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Offering Support...Knowing How Hard to Push

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, 2006

It'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.

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  1. Blogger one smarmy mama | 9:43 AM |  

    I don't mean this to sound harsh......this comes from a mom who was ultimately unable to breastfeed a child, so take with it what you will.....

    There is very little in your post about your friend. Your thoughts are on the effed up hospital staff and the mechanics of breastfeeding.......

    Your friend may very well be having issues that she may or may not be sharing with you about not having the birth she wanted and having her breastfeeding attempts be so thwarted.

    I think what she needs from you most right now is to know that you won't judge her if she quits. She may need someone to speak the words that she's thinking......that she's been through a really tough ordeal and she's tried valiantly, far harder than MOST women do these days. And that is to be commended.

    You've done all you can do. Don't make her your cause, just be a friend right now. You've been such a help, and done SUCH amazing things for her........but maybe it's time to just let it be. Her desire to "wait a few days" indicates to me that she maybe just wants some breathing room. It's no fun to have a newborn and to NOT be able to just SIT and ENJOY them.

    She deserves some peace right now and some support in her ability to mother, even if in the end she won't breastfeed this child.

    In the end, if she has another, she'll probably be much better prepared for the battle ahead of time. It's very hard to arm yourself in the middle of a battle, when you are tired and wounded. You've done an amazing thing for her next child, if she choses to have one. Live with that satisfaction, and just let her know she can rest now.

    *hug*

  2. Blogger Jennifer | 10:13 AM |  

    I think you make good points.

    While I've hesistated to say "You know, it's ok if you quit" I HAVE said several times that she can feel free to call at any hour of the day if she needs to vent. I've also said that I wish someone had told me how hard it would be and that it was ok if I found myself saying "what did I do? I can't take care of this baby!" Really, just trying to let her know that it's OKAY if she thinks it's amazingly hard...because it IS.

    But I do think that as of today, I'm going to move to making no more mention of breastfeeding unless she brings it up, because again, while I want to support, I DON'T want to nag or push. As I said, I think she is amazing...she's made it further than I did with my first and I wasn't recovering from major surgery!

    I always ask how things are, how SHE is, etc...but I remember from my own post partum days that I was LOATHE to say I needed help, or was depressed or whatever and not being a mind reader it's sometimes hard to know what our friends need from us...

  3. Blogger one smarmy mama | 11:18 AM |  

    *nods*
    me too. and, I don't know what it was, but I had some serious PPD that made it harder than normal for me to ask for help.....all too often I just sat in bed with my baby and cried in solitude and tried my best to give a good face to my friends, especially those like you......who are educated, informed women.

    *hug*

    I didn't mean my first comment as harsh as it sounds. I really wish I would have had a friend like you after I had my son. You're amazing.

  4. Blogger Jennifer | 11:25 AM |  

    LOL, no worries, I didn't think you sounded even remotely harsh. :)

    I think it's a hard line for us women to walk...we know what we need and what we wished people would have done/said to us...but we never really manage to get it out there in a way that allows people to help us.

    On the other hand, we can try and do for others what we wish someone had done for us (oh how I wish someone had pushed me to go to a LC with my first!), but the reality is that no two women need the same response...so basing it what we woudl have wanted does little for the person we're trying to help.

    It may be time for me to make another post about how every woman should read Naomi Wolf's "Misconceptions" before they have their first child...

  5. Anonymous Sinead | 2:17 PM |  

    Jennifer, you really are amazing. I don't know how you have the energy to donate breastmilk whilst you are breastfeeding. I find breastfeeding in itself exhausting! But I think it must be wonderful for your friend just to know you are there to help whatever happens.

    I found it best not even to think about how long I would breastfeed initially. I knew that even one feed would boost my baby's immunity. So I decided early on to just take it one feed at a time. Perhaps just telling your friend she has done a great job by managing to give any feeds will give her a real boost.

    Also remember PND can set in soon after having a baby, particularly if the birth didn't go as planned. Maybe she's feeling low about that too, so lots of praise may help.

    But I am quite sure you are doing all that. Just keep doing what you are doing and your friend will really thank you for it in the long run...

  6. Anonymous Anonymous | 2:48 PM |  

    You are a good friend and a wonderful lactavist, but I must take issue with "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."

    Breastfeeding is ONE of the best things a mother can do for ehr child. Just one.

    If your friend has been receiving the message as you typed it, how can she ever get to that second part about taking care of her own health?

  7. Blogger Jennifer | 3:00 PM |  

    Ohh....guilty as charged K...at least in regards to this post.

    You're right, it's semantics, but what I should have said was "best food" you can give your child.

    I will reiterate that I've said several times over that she's got to take care of herself and that she's got it a lot harder than most new moms do. I even told her that Greg found me in near tears the second or third night after Emmitt was born...ready to give up and geeze, I had a SUPER easy delivery and felt amazing right after.

    But the comments coming in are a perfect example of just how hard it is to walk that line, ya know?

    I guess part of my thinking is that in the grand scheme of things, these first few weeks (which make or break breastfeeding) aren't a whole lot of time and once you've made the choice to quit, there's no going back...but again...trying to push through those first few weeks when you have SO much against you...egads. It's hard to be able to see the light when you don't even know that the tunnel isn't a dead-end.

    Hmm...that gives me an idea for another post. ;) Come back tomorrow, as I'll want all of your opinions then as well.

  8. Anonymous Anonymous | 3:59 PM |  

    Jennifer -- truth be told, I wish I had someone pushing me to continue after Henry was born. I had far too many "quit and enjor your baby" comments. Could have used a bit more of the "stick it out -- it gets better" support!

  9. Anonymous Jolie | 5:23 AM |  

    I didn't realize how lucky I was to have a supportive hospital. The lactation consultants came around every day and left their pager number in case I needed help. I had a normal birth and there weren't any complications but bf was really hard and painful at first. I would cry in the middle of the night because I didn't want to do it but I never really considered giving up. I have to watch myself when I talk to pregnant women because I find I can be pushy but I think they should know that it's not easy and you really have to get throught that first week. Your friend's hospital sounds pretty unsupportive. They don't have lactation consultants on staff?

  10. Blogger Jennifer | 6:27 AM |  

    They do have LC's on staff, but as with anything else, they vary in quality. She worked with one one night, but she said the LC was kinda hyper and was shouting out instructions faster than she could keep up with...that kinda led to her just wanting to woman to leave. (After all, she was exhausted.)

    Thankfully there ARE good IBCLC's in the area and when I talked to her husband this morning he said she thought she might call one today or tomorrow.

  11. Anonymous Anonymous | 8:26 AM |  

    Jennifer, I agree w/the previous poster--I didn't have enough folks telling me to hang in there and stick it out. The mentality was quit and enjoy your baby. Why don't folks understand that perservering through the hard times would get them so much more enjoyment in the long run? I know it's a fine line--it sounds like you are doing everything possible.

  12. Anonymous Anonymous | 7:13 PM |  

    Oh, boy. Welcome the world of lactation consulting! I've had these feelings, too, and it's really hard to guage when to push and when to step back. Ultimately I have to remind myself that I'm on the mother's team, but they are the captain. I know that sounds dorky, but it's the only way I can express it. The one thing you can always hold onto is your own hope that it will work out, and I think that when mother knows that there is at least ONE person who still believes that it can work, it has a real power.

    If there's one thing I've learned in doing this, it's that there is a long and complex story behind each new mother, and that there are reasons I'll never understand why people do what they do. This may sound like an excuse (believe me, I bend over backwards to help when I have the chance), but I've come to understand that it's the reality of breastfeeding support.

    Bottom line: Your friend is really lucky to have your help, and there is a lot in this situation that is beyond your (or anyone else's) control.

  13. Anonymous Anonymous | 12:20 PM |  

    It comes down to identity and how she views herself. If she sees herself as a breastfeeding mom, she will do whatever it takes to pump milk, try the breast once a day or revisit it some other time down the road.

    I have been in your position too. I now try to feel out when a mom is too stressed to keep up with the even 8 times a day and offer other solutions. If she just pumps every 2-3 during the day and sleeps all night or some other schedule that works for her (only 5 times a day or just 8 times, no regard to interval) and that keeps some stimulation for her and some breastmilk in the baby, it is certianly better than nothing. Suggesting a "combo" or part-time approach CAN save breastfeeding in the long run and lead to full breastfeeding later. It is tough, but she will know that you were there and gave her good advice and your friendship. Just keep being available. And if she needs or wants help, she knows you are there.

    By the way, did you recently participate in a radio show in Nashville? This ding-bat talk radio guy has been mentioning you but I wasn't sure if you were actually on the show. If you were, sorry you wasted your time. We aren't all like that here!

    Micky
    mochamilk.blogspot.com

  14. Blogger Jennifer | 12:25 PM |  

    Hey Micky, I saw your blog earlier, nice work. I may have to get you into my BlogRoll. ;)

    You sparked my curiosity though...I've never done a talk radio show (at least not re: the Lactivist) and I'm wondering who is talking about me and what they are saying...

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