In a message dated 96-10-17 09:02:59 EDT, you write: >am working with a mom 25 y/o who had a stroke 1 month pp. bf was going fine >untill the stroke. This mom is highly motivated. . does anyone out >there think maby relactating is not a good idea for a mom with a stroke and a >pacemaker and a replaced valve? > >I feel like I am this patients only advocate. Here is a women with an 8 hour >a day therapy schedule spending every spare minute she has pumping her >breasts to make milk for her baby and she is unable to use the entire right >side of her body. she has an entire team of nurses and therapists on her >case and as I was reviewing the goals for her recovery not one thing is >mentioned about her goal to relactate for her son. there is mention in the >notes of depression and the need to treat with antidepressants if needed. I >have explained to the doctor that if she could succeed with this effort I >believe it would go a long way to help her depression, not to mention the >natural calming effects of prolactin. I told this mom tonight how proud she >should be of herself for her efforts. Any thoughts, comments,suggestions, words >of wisdom and especially prayers would be appreciated. Jessica, I know of no reason why this mother should not be allowed and even encouraged to continue her efforts to relactate. Medications would of course have to be evaluated. My first thought is for you to be honest and discuss with the mom that her medical professionals are not seeing her efforts to relactate as even part of her therapy. Tell HER what you told US that it is not even mentioned in her care plan, but that it CAN be. SHE is her own biggest advocate and with all this effort she is putting forth she must also communicate her needs and desires to her doctor and therapy team to get them to cooperate and even participate.(plan times during the day for the pumping just like they schedule the other therapy) She and her husband are a part of her rehab team and need to SPEAK UP! This is a foreign environment to this couple and they may not know that they can bring this up. She needs to ask for her doctor to prescribe your services. You can help her with assertive (not agressive) communication techniques . . . help her use "I" messages: "I feel terrible that I have lost breastfeeding. I want to relactate and nurse my baby again. Part of my depression and feelings of loss involve my loss of being able to care for my baby. This is something I CAN do for my baby and I need your help. I would like to be able to resume nursing my baby at least partly. I want to ask you to prescribe the services of my LC" I learned a long time ago doctors usually respond in a very positive way when a patient asks for his/her help. That is the main reason they went into medicine. These phrases are just a suggestion of course. You can talk with her and write down her words of her feelings. Help her say what she feels in her own words. Help and encourage her to see that she CAN ask her health professionals(if there is a physhologist or social worker this may be the best person to approach first) to hear and understand this very important need of hers. Also you can inform her that she may be the first nursing mother they have ever cared for on this unit! It is NOT that they don't want to help and be supportive of her relactation, it is that they are uninformed of the possibility of it, and of its importance to her, and it has not been part of their routine care. A lot of mothers see themselves as pioneers when you tell them this. Let her know she can help pave the way for perhaps another mother who may have a nursing baby and be in this hospital or on this unit. A lot of good things can happen when you teach people to be better advocates for themselves. The best thing would be for the husband to be with her when she does this. Then they can say . . . "We have discussed this and we would like for you to include my relactation in my rehibilitaiton plan." A lot of the staff--the doctors esp. are older (and see themselves as wiser) than she is. Presenting a united front with her husband elevates her position to that of a mature, married woman and mother, not just a pitiful young woman with a severe medical problem needing their skilled care. Good luck, Jane Bradshaw LLLL, RN, BSN, IBCLC former med/surg nurse & public health nurse (taken care of many stroke patients)