I couldn't come up with a good subject line for this post, but wanted to
relate a recent interesting situation I have had.
I provided prenatal care for a woman expecting her 3rd baby. I did her
prenatal care for her 2nd also, and attended that baby's birth. She has had
a complicated obstetrical history, with her first baby being born at 31
weeks, then she developed hypertension and the last 2 pregnancies have been
complicated by hyptension. She exclusively pumped for her first baby for
about 2 mos, but never breastfed her. Her second baby was born at 38 weeks
and did breastfeed, but was weaned around 6 weeks. The woman's husband is
very uncomfortable with breastfeeding, and didn't want his older son from a
previous relationship to see any breastfeeding and didn't want her to nurse
outside the house. She felt very restricted and unhappy while nursing, so
weaned.
During this pregnancy, she told me she decided not to breastfeed at all,
even though she "knew I wouldn't be very happy about it." This comment gave
me pause, as I certainly don't want my patients to breastfeed just to make
me happy! We had several conversations after that, in which I tried hard to
remain neutral and seek out what things made breastfeeding not work for her.
She did mention that she had enjoyed breastfeeding, and she was worried
about the health effects of not breastfeeding, but just didn't feel she
could do it. In the end, she decided she wanted the baby to have colostrum
at least, and would breastfeed in the hospital only.
Then, her birth turned out to be much different than we anticipated. She
came to hospital with bleeding, turned out to be having a placental
abruption, and had a true emergency cesarean birth under general anesthesia.
Surprisingly, even with this difficult start, she decided to keep to her
plan of breastfeeding at least in the hospital. The baby was just 37 weeks,
and small, but was a fabulous breastfeeder. By discharge at day 4, the baby
had already gained 2 oz over birthweight, and the mother was pleased enough
that she decided to continue at home "at least for a while."
I don't know how this will turn out, and suspect she will wean early again
once faced with the stresses of her daily life - but I was glad she decided
to give it a shot, and she seemed quite pleased that she had, too. It was a
good lesson for me on how my patients perceive me and my advice. Although
it's very hard sometimes for me to counsel someone who believes so
differently from me, there is a lot of value in trying to remain open to the
patient's perspective and help work out their issues.
Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose
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