Carolyn,

So glad you addressed the issue of how to work with the moms and what we need to
say to them.

Yes, as an LC I am very aware that stress and pressure can cause a reduction in
oxytocin release, thereby causing a reduction in milk release thereby causing
milk pressure and a reduction in milk production.  BUT this is not what I tell a
mom whose baby is in NICU or Intensive Care due to a major illness or is
suffereing some other such stressful situation.

I well remember being under stress - my dad was dying and I was pregnant with my
second, had a toddler and needed to get to Puerto Rico from Chicago - if anyone
had told me that in order to breastfeed I would need to relax, I would have quit
nursing!  I KNEW I couldn't relax!!!

When moms are in this situation at our hospital I use warm compresses,  put the
breast pump on and I NEVER say she needs to relax in order to pump - I show her
HOW to relax and pump.  We do deep breathing exercises, massage, visualizations,
talk,  cry, and make plans for when baby is out of danger.  I explain how her
milk supply will fluctuate as the baby goes through crises, and how it comes
back as things get better as long as she continues pumping regularly.  Perhaps
this is too simplistic a description, but we've had only one mom not be able to
pump and she had a great deal of problems with hormonal imbalance and her MD
wanted her to "stabilize from after delivery" before giving her any thyroid or
running any tests.  She was too stressed out to seek another opinion.  (To go to
an MD here is to give up a day while you sit and wait your turn - private or
clinic patients all have the same problem.)

I also loved your comparison with "stars and navigational skills" that we each
must develop.
My thoughts are that the emotional support "Counseling" is an important aspect
of our "Consulting".  In fact, at times we are not a person the mom is
consulting but one from whom she is seeking counsel.  When I percieve this, I
try to clarify to mom what I heard her ask:  "I think you're asking me not a
breastfeeding skills question, but a question related to child care philosophy.
I will answer it in that context - in other words, when I tell you the baby
needs to have 6 wet diapers, this is a very serious "rule" we need to follow in
order to make sure your baby is doing OK - when you ask me "should you pick up
the baby even though he's full", you're asking a philosophical question - and I
have a very strong opinion on it, but there are no rules you MUST follow, and
you will hear my OPINION but you must form your own."

In our work there are so many skills that develop via practice - and what works
for me at my age in my culture and with my personality doesn't work with another
person.  We each must find our own "star to navigate by" and change direction
based on what works and doesn't work...

Jeanette Panchula, BA-SW, LLLL, IBCLC, RN
Puerto Rico
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