Dear Debbie,

I can empathize as I recently went through a very similar situation; so 
sorry.  
You wrote,  "After going through years of infertility treatments and 
miscarriages, she now has her precious baby in her arms and I get to rain on her 
parade by telling her that one more body system is not functioning as it should.  I 
guess I didn't realize that my dream job would sometimes include being the 
bearer of such bad news.  Maybe I thought that privilege was reserved for 
M.D.'s.  "

I recently made a home visit for a mom and her 4 day old baby, and as I sat 
next to her, before she even removed her shirt, I could see very small, widely 
spaced breasts, and my heart sunk.  Mom was referred by her pedi for infant's 
weight loss, but felt it was a latching problem.  Palpating her breasts, I 
felt minimal ductal tissue. Based on her history of inadequate breast 
development, no pregnancy breast changes, no feeling of fullness and baby's feeding 
weight of neg 6 grams post 10 min of valiant sucking, no swallowing, I shared 
information on PCOS of which she had symptoms, but also let her know the jury was 
out at this early stage of the game.  We proceeded to follow "rule number one" 
and fed baby with supplementer at breast.

Amid her torrent of tears, I patted her, telling her I was so sorry and let 
her emote.  One thing I said to her several times was that she needed to grieve 
the loss of the "perfect" breastfeeding relationship she'd envisioned.  I 
informed her of all the benefits of breastfeeding with supplementer, also and 
reiterated rule number one and ways in which she may be able to increase milk 
production.  I left her still crying with her husband (who was visibly angry at 
me).  As I drove away, I hit the steering wheel a few times and swore out loud 
on the way home.

I went home and ranted and raved that her OB had seen those breasts and knew 
her hx and never raised the possibility of supply issues.  I felt angry, 
helpless, and frustrated but when I called her later that evening to see how she 
was and ascertain baby being fed, she said she was sad and realized, as I'd 
said, that she had to grieve this loss.  I think that acknowledging this fact was 
helpful for her and letting her know I was there for her to listen and allow 
this process.  I called her a couple of more times then respected her wish to 
work on things alone for a bit and a week later saw her again to follow up; 
best of all she came to my support group yesterday and will continue weekly with 
group.  There's more to her case but mostly I'm responding to your feelings of 
"being the bad guy" and acknowledging that yes, it is hard, but often 
standing by someone and taking their anger as normal and knowing it's not really you 
but just a "don't shoot the messenger" kind of situation.  So, Debbie, call 
her and simply let her know you're available and that she can call you when 
she's ready. 

It isn't you she's angry with really, as you know.  She has a right to be 
angry and sad, acknowledge that to her.  Please let us know how things progress 
and feel free to email me privately should you need to emote and discuss your 
feelings further.

Warmly,
Barbara Latterner, BSN, RN, IBCLC 


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