compression works for slowing down /
channeling the flow as well as for stimulating it. I think some babies
must be very particular about how much milk is going down their throat
and how fast it is going in, and any mechanical mechanism that evens out
the flow seems to help a bit. For these babies, taking them off the
breast when the let-down occurs can be frustrating, because they tend to
be eager and anxious. Feeding lying down, and feeding before a baby is
completely awake, can be helpful for baby and mother.

I'm not convinced that either the LC or the LLLL missed something
serious, because as it was written it sounded like a typical reaction to
a strong let-down and a mother who is overwhelmed with mothering.

And I would say that Trish's help is *way* better than nothing; it is
given from where things have the most value.

Jo-Anne Elder, IBCLC, telephone volunteer

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