This post was born from a Facebook comment Sejal made about not understanding why professionals are hesitant to share their knowledge. I asked her if she could think about it and share something for the 31 Days project. Sure enough -- she gives her back story, and then shares how fortunate she has been to be mentored by amazing, open IBCLCs.
A few days back while I was in the hospital visiting a friend of mine after their surgery, I saw a family with a brand new baby heading home from the hospital. As I walk past them, I see a lady walking next to them, pushing a hospital cart filled with a few balloons and flowers resting on top of a couple of Trader Joe’s reusable bags and a duffel bag.
This brought back so many memories of my own discharge from the hospital I gave birth at and how it was a cold December morning that we walked to the parking garage with our newborn daughter dressed in a red fleece dress and buckled up in her car seat. I don’t think we realized how cold it was for her tiny little feet to be outside in the breeze.
My baby girl was upset with the draft of the cold breeze and I was so upset with her crying as we tried to get her into the car. Fumbling through the seat belt and a bunch of other stuff to keep her warm, we managed to at least get out of the parking garage. I sat down in the front passenger seat (mind you this was the one time I hated sitting down because of the perineal pain). If I had known what I know about mother infant separation and how I could have been closer to her and kept her less stressed and more warm by being in the seat next to my daughter I would have been able to keep her calm. But what did we know as new parents, apparently nothing, but as they say ignorance is bliss and bliss we did feel when we had her in our arms after a long traumatic birth.
Here we were leaving the hospital, embarking on this journey as three of us instead of two of us, completely oblivious to what was ahead of us. The drive home was not too pleasant and every bump in the road was causing me pain. It felt like I was hanging on to the handle on the inside of car so I did not have to put any pressure on my perineum. At home my kind and loving parents were waiting for us to get home with our little nugget. I just wanted to lay down but the pain was too much and by the time I reached home, my feet had gotten half a size bigger. I still had no idea what was going on. I could not walk properly or sit properly and then the idea of breastfeeding my baby without any help from the nurses seemed daunting. My mom was really willing to help and she did try but somehow my daughter could not latch without a nipple shield. Also no one at the hospital had shown me how to breastfeed my daughter lying down and that was a completely foreign concept to me. Every time that my little girl needed to breastfeed I would sit upright in my bed, get my Boppy pillow ready, cover it with a receiving blanket to protect the pillowcase (mind you I was a clean freak back then) and have my mom bring my baby to me to feed, and every time she tried to latch, either the nipple shield would fall off or she would accidentally whack it out of place and then the whole saga of a screaming baby and flailing hands and crying mama would begin.
By Day 3, my breasts were getting engorged and my feet were super swollen. I could not walk to the bathroom, which was only 10 steps away from my bed. I called my OB's office and they said I needed to come in as soon as possible because they were not sure what was going on with my swollen feet. When my OB came in and saw my face, my feet, and my hands, she smiled and said, “You look like the Michelin Man”. I was unfamiliar with who the Michelin Man was but figured it was a character out of some movie. She gave me a script for diuretics and sent me home. She did not even tell me that the number of times I would need to get up to pee would be exhausting in and of itself. I came home and breastfeeding was still difficult for me and my baby. I kept using the nipple shield and having the struggles. I went to develop mastitis and had a really high fever which put me into a delirium. I kept telling my mom, that she should take care of my baby in case something terrible were to happen to me. The pain with breastfeeding was excruciating and I was feeling like I was going to die.
The doctor’s office called in a prescription for antibiotics and I started them immediately. They told me to use the manual pump that I had to relieve any engorgement. I ended up using the nipple shield for 3 months before I went in for a lactation visit at our local hospital where I met a lactation consultant who helped me breastfeed my baby for the first time without a nipple shield. I had never pictured myself not using the nipple shield.
Fast forward my life 10 years and now I was a veteran mom who has helped her friends through their postpartum journey, and my kids were growing up and I was doing the best I could to fit this mold of a supermom, partly created by the expectations of the society, the family and myself. Due to a life event, I had to make the choice of going back to school to get a vocational certificate that could get me a job and somehow I chose to go to nursing school. I became a CNA and then started taking my prerequisites to apply for nursing school. I was also working as a CNA at a private nursing home. I worked 4 half days and learnt so many things on the job as well. During my year as a CNA, my younger sister who was pregnant at the time sustained a fall and broke her leg. She could not move and had to have surgery. She had to stay in bed until her baby arrived and I left my job to care for her. She had her baby and I was there to help her during her postpartum recovery and so were my parents. She was having breastfeeding troubles, her baby was not gaining weight very well and had jaundice. The hospital lactation consultants came and helped as much as they could and then we went home.
The breastfeeding continued to be a struggle and she had to start supplementing with formula. We tried to look for someone who could come to her home for a lactation consult and finally found a lady who did. The lactation consultant started her visit and I was a mute spectator in the room, and all I could think was, who is this person who is so knowledgeable about breastfeeding and was able explain everything to us so clearly? Her name was Meg Stalnaker. Why did I not meet her when I had my first baby ? I absorbed and listened to everything she did and said, as did my sister and brother-in-law. I just had a lightbulb moment. I wanted to do what she does. That was it. I did not want to be a nurse. I wanted to be a lactation consultant. I talked to my sister and she told me that I should ask for the contact information for this angel who helped her. I don’t know why, but I did.
I kept doing my own research about what classes I needed to take and signed up for them at the local community college. I kept in touch with the Meg via email. After I finished my community college classes, I contacted her again and asked her if she could be my mentor. She said yes, but there was a caveat. I needed to wait until she finished mentoring two other students she had at the time.
I was really sad that there was not enough guidance on how to find mentors for the pathway I had chosen to become an International Board Certified Lactation Consultant. It also felt like there were a lot of negativity in regards to choosing to become an IBCLC as a career. I kept looking to see if someone would be interested in being my mentor and taking me on as a student.
During one of my lactation classes at the community college, we had a guest speaker by the name of Peggy Andrews, who was giving a lecture on the topic of jaundice and breastfeeding. I saw a tall woman with golden and white hair walk into our classroom with a smile. She had the brightest smile I had seen on someone’s face. She started the lecture and I was just mesmerized by her way of teaching and felt like I was back in India in my middle school, listening to my favorite biology teacher. At the end of her lecture she shared her email address with our class and something in my head said, “Sejal, you need to email Peggy and ask her if she could be your mentor.” I mean that was a spur of the moment thought and I acted on it by sending her an email asking if that was possible.
The next moment I thought, oh boy, have I made a big mistake by asking this guest speaker to be my mentor. I was hoping that I would get an email saying how inappropriate that question was. To my surprise, I hear back from Peggy saying she loves to mentor students. I was cooking and jumped up and down in my kitchen saying, YESSSSSS!! Wait that is not it, I actually got a call that evening from Peggy asking me if I wanted to go on a lactation visit in Washougal the next morning. I said, I most certainly would, but then I thought, where in the world is Washougal? Well it is in our neighboring state of Washington.
The next morning I meet Peggy at a designated location and she said to me that she will be driving me to the appointment since it is so far. I was so excited and off I went on my first official visit. I started learning about how to talk to a new mother, ask specific questions and give her plenty of time to tell her story. We were there for an hour and a half and I felt like I still made the right choice by asking Peggy to be my mentor. I have learnt so much about being a good listener from Peggy.
I never for one moment thought that Peggy was keeping any information from me when it came to lactation. I had asked a few other local lactation consultants and they said that they don’t mentor students and I was quite discouraged. I am sure other students like me were discouraged as well. Meg, also let me go on a few lactation visits with her and I kept learning from both Peggy and Meg.
One day I saw a class on hand expression at a local boutique taught by another lactation consultant named Bryna Sampey. I immediately signed up for it, and when I went to the class I was secretly happy that I was one of the two people in class, although I also felt sad that people did not sign up for this informative class. I felt like I had learnt so much about manual expression of breastmilk in this class and that little voice in my head said, “Sejal, ask Bryna if she would mentor you.”
After the class, Bryna asked if I wanted to have a bite to eat at the place next door. I jumped at the opportunity to hang out a few more minutes with this brilliant brain. I was practically salivating. We talked about what I did as a postpartum doula and how I was studying to be an IBCLC and she mentioned to me that she also mentored students. I almost wanted to give her a hug and say, where were you a year ago and why did I not meet you earlier. I did not want to be a total psycho so I did not hug her, but told her that I would love to be her mentee. She said that she would let me know as soon as a spot opened up.
What I learned from Bryna and her brilliance made me think critically about breastfeeding and the challenges that come with it and how she made breastfeeding a breeze with all the techniques and tricks that she shared with her clients. As I followed these three amazing women, as my mentors, each one of them taught me how to help with breastfeeding challenges in their own special ways. I feel blessed to have learnt from them and will be eternally grateful for them sharing their wisdom, knowledge and time with me.
I was talking to other lactation students like me one day, who were in the same boat as I was and one of them told me that when they asked a local IBCLC to mentor them, the local IBCLC said to them, and I quote, “Why would I let you shadow me ? You will take my knowledge and compete with me once you get certified.” I was so shocked to hear this. I have no idea who the IBCLC is and don’t even want to know, but it made me realize how fortunate I was to have mentors like Peggy, Meg and Bryna.
With the struggles I had in finding mentors, I had decided in my mind that if I ever become an experienced lactation consultant, I will mentor students. I am an IBCLC now, and I am a brand new IBCLC, but I hope to someday mentor students. I think it is our responsibility as professionals to mentor the future IBCLCs. My dad used to say, knowledge only increases by sharing. He is a brilliant surgeon and he has helped many other doctors become surgeons and I am certain he never thought this way.
So, why do some people have a hard time sharing their knowledge with others who are seeking mentorship in the field of lactation consulting ?
Maybe the experienced professional does not have the time or the resources to mentor someone. Maybe the experienced professional thinks that, sharing their knowledge with newbies will reduce their chance of personal success.
Maybe the experienced professional does not trust this newbie. Trust building does take time.
Maybe the experienced professional in the specific field is a knowledge hoarder.
Maybe the experienced professional wants to have monopoly in their field.
Maybe the experienced professional feels more powerful if they don’t share their knowledge.
Being a mentor and taking on mentees is also a huge responsibility and one that is not easy. I understand that it may be difficult to take on students, but in the field of lactation consulting, I wish we had more mentors. I wish students had access to mentors without having to wait for a long time. I wish experienced IBCLCs would be willing to share their knowledge and expertise with them.
Mentors are an inspiration. Mentors can connect you with opportunities. Mentors know ways to make you succeed professionally. Mentors keep you motivated. Mentors invest their time and energy in you to help you grow. Mentors teach you about finding a good opportunity. Mentors have been where you are and can empathize with your struggles and help you find your way through the obstacles and hurdles. I am so thankfull to have found such mentors who continue to be there for me and do not feel threatened by my success.
Sejal Fichadia, owner of Kindred Mother Care, is the first 31 Days participant to be featured four years in a row. In 2014 she wrote "Our Culture's Needs for Postpartum Doulas," in 2015 she added "Growing Happy, Healthy Moms." Last year she added "Hitting the Pause Button." She has a love for babies and mothers, and feels it is important to help families learn skills to help them on their parenthood journeys. Sejal works hard at expanding her education and working to improve her knowledge base so she can provide families with up-to-date, evidence-based information, which in turn gives them the tools to parent with confidence. This year she passed the exam to add IBCLC to her credentials. She has a caring heart, and as soon as she can, she will be mentoring others wishing to get to IBCLC.
Poetry ties in with birth work. So often, when moved (or tired), phrases that describe what I am seeing or experiencing come to mind. The way the words arrange themselves isn't linear, like normal, but often spiraling, like birth. Sometimes I write them down, and sometimes they float in, and then out, of my mind. I love that Bryna took the time, while exhausted, I am sure, to take note of the words that came to her this night.
Driving home from a birth or a late-night home visit, it’s quiet.
The car, my mind, the road– the same sort of weighty hush surrounds me that accompanies a snowfall at midnight.
The cobweb-cones of streetlights in the fog reach out for my car as I pass the dark trees on either side, making my way to my bed. The road shines in my headlights and gets dark. A bit beyond that, it’s lit a little by the moon and an orange brush of the lights ahead.
It’s this time when I think the veil is lifted just a bit. I’m jangled and frayed, having ridden the adrenaline and oxytocin and catecholamine waves with the family I’ve just come from serving.
I’m tired, and I’m quiet, so I’m listening. Connected.
In my exhaustion and exhilaration, it sometimes feels like something is standing just behind my left shoulder, just at the edge of my perception. I can all but hear the ebb and flow of life like waves crashing on a beach miles away.
Right now, someone is being born.
Right now someone is dying.
Birth, death, over and over and over again.
It’s endless- but these moments are so singular and defined. Everyday miracles, I guess, but those words fall so short.
It feels a little bit like sacrilege-- tapping into the pulse of the world.
When I get home, I pull off my shoes and grubby birth clothes, leave everything in a pile on the bathroom floor and slide into bed like nothing happened at all.
It’s just another night of work.
Bryna has 4 kiddos, a seafaring husband, and a sweet pup named Amelia Earhart. She loves to climb rocks, play in the surf, and camp in Big Sur.
She has been working with families since 2006, and became an IBCLC in 2010. She owns Doula My Soul, llc -- a private practice in the Portland, Oregon metro area. She works as a doula specializing in high-risk and surgical birth, a lactation consultant offering home, office, and online consults, and teaches classes through both Doula My Soul and OHSU Center for Women's Health.
Bryna has mentored many students through their IBCLC hours, and loves to share the joy of helping families meet their individual definitions of success!
I have known Jessica for over a decade, and she has been an excellent source of information through the years. We have had parallel lives in opposite sides of the country, right down to our tongue tied first babies. Moving in the circle of birth support, breastfeeding help, and the intense caring that comes with walking beside a family while they struggle -- these are not new concept to doulas. It is no surprise that Jessica brings all the best elements of doulas into the world of lactation and tongue tie.
I’ve been a doula-ing most of life, long before I was a professional birth, then postpartum, doula. How is that? Well, the term doula may have started with birth, but the role, the intention, is really about continuous support. We now have postpartum doulas and bereavement doulas. There are even end of life doulas. To doula is to be someone well-informed about an experience another person is having and to offer continuous support. It’s about meeting that other person where they are and offering to be fully present with them as they experience intense feelings, sensations, and processes. It means to be open and supportive of their loved ones as they work to balance their own needs and that of the primary person in this particular journey.
These are intense experiences through which I offered continuous support for people involved -- I met them where they were and included as much information as I could in how the process might be eased for them. I offered guidance in what choices they had to make. In each experience there was struggle and joy and pain, humor and grief. Things that might be petty to others were looming, and things that might overwhelm another were handled with resilience.
This brings me to where I am now in my life and career. I call myself a tongue tie doula. What does that mean? It makes sense to start with the literal. Tongue Tie is the common term for the medical condition ankyloglossia. It’s where the lingual frenulum (band of tissue that connects the tongue to the floor of the mouth) is restricted of function through being too far forward, too short, or lacking elasticity -- or some combination of these.
One might wonder how a person might be a doula for a medical condition? In the same way a birth doula supports a person or people experiencing birth, a tongue tie doula supports a person or people experiencing tongue tie. This role has formed as I found my private practice as an IBCLC merge with my experience as a birth doula.
In May of 2005 I gave birth to my second child. I was already working in lactation and quite committed to breastfeeding. It was a long and very painful process for both of us to find a somewhat normal breastfeeding relationship. Despite being surrounded by world class support, most of my son’s early days are a fog of pain and confusion for me. He was six weeks old before I found out, be it through lucky coincidence or kismet, that he had a posterior tongue tie. From there, I learned. Then I taught. The doula in me began to appreciate that resolving tongue tie, even in a baby, is most often not an event; it’s a process. It’s one that is usually emotional, often painful, and frequently fairly complicated. I would hold people’s hands, both literally and metaphorically, as they made hard choices, moved with their baby through the procedure to release oral restrictions, supported their baby in recovery and healing, and dealt with their own needs throughout. People who’d had a birth doula would often say, “It’s like you were a doula for the revision!”
Many professionals within the tongue tie community who are experts in tongue tie have a plethora of knowledge. Many provide excellent recommendation, tools, and protocols for the process of gaining function from oral restrictions. The doula factor adds continuous support. There are amazing midwives and doctors who provide excellent, thoughtful, family-centered birth care. They are not doulas because they do not offer fully present continuous support. I know midwives who also work as doulas outside of their midwife roles and they will tell you that the roles are not the same. As a doula who is also a midwife, they may have a lot of information with which to guide families, but the difference comes in the emotional, fully present support that accompanies that information.
As a tongue tie doula, my role is like this. Just as many IBCLCs are exceptionally educated about tethered oral tissues (TOTs), I provide referrals, recommendations, tools, and protocols to families as they work to help their baby obtain full oral function. My role goes one step further, however. I also provide emotional support before, often during, and after the release procedure. I meet them where they are when they struggle with choosing a direction in which to go, as far as medical procedures and various therapies, especially in the face of frequently contradicting recommendations. I hold space as they grieve the newborn and breastfeeding experiences they had envisioned or vent about how hard the whole process is.
Am I the only tongue tie doula out there? Far from it. I know amazing people and professionals in many fields who are tongue tie doulas. Some don’t even know it. Many don’t appreciate the nuances of the care they provide as they see the bigger picture of people’s lives and families as a unit. Many tongue tie doulas are creating bigger-picture care plans never knowing that this perspective is often neglected in the lives of the families they serve. My fellow tongue tie doulas, whatever title they may be using, are the ones holding mothers as they cry, and sitting with fathers as they rage, and empathizing with babies as they struggle to learn a skill they were meant to learn before ever breathing air. Always on the cutting edge of care, we work to support evolution toward improvement. We never settle for accepting an unmet need. And we always, always know that at the end of the day, the parents and babies are the real heroes.
Because doula-ing is not about the medical condition. It’s about the human condition.
Jessica Altemara has been an IBLCLC in private practice for 7 years. She officially became a birth doula in 2004 after being surrounded by birth and breastfeeding her whole life due to a mother who was an IBCLC, doula, and L&D RN. She's passionate about staying on the cutting edge of care in her own practice and in the information she shares with her clients about practices in general; valuing a functional medicine mindset. Jessica offers in-person and online education not only to parents but also to professionals. She's a mother of 4, ages 13-3, in Chapel Hill, NC where she and her husband enjoy the dramatic mixture of technology and nature the area provides.
Be sure to visit and "like" her Facebook page to receive updates and information: Tongue Tie Doula.
Tori is the mother of three boys, a La Leche League Leader, and a birth doula. Her baby, Otto, was born in September, 2015 -- he had ties, but no one really knew until his weight dropped in response to his decreased desire to eat. In Tori's words, she documents their journey, and how hard it was to find help while her baby was struggling to eat and grow.
"Here's a timeline of our journey to the breast.
Born Sept 21 2015, weighing 9lb 3oz, noisy latch, unsettled baby, needy baby.
Jan 2016- weight arrested at 13lb 4oz (in hindsight, because milk supply tanked and no longer fueled by postpartum hormones, looking for adequate sucking to maintain it, baby not sucking adequately or very long per feeding). He would pull off at letdown, refused to latch deeply and the bottom lip never flanged like it's supposed to.
Feb 2016- weight unchanged for 1 month, I started pumping, building back my supply and trying every way under the sun to supplement. SNS, Haberman feeder, syringe, 8 different types and flows of bottles, all with little success. Syringe was best because required no sucking and because of severe posterior tongue tie he was unable to suck properly.
In Feb I saw our Ped, LC, and Speech Pathologist. All 3 professionals examined his mouth and stated that tongue tie was not present, because he could thrust his tongue out of his mouth. I mentioned posterior tongue tie with all 3 professionals and was told in so many words, 'it's not real.'
I had 2 meetings with speech pathologist who encouraged me to spoon feed him and use Haberman feeder to help avoid mouth aversion. She refereed us to Children's Hospital to have a barium swallow study done to watch on X Ray my baby swallowing, mainly to check for silent aspiration which can over time cause pneumonia. The soonest they could get my baby in was April 7th, 2016, 2 months from the time the study was requested.
Over this month my frustration and desperation grew to a crippling degree. I didn't sleep, I was spoon, syringe, bottle, breast feeding around the clock. My baby was fussy but never showed signs of dehydration that I was told to look for (soft spot sunken, dry lips, listlessness, dark urine, few diapers). He had normal large stools and urinated clearish non-smelly urine 12 times per day. At urging of Speech Path, I started keeping a detailed log of every single bit he would eat. I did this for 5 days, it varied from 14 oz to 20 oz, guessing with how much transferred during breastfeeding.
March 4th 2016- I took him for another weight check with Ped. Still no weight gain. 2nd month. I lost it in the office. She offered to draw labs on him and I said yes. Labs showed a drop in blood sodium levels.
March 6th- we repeat labs at emergency room and sent to Childrens because of sodium. By this time I had connected finally with dentist who does posterior tongue tie revision. It's $500, and our insurance was not accepted, so I had been trying for several weeks to get an appointment and gather the money to pay for it. I wanted to revise him before our hospital stay, but both Drs agreed he was too sick. So we put it off until after the stay.
March 7th- after 6 hours of stress for my exhausted baby, with multiple more lab and urine draws, Children's finally placed a feeding tube in my baby. We fed him through a tube down his nose, 2 oz every 2 hours for 3 days. His weight gain was on average 15 grams per day. They were also supplementing his sodium and watching it closely to make sure it was rising, and it was.
March 8th- Barium swallow study performed and severe tongue restriction and silent aspiration of syringe feeding observed.
March 9th- I was persistent enough to get an ENT doctor in my hospital room to revise his tongue. This doctor used a long metal tool to lift my baby's tongue deeply and revealed a frenulum far back under his tongue that no one had ever laid eyes on before. The ENT doc cut this about 1/2 inch long piece of skin and handed my baby to me. My baby IMMEDIATELY latched differently than he ever had, drained my entire breast, which he never had done, and we only did one feeding through the tube that day as he learned to use his newly released tongue. ENT doctor exclaimed 'Oh, that released a lot,' when he did it, in surprise.
March 10th- morning weight gain was 130 grams after breastfeeding all night.
March 11th- consulted with speech path, ped doc and ENT about stretching his tongue to keep revision from re-adhering and all told me not to, but because of my own research I did it anyways.
March 13th- constant weight gain of on average 120 grams per day and maintained sodium levels, so we went home.
I'm attaching two pictures, that were taken 9 days apart. The first one is the day of the lab draw and the 2nd one is the day of hospital release.
I believe sodium levels were low because my baby was starving, not unlike someone with anorexia. I received consults from endocrinologists, geneticists, nephrologists (kidney doctor), lactation consultants, urologists and speech pathologists during our hospital stay. The doctors didn't think sodium was low because of his lack of feeding but were searching for other causes. They did an ultrasound on his kidneys and discovered they were enlarged, but recommended just watching them every few months to ensure they don't get worse. It's my opinion that the kidney issue is unrelated to the sodium levels, but there are still some tests out on his hormones that will answer that for sure (adrenal hormones).
I urge you to educate yourself, if you work with moms and babies, and stop telling mothers that posterior tongue tie isn't real, and to start learning how to clinically recognize it. My case was typical yet on the extreme side, and my baby and I were made to suffer because it went untreated.
I'm personally feeling a huge amount of guilt, and the months leading up to our hospital stay were traumatic for us both. I share this with you in love and kindness and hope you will learn and grow as I have."
I am grateful to Tori and her willingness to share her story. Tori and Otto were let down by many health professionals -- any one's education or awareness could have quickly changed the course of events before hospitalization was needed. Tori has chosen to contact these health professionals, not to stir angry feelings or place blame, but to simply ask them to learn more, so they can help the next family and prevent complicated issues like she and Otto faced.
This week we celebrated IBCLC Day...
to recognize those amazing, top-level lactation professionals who have gone through the difficult steps to becoming International Board Certified Lactation Consultants. IBCLCs are at the forefront of breastfeeding difficulties -- or at least they should be. What seems to happen, though, is when breastfeeding problems arise in the early days after birth, many families turn to their doctors for breastfeeding help. It is natural to assume this provider who cared for you during pregnancy would have the skills to treat sore nipples or inadequate weight gain, right?
Liz is a friend of mine in medical school, and I am so glad she set her sights on becoming a doctor. I know she will do a world of good, absolutely A WORLD OF GOOD, because of her knowledge base and her passions. Liz gave a "Breastfeeding 101" presentation last weekend at Take Root: Red State Perspectives on Reproductive Justice conference. Spend 10 minutes watching this and you will gain understanding of why lactation knowledge is so lacking among our doctors, and why we should be shouting from the rooftops the value of IBCLC help and support.
Unfortunately, the end was cut off, so I let me add Liz's takeaway points:
The last point in particular is one of interest to me: What if all residents received the same three-hour lactation education required by physicians when a hospital is working toward Baby-Friendly Hospital Status? That three hours could be a consistent way to provide lactation education to new doctors.
Three hours -- many of us would be happy if doctors received just three hours of education. Think about this: I just finished 90 hours of specific lactation education as I work toward becoming exam-eligible to get to IBCLC -- 90 hours! And there is something busy doctors out there can do to add to their skills in an easy, effective manner -- today, without even one minute of extra education: Get to know local IBCLCs, and refer to them often!
I had a doula client once who was struggling to breastfeed her baby. Nikki's baby was on her breast about 50 minutes of every hour, 24 hours a day. We were in contact daily, either by phone or in person. I kept connecting her with IBCLCs to troubleshoot the issue.
The first IBCLC was Ashley. She was very experienced, and a friend of mine. She suggested Nikki pump after each feeding and then offer the baby breastmilk in a bottle – in addition to feeding him at the breast. Nikki tried this and quickly realized it may help her make more milk, but it was not helping her stay sane. Ashley had to go out of town, so she suggested we meet with another IBCLC, Brenda.
Brenda was a very new IBCLC, having just passed the exam -- and she was also a friend of mine. Without regard to Nikki, Brenda created a plan to have mom weigh baby before and after every feed and record this information on a sheet of paper that looked like a chart with about a hundred boxes on it (read that sentence a few times so you feel overwhelmed -- that was the intent). Nikki didn’t even get so far as to try this – she said, sadly, “I can’t imagine being able to do all this without having a full-time nanny.”
Alone, Brenda and I discussed the situation. “What do you think?” I asked.
“I don’t really think there’s an issue – I think it’s in her head.”
I was hurt by this statement! I had wiped this mother’s tears, sat with her and listened to her share her fears that she was starving her baby -- that she just knew something was wrong. I didn’t realize how damaging it is to hear a care provider state she doesn’t believe her client/patient.
Compelled to say something, I responded quietly: “Whether it is real or not, it is real to her. How can you help someone if you don’t believe them?” This was real bravery on my part, to tell Brenda how I felt. Embarrassed and feeling vulnerable, I changed the subject. In a couple of minutes, I made up an excuse to leave.
I didn’t say anything to Nikki about this exchange, but she chose to discontinue seeing Brenda. Working hard to keep breastfeeding, she continued to nurse her baby as often as he needed, leaving time for just about nothing else. Exhausted is not even a word to use here – Nikki barely had time to use the bathroom, eat, or shower – forget about self-care, healing, meaningful time with her partner, or just stopping for a minute. Everything was rushed, and what was accomplished was accomplished with a baby crying in the background.
I was able to finagle one more meeting with a third IBCLC, Carly. She was very experienced, and also a friend of mine. Normally Carly wouldn't have been an option because of insurance issues, but as I discussed the situation with her, she agreed to see Nikki.
I was so excited to share the news with Nikki! I called her immediately and said, “Guess what? Carly can see you! She said to just call and set something up!”
Then came a long pause, and, “You know Stacie, I think I may be done.”
Oh, my heart fell. I knew how hard she was working. I knew for Nikki these early days were not about bonding and enjoying her new baby, but about feeling scared and always feeding, all-around-the-clock. I wouldn’t fault her for moving on and putting the breast to rest. Who could? And knowing what I did about this woman -- as we had been building a relationship for months -- and witnessing the strength and power she built and held during her birth, I was concerned she might look back and regret not having tried just one more thing.
I didn’t want to press her, and I resigned myself to one last sentence on the matter before leaving it all alone: “I would hate for you to look back and wonder if this might have helped.”
And then I changed the subject.
After we had been talking for about 10 minutes, Nikki interrupted the conversation with – “Okay, I’ll see her.”
This mother had PCOS, which we all knew, but as her milk came in promptly after birth, we mostly put that on the back burner. Baby was gaining 4ish ounces a week, nothing terrible enough to raise a red flag with the pediatrician. And like I previously mentioned, her baby was on the breast almost constantly.
At this consult, Carly suggested Nikki ask her doctor for a Domperidone prescription, to increase her milk supply. Carly felt Nikki could stop pumping (more like, stop feeling guilty about not pumping). Carly suggested if the baby was nursing that often, there should be adequate stimulation to keep up Nikki's supply. Nikki finally felt her needs were being taken into account as this plan was created and shaped -- that meant it was more likely to be followed.
And things got better, quickly. Nikki got the medication on a Wednesday. She and her husband and baby were going out of town for a weekend wedding. She called me, overjoyed on Saturday, saying she was already making more milk, and her baby was happy and satisfied. “He has been eating every couple of hours instead of every hour for 50 minutes! For the first time ever!”
So what’s the point here?
1. I knew all of these IBCLCs well and continued to trust and refer moms to them. It wasn’t that any one was better than the other. No one made a mistake or mishandled the situation. It’s just that something different came into each lactation consultant’s mind first, and that is part of being human.
2. When we are in a helping position and a mother tells us the plan we have created isn’t going to work, we need to let go of our egos and the feeling of wanting to discount the mother and her experience. She has a better picture of what is happening in her life than anyone else, and we need to trust that.
3. If you are presented with a plan that doesn’t seem workable to you, that doesn't mean you are stuck. A care plan should be made with you in mind, not absent of your specific needs and unique challenges. Seek out a second opinion. Even a third. Because you never know -- sometimes the third time’s the charm.
Just a few end notes:
I used to weigh myself weekly at the midwifery office in Chico, CA where I worked. I could pinpoint reasons I might weigh less or more. For example: fully dressed and Danskoed, I would weigh almost 5 pounds more -- my Danskos alone were about a pound! Despite what I could manipulate on my own, including drinking a ton of water, or peeing a ton of water, there was one other way my weight could change. This office had two scales. One was digital, and that's where I saw the precision of ounces. The other scale was the old, slide-over-the-doo-hickeys one -- you know, the tap-tap-tap-balance kind? The two scales rarely matched exactly, leaving a discrepancy of two-ish ounces lost somewhere in the hallway between bathrooms.
This sweet little one was born at 35 weeks, 6 days, weighing 5 pounds, 13 ounces. His mom is a doula in Bakersfield, CA -- and a friend. Late preterm babies aren't new to her, but solely breastfeeding is. She has been so proud to nurse him, and even prouder to pump for him. He had to stay under the bili lights for jaundice treatment, and since his official discharge, he has been monitored by his doctor through repeat visits for weight and lab checks.
From a Friday to a Monday, he gained 2.4 ounces, checked on the same scale. Great news for a baby at 7 days, who in there somewhere had lost 9% of his birthweight, right? (Mom also had 3 bags of IV fluids during labor.)
On Wednesday, he had only gained .5 of an ounce, and Mom was devastated. "Was it the same scale?" I asked. She replied: "Same office, different scale." I was surprised they didn't want to verify his weight with the other scale, and this mom didn't think to ask in her postpartum haze as her roller coaster dropped down...very fast.
The doctor asked, "Are you able to pump?" Mom responded with a hearty yes, she had almost 50 ounces in her freezer by now. The doctor then looked at her chart and said "Hmmm, let me go get you some formula. Give him an ounce to an ounce and a half after every feeding." The doctor sent this mother away with a bag filled with formula.
We had more time, the mom and I, to troubleshoot. The first thing we looked at was his output, and he was having 7-8 wet diapers, and 7-8 poop blow-outs in 24 hours -- his stool had been yellow since day 4. Even with jaundice at play, I shared the ABM Protocol for Jaundice, which states "Breastfeeding infants should not be supplemented with water, glucose water, or formula," and that supplements offered, if needed, should be "expressed breastmilk, banked human milk, or formula (in that order of preference)..." I suggested she read that document and arm herself with what the AAP's own breastfeeding specialists have agreed is best practice, so she could ask, why is her baby different than the norm? Why is the doctor suggesting formula versus breastmilk?
All along, I encouraged this mama meet with an IBCLC, and I wondered why her pediatrician wasn't suggesting the same? Mom was making arrangements to do just that. Mom was so worried, the evening of the "weight loss," she offered the baby a bit of formula -- and he threw it up. Reaffirmed by this response, she supplemented him with an ounce of her own breastmilk after each feed.
At the next 24 hour weigh-in, back on the same scale that showed the original gain of 2.4 ounces, guess who was up three ounces in weight? As the nurse brought Mom and Baby to the exam room, they passed by the other scale. Mom asked if they could weigh him there? The nurse agreed. Suddenly he was 2 ounces less in weight! Mom came unglued and her Mama Bear claws started to emerge. The nurse showed a doctor, and the doctor tried to explain it away...this Mama was not having it! She demanded a new doctor! The new doctor apologized profusely as Mom told her everything they had experienced, including being sent home with formula and no further breastmilk or breastfeeding information/clarification. This new doctor was understanding and agreed things weren't handled well.
So there you have it -- 2 ounces to me could be the difference between taking my keys out of my pocket or not. But for a new baby, pre-term and being watched closely (not closely enough?), 2 ounces is huge! The importance of sticking with the same scale cannot be underestimated when looking for true accuracy. It was one of the first questions I asked this mom, and it proved to be the point of contention. I am so proud of her -- she is pushing upstream against society, her doctor's suggestion of formula, and even her own doubts and past history, to listen to her gut and provide the best to her baby.
Way to go, Mama!
You may not even know it, but you and your baby have been working hard, preparing for the next step in your relationship after pregnancy and birth -- breastfeeding. Just as you provided everything your baby needed to grow on the inside, you are sequenced to continue this job once baby is on the outside. Currently I am working toward increasing my formal lactation knowledge to better serve the Bakersfield and Visalia areas. To add to my current 6500 direct breastfeeding counseling hours, I am completing 90 hours of specific lactation education (required to become eligible to sit for the exam to become an IBCLC). I came across these quotes while studying, and I was struck by the timing of these events!
While we are designed to nurse our babies, that doesn't mean it will happen easily. If you are experiencing breastfeeding issues, reach out for some help! There are many places to look, starting with the hospital where your baby may have been born, WIC offices, local public health options, private practice IBCLCs, and group support gatherings, such as La Leche League and Breastfeeding USA. Often you can call any of these resources for some phone help or questions answered. If you need more support, hopefully the person on the other end of the phone can further direct you to the best resources for your situation.
Just because we are mammals and breastfeeding seems like it should be "natural," that doesn't mean we won't need some good information and ideas from others who are in positions to help. Don't be afraid to get some guidance -- you are your baby are in this together!
For more resources, view this past post.
My older sister likes to remind me that once upon a time, while pregnant with my first, I responded to her question of, "Are you going to breastfeed?" with an unsure, "...if I can." To this day I still deny it. I honestly have no recollection whatsoever of that conversation -- I know she wouldn't make it up, though.
Over 16 years later, life has put me in a different place. I have successfully breastfeed my four children. Soon after my second baby's birth I went on to become a breastfeeding counselor, leading meetings for local mothers and mothers online, taking phone calls from frantic mothers all hours of the day and night, making home visits and hospital visits, and participating on our county's local breastfeeding coalition. I have written articles for journals, magazines, and blogs, spoken at breastfeeding conferences, and I am currently working toward becoming eligible to sit the exam to be an IBCLC. I cannot imagine who that person was who meekly replied, "...if I can," all those years ago.
Yet with all the future-breastfeeding moms out there, this is a common feeling. I think it stems from allowing a bit of room for failure -- not setting the bar too high in case of disappointment. Simply put, lowering expectations.
You only have to go as far as your nearest mother to find why this answer has held its place as, I would guess, the number one response: We love to share our horror stories. Any pregnant woman can attest to this when it comes to birth stories -- suddenly women are crawling out of the wood-work to tell you their impossible experiences -- the pain, the suffering, the horridness of it all, oh, and good luck! This carries over to breastfeeding experiences as well.
One day in the grocery store, a young clerk asked, while checking my items, if this was to be my first baby? I was prepared for her to launch into her personal drama, so with my fists clenched, and most likely talking through gritted teeth, I replied, "Yes." She looked at me so sweetly and honestly. "You are going to do just fine." I was stunned! She must have sensed this -- she went on to say, "Having my son was the best experience of my life. I wouldn't trade his birth for anything." I left for my car feeling like she had just revealed a secret to me -- I felt this young lady, about my age, had seen something in me I did not know I possessed. I felt powerful.
Birth and breastfeeding are related in the way we think about them both: We hope for the best, but in the end, we do not have ultimate control over how things will turn out. This tends to be more true for birth than for breastfeeding. Some of the most committed breastfeeding mothers I have met have been mothers who had to have cesarean births after planning completely natural births. I think many of them found exerting energy into the breastfeeding relationship healed the loss the cesarean birth left with them.
As women, we need to focus on sharing our positive feelings about birth and breastfeeding. We need to assure other mothers although there can be problems and set-backs, there is always a way to accommodate, adjust or overcome with the right network of support.
Let me share the biggest secret to a successful breastfeeding relationship: Know where to get help. You can always call me with your breastfeeding concerns. My doula role ends after your baby's birth, but my role as your breastfeeding counselor continues until you no longer need me.
I help breastfeeding moms with lactation support in the Bakersfield, Visalia, Tulare, and Hanford areas of California's Central Valley. So often when I answer the phone to a mom looking for breastfeeding support, somewhere in there I hear the voice-cracking and the tell-tale pauses that show she is working hard just to reach out and share her story. We are often not prepared for how hard breastfeeding can be, and the toll it can take on our hearts. We hear of the joy babies bring, the bonding, their smell, their sweetness -- maybe someone out there mentioned being really tired or not showering easily in the first weeks. We are culturally conditioned to worry more about birth than breastfeeding.
When a mom is struggling, what can we do to lift her up? What words and actions can scaffold her, infuse her with strength? I asked women to think back to what was encouraging and motivating, that anyone (not just a breastfeeding helper) could do, to make the journey a little easier. Here is what was shared:
1. "Keep the focus on me." Many of us have had issues with breastfeeding, and often the inclination is to quickly get to our own story and how we survived. "I cracked and bled for two weeks. I didn't have enough milk so my friends gave me donor milk. I locked myself in a room and said, 'we will figure this out,' and I never gave him a drop of formula, even though my doctor suggested I was starving him -- I just powered through." This is not helpful. It isn't that on a normal day Mom can't appreciate your experience, it's just that right now, it takes away from her very-current state of being vulnerable and needing support. If you can relate, say something simple that doesn't turn the whole subject back to you, like, "I remember that." It's okay to reaffirm you have felt something similar; it's not okay to shift the focus so now you can talk about yourself. In this moment, it needs to be all about Mom and Baby. It takes acute awareness to stay in the present with her, and this truly is your gift to give.
What is not helpful: Launching into your own tale of triumph, terror, or failure, especially with the intent of showing Mom you had it worse; the same holds true if you feel compelled to share your grief, your anger, or what you would do. Apply Susan Silk's "Ring Theory," which I have adapted. The idea is, the person facing the crisis (Mom) has the center spot. She is allowed to say whatever she wants or needs to, to anyone else. As the rings extend, others are assigned positions according to how close they are to the center. So Mom's partner is next. Again, he or she is allowed to vent in an outward fashion. Family and friends will have their own feelings, and it is appropriate to dump those outward as well. Advising, sharing your worries or coping methods, explaining your exasperation with the situation, etc., is never done inwardly, because this adds to the load of those dealing most directly with the crisis.
2. "Use those active listening skills we hear about." Rephrase what she says: "It sounds like you are scared that breastfeeding is not going to work." By restating what you heard, you aren't going to tell her something she doesn't already know, and it lets her know you heard her. If it isn't what she's feeling, she can clarify by offering more information: "No, I feel like it is working, I just think maybe it will never end up being a smooth, easy process, like I imagined." It's okay if you don't get it right -- she will understand you are trying to listen to her feelings. Acknowledge her struggle -- you can never go wrong by saying something like, "I see how hard you are working." Don't ever under-estimate the therapeutic power of being a good listener.
What is not helpful: "Maybe it's not meant to be." "Haven't you tried hard enough?" "Formula/ bottles are here for a reason." "Your cousin Jill wasn't able to breastfeed, and everything turned out fine for her."
3. "Don't be afraid to touch me." When the dam holding back the tears and feelings breaks, she can feel cracked open and raw, and having an audience can make those feelings even worse. You can touch her shoulder, take her hand, or offer the comfort of a hug. Sometimes touch can give more solid support than any words can. When a baby cries, he is letting us know he needs something, and that gives us the opportunity to respond and help him feel better. When adults cry, there is the same opportunity to help someone feel better while also creating a bond of love or friendship. You may not know what to say when you see her like that, but you can't go wrong by showing her physically that you care.
What is not helpful: Staring at her, pretending she's not showing emotion, visibly looking uncomfortable, or telling her not to cry.
4. "Share in the loss I am experiencing." Whether breastfeeding will ever work for Mom and Baby, in the middle of the crisis, it is a loss -- a loss of hopes, a loss of dreams, a loss of what she thought would be an "easy and natural" way to feed her baby. It is okay to treat this as any loss a friend might face. This isn't the same as having two choices for dinner -- chicken and rice or beef and potatoes -- and then having the choice made for you. Breastfeeding comes with many overwhelming emotions. When she feels like she can't feed her baby, in that moment there is nothing that can feel worse, and it feels like loss. We can accept and value that, even if we can't understand it.
What is not helpful: "It could be worse." "At least you have a healthy baby." "I don't understand why this is affecting you so much, it's not like someone died."
5. "Let me decide when I am done." Well-meaning friends and relatives who are concerned about Mom's physical and emotional well-being may try to convince her that she's worked hard enough. Mom is the only one who can judge that -- she knows her options. Wait for her to tell you where she is in this journey. One woman, a neurologist, shared: "If you say you are suicidal, people don't say, 'yeah...you should probably just go ahead...' They figure out how to help you, they talk you off the ledge." It obviously isn't the same thing, but in the storm of hormones, emotions, life changes, and struggles, the very-real feelings of hopelessness and loss of control can be strong and similar. Keep encouraging her. This is her marathon to run -- she decides the pace, the route, when to take a break, or even when to stop -- you cheer her on from the side no matter where she is in that loop, no matter how you are feeling about her situation. As another woman put it: "It's cruel to try to take someone's hope away."
What is not helpful: "It's unlikely by this age your baby is going to figure out how to breastfeed." "Just try X, Y, or Z -- it fixed our issues." "Not everyone can breastfeed." " I just can't bear seeing you so upset."
6. "Do something for me that will save me from having to do it myself." Rabbi Harold Kushner is the author of, "When Bad Things Happen to Good People." When asked to share what he's learned in his years supporting people in the midst of suffering, he said it could all be summed up in this statement: "Show up and shut up." Anything you can do for Mom that gives her more time to be with her baby and concentrate on self-help and healing, is priceless -- and ANYONE can help. "My husband has always been supportive. He always left it up to me to decide what I wanted to do. And when I decided I wanted to continue to try, he helped me pack up the baby and drove me to LC's and LLL several times a week. He washes bottles and pump parts, he's a pro at freezing, thawing, making bottles, hooking up my pump. His labor of love is so important at continuing exclusive pumping, because I alone have logged about 3,000 hours of work towards pumping and pumping-related activities for the first year of my baby's life." Further out of the ring, family and friends can take care of pets or outside responsibilities, bring meals or snacks, run errands, make phone calls, drive Mom and Baby to appointments, and always, always there is housework and laundry.
Ronald A. Rasband shared: "If you come upon a person who is drowning, would you ask if they need help -- or would it be better to just jump in and save them from the deepening waters? The offer, while well-meaning and often given, 'Let me know if I can help,' is really no help at all." It can take energy, effort, and humility for a person to list what she could use help with. In the movie "Robots," one of the characters, Bigweld, had this motto: "See a need, fill a need." Jump in and do what you can -- when there seems to be nothing else, there is always service.
What is not helpful: Service with conditions; making the job seem too complicated to take on, or making it too complicated for Mom to delegate; rushing in to offer babycare when Mom and Baby could be bonding; expecting a thank you card.
Society says feeling bad when breastfeeding is hard is not appropriate or okay. We don't want to make anyone feel bad if they can't breastfeed, so when a woman struggles to continue, her hard work is not always encouraged or even noticed. To really help, though, we need to suspend this judgement and be willing to accept her feelings and her reality. Becky Bailey writes: " Acceptance means recognizing that people, situations, and events are what they are. Each moment simply is as it is. Acceptance doesn't mean that we approve of the moment, only that we recognize that what is happening at a certain moment is, in fact, happening."
Two women in particular said they couldn't remember anything helpful or hopeful that was said to them. This lack of acceptance is apparent when they shared what they wished they had been told:
"This is the hardest thing you will ever do, but you will get through it. You are getting through it. One day at a time. You are amazing and strong and this will be worth it. It does matter."
"I support you and will be here to help you if you decide to keep trying or you want to stop. I value you and think highly of you as a mother and person, no matter your decision."
Accept her struggle. Accept her feelings. Open yourself to her reality and you increase her willingness to accept your help. When she comes out the other side (whatever that other side looks like), it can be with positive memories of the support and care that was shown to her and her baby.
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I value your comments and stories, and I am appreciative of the time taken to share them <3.
♥ four young boys and a boy dog (offspring)