Hi everyone,
I'm going to be nomail starting Sunday for a couple weeks since I'll be out
of state, but would really appreciate any support or ideas you have about a
woman I just referred to another LC locally for help.  I have referred her
to a wonderfully knowledgeable, compassionate LC whom I'm confident can help
her IF the client calls.

Please note that all capitals below are for emphasis only.

IF she calls, and that's a big IF, it would be for help with relactation.
OR for a suggestion for what ABM to try next.  GROAN.  I'm frustrated with
what appears to be a major case of this woman having the YES, BUT attitude.
I know you will appreciate that this little baby is the one who may suffer
because of mom's YES, BUT's.....

She has a two month old premie, born at 4 lbs., now 7 lbs.  Has been on so
many different ABM's that it makes my head spin.  At one of her Lamaze
classes with me I noted that the mother had marked fluid retention.  I spoke
privately after class to her and her spouse, questionning her BP status,
asking about
headaches or visual changes.  She reported headache and visual disturbances.
I discussed pre eclampsia, toxemia, HELLP syndrome.  She was adamant that
she didn't consume ANY sodium.  Verbal diet history  (mostly given by
husband in her presence) revealed that she DID take in LARGE amounts of
sodium.  YES, BUT she couldn't (read WOULDN'T) cut it out.  Advised her to
call MD that night.  Said she would.  Husband said he'd make sure of it.  I
called her again in a.m.  No answer.  Based upon her attitude the night
before, I was sincerely concerned that she might not call the doctor.  I
spoke with her doctor (with whom I sometimes work)  learned she'd called,
was admitted, and delivered by emergency cesarean that day.  Whew.  Mom in
ICU few days.  HELLP syndrome.  I kept in contact with husband.  Very
worried about his wife of course.  Long story short, she
finally got home.  Took meds for high BP x 3 weeks.  Never BF baby.  Never
expressed any desire to BF and had not taken my BF class.  Baby on ABM.  Ok,
that's her choice......  I make a few followup calls, and all seemed well.

Time passes.  Okay, now at 2 months she suddenly calls.  I learn baby's ABM
hx.  My
head is spinning.  She calls ped every day.  Switches formula's nearly as
often.  Sometimes daily.  Baby has been on all but two formulas she says.
Back and forth.  You name it, she's tried it.  Never seeming to give baby's
system a chance to clear one formula before compounding things by adding
another into the fray.  Cites reasons such as severe gas or that she knows
baby doesn't LIKE formula which she can TELL because when she puts her down
milk runs out of baby's mouth......  She's sure baby must be allergic to all
of them.  Baby continues to gain weight but has gasiness and has been
struggling with diarrhea for a week or two.  Pediatrician well aware of
this.

I bring up relactation.  Gently.  But firmly.  As a potential relief to her.
And to baby.    Citing no baby's ever been allergic to breastmilk.  Am very
compassionate.  Lots of empathy for how difficult this must be for her.  And
for her baby.  Briefly trying to point out there's a likely solution to this
dilemma.   YES, she says, her aunt suggested it, BUT she doesn't think its
possible.   I offer ideas about relactating,  give the LC's name and number
since I'll be out of state a few weeks and won't be available to her myself.
Say wonderful things about the LC (all true).  Mention she can rent or
purchase a breast pump from her and get lots of information and guidance on
establishing lactation.  She takes number, BUT says the hospital said 2
months ago they'd give her a pump and so maybe she'll just get that.
Divulges she did pump and dump for a few days when on BP meds right after
birth.  This is news to me......  The YES, BUT attitude is getting
complicated with I'LL TELL YOU WHAT I WANT TO IF AND WHEN ITS CONVENIENT FOR
ME SYNDROME (about sodium intake, pumping, etc...)

I emphasize to her the need for working one on one with a terrific
supportive
knowledgeable LC, and that insurance may likely reimburse.  She says money
not a problem since ABM that she's using is costly a fortune anyway.  Goes
back to YES, BUTs about she doesn't think milk can be brought back in.  I
point out that even adopting moms can lactate.  I've had moms relactate
before.  Tell her that LC I'm referring her to will be a wonderful support
in this.  Meanwhile she's constantly bringing up baby's apparent discomfort
and her frustration.   YES, BUT, she says, if all it involves is pumping she
can probably pump.  (Note word PROBABLY)  Says she doesn't need an LC.  I
feel confident pediatrician is seeing  baby frequently but am so frustrated
with this mom's
YES, BUTs.  Perhaps she just needs to say NO via her YES, BUTs, before she
can say YES to calling the LC.

Oh, and the reason she gave for calling was that she wanted me to tell her
which formula is the next one she should try.  My response, is that I'm not
an expert on ABM and do not recommend any of them.  I'm an LC.  If she does
call the LC, I wouldn't be surprised if the first question is about what
other ABM she should try.

I'll be grateful for any feedback, ideas, etc. you can offer.  I know I
remained professional, compassionate, and supportive to her.  I feel good
about that.  But I'm
feeling so troubled for this little baby and this mom's attitude.  She did
(finally) call me, right?  So that does indicate she may be open to my
suggestions.  I'm hopeful she'll call the LC I've recommended for help while
I'm away.  It could be a very frustrating consult.
Or maybe a very rewarding one, if she can put the YES, BUTs aside in the
interest of her baby.

Any thoughts gratefully accepted. Thanks, folks.  I appreciate it from the
bottom of my heart.
Joyce Blangiardo RN, FACCE, IBCLC
LamazeLady+AEA-msn.com