​Because the body makes milk by wanting to replace the milk that was used, we know cookies, special drinks, supplements, etc., don't improve supply alone. You can't eat lactation cookies and drink Starbucks' Pink Drink and expect more milk if you aren't feeding your baby (or pulling milk out via a pump) 8-12 (or more!) times in 24 hours.

We are a culture steeped in instant gratification. We can get things next-day from Amazon. We can get fast food 24 hours a day. We don't have to wait long in many cases to get what we want. Milk supply doesn't work like this. There is an element of work that comes with having an adequate supply, and that is feeding or pumping 8-12 times in 24 hours.

Some people respond more to negative messages, so for fun, let me share ways to make breastfeeding hard:

• Let other people hold and feed the baby for you, so you can get a full night's rest. Night nursings actually help us make more milk, as we have higher levels of the milk-making hormone prolactin when it is dark. Studies have shown babies consume up to 30% of their daily milk intake at night -- both important reasons not to skip night feedings. There is a growing body of evidence that suggests babies aren't ready to differentiate their days and nights until they hit two-ish months -- and even this varies from baby to baby.
• Offer pacifier when baby is fussy so you don't feed them too often. Many experts agree breastfed babies cannot be overfed. Did you know a cobra can decide whether to inject venom into the animal it has bitten, or it can just bite without venom? Babies can do something similar -- they can suck to pull out milk, and they can suck for comfort -- both are natural, wanted behaviors for newborns.
• Schedule your baby's feeds by watching the clock, even if baby seems upset like they want to eat. Let's be honest, babies don’t have a whole lot going on. If you are a baby, your main goals are eat, sleep, pee/poop, stay awake for a while, and repeat. It is perfectly okay to feed your baby when they exhibit any sign of disturbance or upset -- this is a programmed mammalian response for this age. 
• Doubt your body's ability to make milk. If you are pregnant right now, your body knows to grow your baby because of the location of your placenta. It knows the baby is inside because the placenta releases hormones that say, "Baby is inside, let's grow this thing!" Once your baby is born and the placenta is removed, the drastic drop of hormones tells the body, "Baby is outside now, let's get those milk factories going!" Doctors check the placenta to make sure it looks like it is all there, because even a small piece of placenta can send hormonal signals out that confuse the body: Is baby inside? Or is baby outside? And this can stop the body from making the full hormonal switch needed to make milk. Just as your body grew your baby on the inside, it is prepared to grow your baby on the outside through feeding baby at the breast.

The biggest success factor for breastfeeding is time for you and your baby to be together. Your baby is programmed to be with you, to want to be close, to want to feed freely. Babies don't come out and say, "Hey, we've been a little too close for a little too long -- please put me in my own room, in my own crib." In actuality, babies do not know where they end and their parent begins. They have been rocked, held snugly, been kept warm, heard all the sounds of your body and your voice, and they have not been hungry -- think about that! They were fed through their blood. So suddenly, it's bright, they're cold, they have no control over their arms or legs, and where's that person!? My person? It is a lot to adjust to. And can you guess what answers all those questions of discomfort? Being at the breast.

There is an amazing author out that by the name of Kimberly Seals Aller. I heard her say this at a conference once: The first time you had consensual sex, it probably wasn't the greatest. You may have wondered, How do people do this? Why do people make it seem so easy? I'm pretty sure I did that all wrong. Did you walk away and say, "Well, that didn't work, so I'm never going to do that again." Generally not. We stick with it. We figure things out. It takes time and practice.

While breastfeeding is not sexual, the idea that, if it doesn't work the first few times it isn't going to, often causes many of us to quit before we have even had a chance to practice and figure things out better. Repeat this to yourself: Just because it isn't working right now doesn't mean it won't work. Seek help, because it is out there. We should not be expected to figure things out on our own. Heck, if you can't find help, reach out to me! I may be far away from your location, and I can try to help you find support appropriate for your situation.

Let me close with Linda Smith's "Coach's Rules":
1. Feed the baby
2. The parent is right
3. It's the parent's baby
​4. Nobody knows everything
5. There's another way

You can do this! And with support, you don't have to do it alone! 

Places to reach out to before baby, for support, or if struggling:
Find an IBCLC
La Leche League 
​Breastfeeding USA
​Baby Cafe

Resources for further reading:
Importance of Responsive Feeding
​Are Pacifiers a Problem for the Breastfed Baby?
Six Ways to Help When Breastfeeding is Hard
Why Doctors Aren't Lactation Consultants

​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.

​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.

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.
​

• When a friend in middle school struggled with nosebleeds that were uncomfortable and embarrassing and I would go with her quietly to a rarely used bathroom, hide in a stall with her and figure out what she needed to get back to feeling normal, that was doula-ing.
• When a friend in high school told me and me alone that she was having a miscarriage from an unplanned pregnancy that she had shared with no one, and I went home with her to sit with that process, that was doula-ing.
• When a friend’s dog was dying and being put to sleep and I sat with them at the veterinarian’s office and held space for that experience, that was doula-ing.

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.

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. ​​

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:

• 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.

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.