I recently had the opportunity to be part of a training for a local hospital's BFHI process. I wanted a tactile way for people to feel the differences in palate shapes. Needing the models to be comparable to a newborn's mouth-size, I had the idea of using plastic spoons.
1. I used an air-drying clay and I formed different shapes onto the spoons. They dried overnight without shrinking, which was great since I hadn't put much thought into my supplies. I then used a cement glue to adhere the forms to the plastic spoons. This was all pretty easy stuff. Originally I planned to make lower gums as well, hence the spoons with just the gum-lines. I imagined putting the spoons together with palate-spoon facing the gum-spoon, and adding a tongue in between (balloon with Play-Doh in it so it was flexible). I didn't end up following through with the complete mouth as it wasn't crucial to the skills I was teaching.
2. Up until now this was all pretty simple stuff. But I wanted a coating over the forms, so I decided to use balloons, and this is where it got tricky. I used water balloons, and I had to not only stretch them over the spoons and forms without them breaking, I also had to use the cement glue to ensure the balloons were tightly applied to the forms' odd shapes. The bubble-palate balloon kept pulling away. I had to go through a few balloons because they kept tearing, and then I had to keep my thumb in the bubble for a few minutes to allow for the glue to really grab hold of the balloon. Also the glue is messy, and it will get all over your fingers and your project -- try to wipe it off the spoons ASAP because it is hard to get off the latex later.
3. Overall the process was pretty easy, and I created an ideal-shaped palate (u-shaped and gently sloping from front to back), a bubble palate, a v-shaped palate, and a channel palate.
4. This is how I had participants engage with the spoons -- in a similar fashion as when they are engaging with a real baby's palate, from underneath. The feedback from folks was excellent. The nurses appreciated the variations present, right next to each other, so they had immediate comparisons. Most admitted they never felt a baby's palate except to rule out a cleft, and they could see how this information would be helpful when encountering babies who are struggling with feeding.
This is Max, my amazing demo doll I bought from Magic Cabin Dolls. His tongue sticks out, he is intact, and anatomically correct. These sweet dolls come in different colors, genders, and are machine-washable as well.
If you have questions, or you make your own, let me know! I'd love to see what you come up with.
I recently met Nicole at a local doula gathering. When she shared her breastfeeding story with me, I was overwhelmed by emotion. I immediately asked her two things: 1-How will you work through this to help other women as a doula, and 2-Do you like to write? I am so grateful she generously poured her heart out to let others know how painful and confusing it can be to face the obstacle of not producing enough milk. I say it to moms everyday: We don't expect feeding our babies to be so hard. I have worked with many moms experiencing milk supply issues due to IGT, PCOS, breast reductions, and extreme blood loss during birth. Very often there is a deep sense of loss. Thank you to Nicole, for being vulnerable and honest -- I know it will help others.
"Your worth as a mother is not measured in ounces." This, this right here has been my solid ground -- my strength when I just can't seem to stop beating myself up for things I cannot control. Let's rewind a second, shall we?
Being a young mother is never easy, especially when you're the first of all of your friends to have a baby. You have no one to look to for advice or wisdom, it's just you and a new baby who won't stop screaming and nurses who are less than helpful. I was 19 when I gave birth to my greatest accomplishment and I was so proud, but what was I doing wrong? Why wasn't she latching? Sure, I knew breast is best, but as a first time mom, the crying was overwhelming and I just wanted her needs to be met. The night after she was born she got a bottle of formula because she had been crying non-stop and hadn't eaten because she hadn't ever latched for more than two minuets at a time. I was sad but I was just happy she wasn't screaming from hunger anymore. I had about 6 women give or take look at my breasts (or lack there of) and touch them, without permission at that, and no one had any advice for me -- so I went home, formula in tow and with no regrets.
At home I continued trying to pump, trying to latch her, and just trying to get a supply when I only had drops at a time. I tried a nipple shield, pumping religiously, teas, supplements, and I just gave up because I read some women just don't respond to a pump. Afterall, she was fed so she wasn't really going without, was she?
I have since given birth again, 11 months ago to be exact. This time to my son and my second greatest accomplishment. Before I conceived him and during my pregnancy, I devoted HOURS to researching the best parenting practices, and that included breastfeeding. Breastfeeding: Natural. Normal. Tradition. Instinct. The reason the human race has survived for centuries. I learned that every woman should be able to breastfeed if she "tried" hard enough. I learned about proper latch, feeding on demand, skin-to-skin, the benefits of natural labor, tongue ties, lip ties, no pacifiers or bottles for a minimum of 6 weeks. The list is basically endless, I knew it all and I was confident. You can ask my doula, the one thing I wanted the most out of my birth plan was to be able to breastfeed, and my worst fear was not being able to breastfeed.
After 7 hours of labor I gave birth to my son, completely naturally. Yes! I did it! I was so proud of myself and immediately placed him to the breast. I remember looking at my doula and saying, "look, his mouth is big, he should latch nicely," and he did. He latched and we spent so much time nursing. We denied baths and took off that annoying hat they put on him -- everything was textbook. We went home after some time on the lights for jaundice.
Did I mention everything was textbook? It was...until it wasn't. He constantly wanted to nurse, which is normal for babies. But then I noticed he wasn't peeing much anymore, and he wasn't satisfied after nursing for what felt like an eternity. I birthed him on Friday afternoon, and by Monday he had extremely chapped lips, yellow skin, yellow eyes and little urine output, but I was basically in denial. The next day he was admitted to PICU for jaundice and had to spend 24 hours on the lights. I HAD to start supplementing because my son was starving. I was starving him. My body was failing him. I cried and cried and cried. From 7 lbs 6 oz, to 6 lbs 3 oz and NO urine output. I did everything right, why was this happening to me? I was devastated, but despite my pain I kept at it. I met with an LC who gave me an SNS and and an abundance of advice that included "if things don't change in 1-2 weeks then you just might be one of the small percent of women who can't breastfeed."
Can't breastfeed, what? Some women can't produce milk, but why?
We went home the next day and he was thriving from being supplemented, but I hated myself -- hated the body that birthed two beautiful children. It's an awful feeling, a feeling that left a wound that is still as fresh as when it appeared. I kept at everything I had learned and I never got an increase in supply. Between both sides I couldn't even pump to cover the bottom of a bottle. Prescription drugs, water, clean diet -- NOTHING helped, but why?
IGT: insufficient glandular tissue. I found a great support group on Facebook that was my saving grace, they encircled me with comfort and understanding. There are markers for IGT and I realized that I had most of those markers. Buy why hadn't I heard of this before? All of the articles I read and people I talked to and I had never heard of it. All of the medical professionals that had seen me topless and I never heard a word spoken about it. Why aren't people trained to notice this, and why isn't this a more well-known issue?
This has been a long road and I'm still suffering. I can't feed or nurture my baby the way I was designed to. He's missing out on the best kind of milk his little body was designed to live off of. We did donor milk but it's hard to come by, honestly. He's now exclusively formula-fed and I hurt every time I wash or make a bottle.
I have since became a birth doula, and I almost feel hypocritical about it. How can I offer breastfeeding support to women when I can't breastfeed myself?
I'm healing and I've come to be a huge lactivist. Just because I wasn't and couldn't be successful doesn't mean I don't know the dos and don'ts of breastfeeding, and it doesn't mean that I won't run in to someone who will struggle like I did (and still do).
My heart hurts often and I still cry a lot, but I am healing. I need to start loving my body again. My first step to forgiving the things I can't control is writing this in hopes that more people will understand this kind of terrible struggle. It may not be a big deal to some, formula vs. breast, but to others, it's extremely difficult to accept.
And that's what I have learned to accept.
Nicole is a new doula in the Bakersfield Area. The mother of two little ones, she has experienced a wide range in parenting beliefs and ideals in a short time. She understands birth and mothering isn't always about choosing what you want, and rather, adjusting the best to what comes your way. Nicole is dedicated to supporting women during birth AND breastfeeding, to help them find success as they define it, with some fine-tuning here and there according to what the experience brings.
You can find Nicole on Facebook.
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.
I don't know about you, but I always love a good doula review written by a dad! Thanks to Russel for sharing his thoughts about his experience with their birth doula. Incidentally, their birth doula was Julisa Lagos, of Lansing, MI.
I was all for a doula, once I realized what doulas do. While pregnant, my wife's idea of a fun night together was sitting at the library, pulling down pregnancy book, after birth book, after breast feeding book, after baby book, and telling me all the things I needed to know. My idea of a fun night together was...not this. Don't get me wrong, when it is time for me to buy a TV or a car or a grill I am all about reading up on all the specs and reviews I can possibly find. When it came to having a baby, I was content to just go along with the flow; I didn't know there was much choice out there or options to decide between. Bottom line: if a doula was an encyclopedia of all-about-babies-and-how-they-get-here, then sign me up...because I need to focus on the best carseat and crib and baby bath.
Our doula came to our house and brought information when we needed it. When my wife had a question and wanted the best information about it, bingo, best sources without having to scour the internet.
When I was out of town for work our doula was on call, ever though it wasn't really close to my wife's duedate. For me, knowing our doula could be with my wife in case labor happened while I was gone, gave me a sense of comfort.
My wife's water broke and we called the office. When we called, the after hours answering service said they would take a message and a doctor would call us back. Panicked about what to do while we waited, we called our doula. She reminded us of the talk we had with our doctor about handling this situation. She reminded us about writing down the time, the color, the smell, and the amount of fluid (yay!), plus how our baby was moving and if labor contractions started yet, and to give all this information to our doctor. She said she was ready and waiting for our next move, and that could be waiting at home, or going to the hospital. It made me feel like a huge weight was just lifted from my shoulders!
Once my wife's labor started our doula was there helping us through the birthing contractions. She reminded me how I could help my wife. Our doula answered questions for me before I could even ask her. She knew our doctor and was very friendly with our nurses. It seemed like everyone was there for us as a team, and I think that shows she had a good relationship with the hospital.
As a nervous dad I suddenly felt like I was getting a pop quiz for a subject I never studied! But our doula made up the difference in a way that showed me I wasn't a slacker, I was just a new dad. I'm not quite ready to do this all over again since we aren't really even sleeping through the night yet. But I do know, next time, it's doula or bust.
Russel and his, Ruby, have two children now. He wrote this as a review for his doula, who they invited back to their second birth.
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:
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 parents 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 parent looking for breastfeeding support, somewhere in there I hear the voice-cracking and the tell-tale pauses that show they are working hard just to reach out and share their 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 parent is struggling, what can we do to lift them up? What words and actions can scaffold them, infuse them with strength? I asked parents who experienced these hardships to think back to what was encouraging and motivating -- things 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 this parent can't appreciate your experience, it's just that right now, it takes away from their 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 Parent and Baby. It takes acute awareness to stay in the present with them, 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 this parent 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 (breastfeeding parent) has the center spot. They are allowed to say whatever they want or need to, to anyone else. As the rings extend, others are assigned positions according to how close they are to the center. So the breastfeeding parent's partner is next. Again, they are 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 the parent 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 them something they don't already know, and it lets them know you are listening. If it isn't what they're feeling, they 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 -- they will understand you are trying to understand. Acknowledge this 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, the struggling parent can feel cracked open and raw, and having an audience can make those feelings even worse. You can touch their shoulder, take their hand, or offer the comfort of a hug. Sometimes touch can give more solid support than any words can. When a baby cries, they are letting us know they need something, and that gives us the opportunity to respond and help them 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 the parent like that, but you can't go wrong by showing physically that you care.
What is not helpful: Staring at the parent, pretending they're not showing emotion, visibly looking uncomfortable, or telling them not to cry.
4. "Share in the loss I am experiencing." Whether breastfeeding will ever work for this dyad, in the middle of the crisis, it is a loss -- a loss of hopes, a loss of dreams, a loss of what the parent thought would be an "easy and natural" way to feed their 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 a person feels like they can't feed their 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 the parent's physical and emotional well-being may try to convince them that they have worked hard enough. The breastfeeding parent is the only one who can judge that -- they know their options. Wait for them to tell you where they are on 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 this parent. This is their marathon to run -- they decide the pace, the route, when to take a break, or even when to stop -- you cheer from the side no matter where the parent is in that loop, no matter how you are feeling about the situation. As another parent 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 this family that gives them more time to be with their baby and concentrate on self-help, connection, 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 the parent 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 the family to delegate; rushing in to offer babycare when the parent 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 parent struggles to continue, their hard work is not always encouraged or even noticed. To really help, though, we need to suspend this judgement and be willing to accept the parent's feelings and their 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 people in particular shared they couldn't remember anything helpful or hopeful that was said to them -- nothing came to their minds when looking back at their struggles. 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 this person's struggle. Accept their feelings. Open yourself to their reality and you increase their willingness to accept your help or be buoyed by your efforts. When this parent 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 them and their baby.
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♥ four young boys and a boy dog (offspring)