Jennifer,

When I read your post re mom not breastfeeding frequently enough, but pumping 
instead, what jumped out at me is a need to ask mom how she feels.  I don't 
know if you've already done this, but offer these insights. What are her goals 
for breastfeeding and why is she having difficulty following plan of care?  
The following scenario might elicit information that would help you help her:  
"It seems you're having difficulty with breastfeeding and making sure your baby 
is getting enough.  How do you feel about this?  It can be scary when you are 
used to seeing what baby gets by bottle (it can be measured) and then trust 
that baby is getting enough by breastfeeding."  Something along those lines 
might help this mom express her fears and explain why she's feeding as she is.  I 
feel moms need to verbalize what they're feeling first, before they can ever 
incorporate what's being told them.  I can think of alot of different reasons 
for this mom's lack of follow through with what you've suggested; lack of true 
understanding of infant's need to eat frequently, ambivalence about 
breastfeeding, lack of support/interference from family, difficulty juggling the needs 
of her first child.  

Clinically, if available, a home visit to assess situation of home, feeding 
weights to show mom her baby is getting x amount of milk from her breast, a 
trial of breast only with weights done after a day or two of this, and treatment 
of thrush (which I'm sure was adressed).  

I think her previous experience with first child is influencing how she's 
approaching this baby and sometimes what seems like indifference to breastfeeding 
(glad baby is sleeping long stretches) is merely fear on mom's part; fear of 
her baby not thriving, lack of confidence in her ability to breastfeed.  
Addressing her feelings and exploring how these impact breastfeeding and plan of 
care, in my experience, then helps mom to be better able to reach her 
breastfeeding goal, not ours for her.

I'm not negating your frustration as I've been there, but usually if I 
reassess why I'm hitting a brick wall and act on this by talking with mom, the 
bricks fall down, sometimes one by one, and thankfully, sometimes in a heap.

I just experienced this with a Japanese mom who speaks/understands very 
little English; we finally communicated that I will see her again only if this is 
what she wants.  (An interesting case of cultural differences and respect which 
I will try to share later).  Hope this helps at all, and I am impressed, as 
always, that you analyze your cases so thoroughly; moms are fortunate to have 
you.

Barbara Latterner, BSN, RN, IBCLC

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