Dear Friends:
    This is from  the hospital LC where the mother from Sudan delivered her
premature daughter.  She gave her permission to copy this post, minus some
identifying  details.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
" There is often more to a story than  meets the eye and ear.
This mom not only was educated about  pumping, but also about breastfeeding
and childcare more times than we all could  count. When I first met her, she
refused to look at me and deferred to her  husband to speak in Arabic for her. I
could tell that she understood much of  what I said and that she could
communicate in English. Eventually, she responded  and developed a relationship with
me. Her husband informed me that in Sudan, she  lead a life of great
privilege. EVERYTHING was done for her and she knew how to  do nothing for herself or
her husband. Her frustration with him showed  constantly, and he was nothing
if not totally devoted to her. She showed extreme  detachment from her child -
at first refusing for over a day to even visit  because she was too scared. I
manuevered her passage into the NICU, because she  kept focusing on a 25 week
old  in the crib next to her daughter's. Using  privacy screens, I blocked off
her view of this infant, even circumventing her  entrance around other cribs.
All this mom kept focusing on was that her baby was  too small. Meanwhile,
she was an excellent weight, and from my recollection, at  35 weeks gestational
age. All the mom wanted me to do was to clothe her infant  so she wouldn't
have to see how tiny she was. After much coaxing, I had her  touching her
infant's fingers and body. Not only was she educated on pumping  techniques, but I
even arranged for her to get a WIC pump - which she did.  Meanwhile, her milk
was NEVER thrown away, nor was she ever told it was  unclean. Those were her
words and not mine or the staff. A translator was  brought in several times for
her in the NICU. She was taught by me to  breastfeed, but always felt she
didn't have enough to feed the baby. On day of  discharge, she never even attempted
to dress her baby, the nurse had to do it.  She was so overwhelmed by
everything that we were very concerned about her  emotional well-being as well as the
infant's physical well-being. She complained  of not getting enough milk yet
didn't pump frequently. She felt her breasts  couldn't nourish this tiny
child, and didn't successfully put infant to breast.  Follow-up visits at home were
arranged for quite awhile because of this mom's  emotional state and
naivete.Every staff member displayed the utmost compassion  and patience with this
couple. This mom continuously asked about things being  wrong with her daughter,
as if she couldn't believe that all she needed for  discharge was a little
time. Her questions were incessant and redundant. She not  only asked about her
daughter, but every other child in the nursery. ALL of the  staff did an
outstanding job working with her, but we never felt as if she'd  made a maternal
connection.
Upon d/c, we felt that given all her  anxieties and lack of initiative with
breastfeeding, that having her  continue to bottlefeed might enable someone to
help her and keep her from  feeling more overwhelmed than she already did.
Now you have the whole story. As I  tell my students, "sometimes with
breastfeeding, you have to know when to hold  them, and know when to fold them".


++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

        After reading this  response, and being fascinated, amazed and
grateful for such collegial  communications, I had more thoughts about this mother
who is a woman about  whom we know very little, except by her behavior. I
wonder if she was considered  a 'catch' in her society because of her status. Did
her pampering reflect a high  status on the part of her parents; was this part
of the attraction for her  husband? Did he dream of sustaining her at that
level, as a sign of his own  growing prestige?

Does her behavior reflect a basic lack of life  skills and flexibility?
Perhaps some defect in personality, fostered by her  upbringing? Or some other
trait that would have been just fine, at home in the  Sudan? How essential is the
role of her mother ( the baby's grandmother) for her  to take on a mothering
role herself?
    The only question she asked me directly, with  sustained eye contact, was
"How can my mother and sisters come to be with  me?"
    (In some cultures, eye contact is considered rude.  I never know where to
look when I am in the home of some Asian or African  national. Do I address
my questions to the husband? How am I being  perceived? How can I get my
message through? I compromise with sideways  glances or looking at the floor while
sitting next to  the woman, unless she looks directly at me. They probably
still  think I am rude.)
    Is this woman showing signs of PTSD? Is she in such  shock, and needing
such mothering herself that she is unable to care for her  baby adequately? Is
she constantly fearing for the lives of her mother and  sisters and loved
ones, as her country is torn apart by war? What was the impact  of a
state-of-the-art NICU on a woman whose only experience of prematurity was  that the mothers
stayed with their babies in a possibly far simpler setting?  Does she see the
prematurity as some punishment by god for leaving her country,  abandoning
her family to their fate?
    At the same time, I am concerned about the safety  of this baby. The
father works long hours. The home, while simply and sparsely  furnished (by our
standards) was immaculate; the mother was very thorough about  washing and
cleaning bottles and pump equipment before using them with her baby.  The lack of
infant contact and cuddling is alarming.
        warmly,


Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct  Faculty Union Institute and University
Film Reviews Editor, Journal of Human  Lactation
Support the WHO Code and the Mother-Friendly Childbirth  Initiative

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