Nikki Lee Health

All the local birthing hospitals are working to implement best practices for new mothers who are breastfeeding. This is now the fulfillment of a career-long dream that I have had for as long as I have worked as a nurse, childbirth educator, and lactation consultant in my region. Hospital culture is changing in favor of breastfeeding; this is a long, slow and important process. YAY!!

I expected my private practice to disappear once the hospitals supported breastfeeding with encouragement and accurate advice. To the contrary, it is expanding. I am surprised. I’ve seen dyads in my private practice who have delivered at all of the local hospitals; this gives me a window into what is going on everywhere in my region. Hospital breastfeeding help has the best of intentions, yet it is not always effective.

What is really going on is that mothers are not left alone with their healthy term babies to figure out breastfeeding in their own way. Instead, hospital breastfeeding helpers are rushing in to evaluate and to correct too soon.

Recently, a dyad came for both breastfeeding help and craniosacral therapy. The mother had a lovely spontaneous, undisturbed labor in a hospital that is working to meet a deadline for implementing best practice.  The first few hours after birth were wonderful; her baby was skin to skin and crawled to breast and self attached. She kept using this baby-led self-attachment technique until hospital staff and lactation specialists told her to be “more aggressive” when breastfeeding, and not to let the baby control the attachment. She was counseled to sit and to hold her breast in a particular way, to wait for the baby to open wide and then push her baby and breast together.  She was told to feed every 2 to 2 1/2 hours. Breastfeeding then became painful and damaging, leading her to seek help from 3 IBCLCs in community for relief. 2 of the community IBCLCs said the same things that the 2 hospital IBCLCs said; 4 of 5 reinforced that her latch was “shallow” and “wrong”, and gave her lists of corrections. The only useful help they gave was to prescribe a compound that relieved the nipple soreness.

As a result of all the expert advice, she stopped doing the things that she and her baby had figured out in the first few hours after birth.  Breastfeeding then became something dreaded; she would think, “I can’t believe I have to do this again”, before every 2-hour routine of breastfeed, pump, and bottle-feed. She and her partner wondered, “Why are lactation consultants so mean?”

One community IBCLC suggested a visit for craniosacral therapy, as the baby had a tight jaw and was clenching.This baby gained a more relaxed internal connection after some CST, as a parietal knob softened and flattened and her little skull became more symmetrical in shape. However, the biggest boost to the relationship was to suggest to the mother that she forget all the rules and everything she had been told to do. Instead, she was to help her baby do what it wanted to do, to follow the baby’s lead and figure out together how to be comfortable.

The tight jaw and clenching were the result of a mother-controlled latch that was out of synchrony with the baby’s needs. Battles at the breast create disharmony.

Rebooting the system led to many painless, even blissful feeds in the office. She breastfed at least 6 times: once lying down, once standing up, and the rest leaning back against a wall, on pillows. Her partner came and took some photographs of her standing to feed, including one taken from an over shoulder view.  (That photo is a reminder, should she forget anything.) Now she has a strategy to feed the baby while getting housework done.

When I have these cases, I contact the lactation professional at the hospital where the baby was born. I feel strongly that without feedback, we can’t learn and grow. I would appreciate someone to do that for me! The lactation professional at the institution receives a call or an email to ask if she is interested in details of the case of breastfeeding Dyad NM who came for help. The usual response is a groan, “Shit, it must be bad.” I stay calm and remind her of my intention to give loving feedback,  for growth and learning, positive reasons. After that,  we can talk. Once, a LC asked the mother for her name and the mother agreed.  They contacted each other and I bowed out of the picture.

The advice the LCs in this particular situation gave was correct; the timing was wrong. The recommendations that were made would have been perfect for other situations; for example, with a sleepy premature infant. This particular mother was doing well; she didn’t need any guidance or help. The wrongly timed advice completely derailed her lactation, damaged her nipples, and cost her money. Her confidence was undermined when help led to doubting herself at every feed.

Something else occurred to me during this visit. Lactation professionals NEVER tell pregnant women or new mothers how often newborns REALLY breastfeed. We are afraid that more than 8-12 times in 24/hour might be too much and scare a woman away from breastfeeding. So we duck the question. Some women are horrified when they discover that a newborn, weaning away from the continual feeds of the placenta, will want to breastfeed more like 20 or 30 times in 24 hours.

Women haven’t grown up seeing neighbors, family members or friends breastfeed a newborn. Today, parents expect their newborn to look like the others they have seen, a burrito all wrapped up in blankets, with a hat on and a plug in its mouth. (“Oh, how wonderful. Leave me in that carseat,” said NO newborn EVER!!! )

Women who are ignorant of the normal newborn breastfeeding relationship may panic or be overwhelmed. This is why the new mother needs folks around to cook and clean; it is enough to discover how to live in a new world, with a newborn. Most dyads will do well with watchful waiting, encouragement, and good food. The healthy term baby can be trusted.

The best beginning of breastfeeding at birth is to let the dyad figure it out together. This means keeping them together (as much skin-to-skin, s2s, as possible) to encourage the development of relationship. Health care professionals are there to encourage, to serve, and check in, giving guidance only when asked. Building a breastfeeding relationship takes time. Respect the learning process, before judging and intervening. It takes fumbling around to make something easy.

New mothers do best when they surrender to the newborn for the first month or so; instead, they are told to control breastfeeding. My question is, “How do we present the truth to young women about how often a newborn wants to go to breast so they will accept the intimacy of the new relationship?”

I’ve been suggesting that the newborn is like a lover with whom one has just moved in. Sharing a house leads to lots of. . . kissing. Does one tell the beloved to go away for a few hours, because you kissed many times an hour ago?

What do you think?