Third Time's a Charm

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:

• All names have been changed.
• This happened 10+ years ago, when Domperidone was easily available through compounding pharmacies.
• Just as Carly "saved the day" here, I know for a fact Ashley and Brenda have had instrumental roles in stories just like this.
• PCOS is a very complicated issue, and women aren't always aware it might affect breastfeeding. In my opinion, one of the best sources of information about PCOS and breastfeeding for moms is "The Breastfeeding Mother's Guide to Making More Milk," by Diana West and Lisa Marasco.