Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.
Monday, December 11, 2006It's a hard line these days in being supportive of breastfeeding without going overboard. I never really realized that until this past week.
See, I have a friend that was planning a home birth early next year and that was determined to breastfeed. Quite honestly, of anyone I've known (other than myself) I'd have given her the best shot at making a go at it, because she isn't afraid of hard work and is a VERY strong individual.
Unfortunately, she ended up with a previa that wouldn't quit and had to have an emergency c-section early last week. Since she was only 34 weeks along, that meant that the baby spent a few days in the NICU. Since there was a previa, that also meant that during the c-section they had to cut through the placenta (which ups the risk of hemmorage) and she lost about 1.5 liters of blood. Put all those things together and you have a mom that is so far from exhausted and stressed that it's ridiculous.
Nonetheless, she was determined to breastfeed, so I wanted to try and help in terms of that so that she could focus on other things. But again, this is the question of how hard to you push. There's also the issue of how many times can you say "the hospital gave you bad information...you need to do X instead."
We all know that mom needs to nurse or start pumping ASAP after birth. In fact, within six hours is the ideal. Unfortunately, when her husband tried to get the nurses to bring her a pump, the nurses pitched a fit, saying that she had to rest and she didn't need to pump that day. (In fact, they said the ONLY reason for her to pump was to get her used to the "sensation" of pumping....arg...sure, let's wait a day or two and make sure the milk NEVER comes in.) Her husband went to bat for her though and pitched a fit until he found someone to bring a pump.
That said, they never showed her how to use it or hook it up. So I headed back into the hospital that night to show them what to do. We got the pump hooked up, I showed her husband how to work it and we got them setup with a schedule. (He'd brought an alarm clock so that he could wake up, run the pump for her, and clean the parts.) That said, we still had to call to request dish soap (to wash the parts) and Lansinoh (since pumping is VERY hard on the nipples) and ready-feed bottles (so that she could pump straight into them instead of losing milk during transfer). Quite honestly, it was like this hospital knew NOTHING about pumping.
That was the last I saw of them for a few days as I had to head to Chicago for a show. I checked in when I got back and things weren't too much better. She was still valiantly pumping away, though she was now down to about 8 times a day instead of the 10-12 I'd told her to aim for. (The hospital lactation consultant told her she could pump much less than I'd suggested.) Unfortunately, she said that she'd gone from getting a decent amount per session to getting almost nothing. She was also now nursing, them bottle feeding, then pumping.
Once again, it was an issue of I knew she wasn't pumping long enough OR often enough, but I also knew that she was about to pass out from exhaustion every other second of the day. So how hard do you push? She also hadn't seen a lactation consultant to work on the latch and getting baby moved to the breast, but again, how hard do you push? When I went to visit I saw that they were feeding the baby from those ready-feed bottles that the hospital has and were using one of those teeny tiny nipples that allows baby to feed with the lips almost closed. (As opposed to a wide bottom nipple where you can flange the lips to mimic a proper latch.) I asked about that, but they didn't have any other bottles. (I took them a set the next day that had the Playtex wide-bottom nipple)
The hospital had also put the baby on neocate, a soy-based formula. I asked why and they simply said that the were trying to get more calories in her. (Neocate has 22 calories an ounce while most regular formula has 20 calories an ounce.) But still, I'd always been under the impression that soy-based formulas were ONLY to be used if baby couldn't tolerate a milk based formula...otherwise your only option if baby can't tolerate the soy is to go straight to the prescription based formulas like Alimentum (sp).
So, I offered to pump. After all, I'd be pumping to donate to babies I didn't know, I might as well take a few days or a week and send that milk to a baby that I DID know. Plus, we know that my milk is really high calorie (25 calories an ounce on average) and if I pumped after Emmitt nursed, I could kick that up to 27-30 calories an ounce. That's way more nutrition per ounce than the Neocate and coming in a form that's more easily digested. So today is day three of pumping to help supplement what she's getting on her own. Thankfully, as of yesterday, she was starting to get some volume again.
That said, she's still not been to see a lactation consultant and as of last night was planning on waiting "a few days, or maybe until next week" which just doesn't seem soon enough to me. After all, the longer they avoid getting a good latch and the longer baby gets used to a bottle, the harder it's going to be. There's also the hard and fast reality that not everyone can bring in a milk supply with a pump. But again...how hard do you push?
Breastfeeding is the absolute best thing that you can do for your child, but there's also a point where it's not unreasonable to give up, get some rest and get to the point where you can care for your child without risking your own health. Knowing where that point lies can be tough though.
I guess the best thing I can liken it to is the person bound and determined to have an unmedicated childbirth, but knowing that they'll probably lose it in transition. Almost every woman I know who attempted unmedicated birth in the hospital broke down and asked for an epidural. Most of them made it clear ahead of time that they were to be stalled until it was too late if they did so. In fact, I made my husband promise to make me wait 20 minutes at least three times before "letting" me get one if I asked.
Now I realize just how hard it is on those support persons. People DO change their minds and it's not unreasonable to do so. I know that if I'd asked for an epidural and my husband had immediately gotten me one that I would have been furious with him after the fact. On the other hand, if I'd REALLY needed it and he'd tried to keep me from having it over and over again, I'd be mad at him for that too. Thus, the balancing act of a support person is a tough one. Part of me wants to tell my friend that it's ok and understandable if she wants to give up, but I also think there's a very high chance that if we gave her that "out" and she took it, that she'd be really mad at us down the road. On the other hand, I don't want to be the obnoxious person who makes someone feel guilty for giving up after what has amounted to an incredibly valiant effort.
So what's a friend to do? Stand by, offer support, offer suggestions and gently push...knowing that by ONLY gently pushing, things may fall to the point that breastfeeding become impossible? (which is what's happening now) Or risk long-term anger by either pushing HARD or by giving "permission" for someone to quit?
And do hospitals sit around all day planning out all the little things they can do to tank breastfeeding? I mean SERIOUSLY! It's like they read the book of how to make breastfeeding easier and then did everything the exact opposite. It's pretty infuriating.