Belly Tales

People ask me a lot of questions, and unfortunately I rarely get a chance to post very many of them here. However, I thought this was a particularly good one, and might be useful to other readers as well, so here we go:

“I came across your website when I was google searching the words “Ina May” and hyperthyroidism. Reading a bit on your blog, I saw that you did a monstrous report on the condition. I have a ten month old baby girl (my first) and was recently diagnosed with hyperthyroidism (my TSH was .004) but have not yet been to an endocrinologist. My physician put me on atenolol, but I am still breastfeeding so I’m not taking it. Anyway, I was wondering what your report was about, and if you might have any suggestions that you could share. Many thanks in advance.”

Funny that you should ask about this, because we actually had our lecture on thyroid conditions during pregnancy today. My earlier report was on different thryoid conditions which are often seen during primary care of women (not necessarily during pregnancy), although today’s lecture focused only on pregnancy. My first suggestion would be to go to an endocrinologist as soon as possible. There are many different causes of hyperthyroidism, the most common cause being Grave’s Disease, which is an autoimmune disorder caused by thyroid stimulating antibodies. However, there are many other different causes of hyperthyroidism, running the gamut from pituitary tumors (very rare) to iodine-induced hyperthyroidism. This is why you’ll really need an endocrinologist to help figure all of this out; it’s complicated stuff, with many different etiologies.

Another thing to think about is when your symptoms first began. Was it before your pregnancy, during your pregnancy, or has it been only during the postpartum period? If only during the postpartum period, there might be another cause for the hyperthyroidism: postpartum thyroid dysfunction (also called lymphocytic thyroiditis or postpartum thyroiditis), which occurs in about 5-10% of all pregnancies. With this disorder, usually hyperthyroidism develops first, about 2-3 months postpartum, and will continue for up to 4 months postpartum, followed by a hypothyroid phase lasting 1-3 months. In 70-90% of all cases, this will usually resolve spontaneously without treatment, usually within 6 months. However, 10-30% of women with postpartum thyroiditis may have permanent hypothyroidism, so again, it would be a good idea to have an endocrinologist following this in order to determine the true cause of your hyperthyroidism, and whether it will resolve or not.

Treatments for hyperthyroidism usually include either PTU (Propylthiouricil) or Methimazole (Tapazole), both of which interfere with the synthesis of thyroid hormones by preventing iodine uptake. Both of these medications can be used during pregnancy AND are safe for breastfeeding. Atenolol (a beta blocker) was also listed in our lecture as one of the drugs used to help control the severe hypermetabolic symptoms of hyperthyroidism, such as tachycardia (fast pulse), tremors, palpitations and heat intolerance. Beta blockers are actually the treatment of choice for thyroiditis, and are safe to use during pregnancy. There is no contraindications to using beta blockers while breastfeeding. I just visited the website forum of Dr. Thomas Hale, one of the leading experts on pharmacology during breastfeeding, and looked up Atenolol. In this post, as you can see, one woman was concerned about the possibility of a baby having hypoglycemia after breastfeeding from a mother who was taking atenolol, but it seems that while atenolol might cause hypoglycemia in adults, he didn’t think it was present in breastmilk in suffiicient quantities to cause hypoglycemia in an infant:

I spoke with a Pediatric Cardiologist whom I greatly respect. He assured me that he’s used beta blockers and atenolol many times in pediatric patients and has yet to see hypoglycemia.It is true that in adult diabetics, it may induce hypoglycemia, but I’m reassured that his probably does not occur in infants, particularly from minor exposure via milk.He also told me that infants are apparently less sensitive to beta blockers and that even higher doses are sometimes required to be effective.So I’d look for something else causing hypoglycemia in your infants.

The thread on antihypertensives makes it very clear that beta blockers are fine during breastfeeding, so I think you would be okay taking atenolol and nursing at the same time. Medications in Mother’s Milk might be a really good resource for you.

Other treatment options for hyperthyroidism, if that is indeed what you have (as opposed to postpartum thyroiditis), include radioactive iodine treatment or surgery (partial thyroidectomy), but again, these are options best discussed with your endocriniologist.

I’m including a few resources here in case you want to look any of this stuff up yourself. These were some of the references from my presentation. Hope this helps!

Smeltzer, S., Bare, B. (2000) Metaboloic and Endocrine Function; Assessment and Management of Patient with Endocrine Disorders. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, Lippincott, Williams and Wilkins: New York.

Reid, J., & Wheeler, S. (2005) Hyperthyroidism: Diagnosis and Treatment. American Family Physician, 72(4): 623-630.

American Association of Clinical Endocrinologists. (2002). Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism. Endocrine Practice, 8(6):458-469.

Via Gothamist, New York City mayor Mike Bloomber has recently pledged $2 million dollars to city-run hospitals for the promotion of breastfeeding, with the goal of getting more women to breastfeed for six months or longer.

“We don’t yet have any hospitals in New York City that meet national ‘baby-friendly’ standards,” Bloomberg’s health commissioner, Dr. Thomas Frieden, said at a parenting conference last week.”That means getting formula out of the nursery. It means putting the baby on the breast immediately after birth. It means that every person who interacts with that mother and child is supportive and encouraging of breast-feeding.”

Well, three cheers for that! I can tell you, a boost like this is sorely needed, particularly in public hospitals, since research has shown that the rate of breastfeeding increases with income, education and age, and public hospitals most often take care of the women who have the least. I hope a fair portion of this money is spent not only advertising and promotion among the general public, but on education for hospital staff. Women need so much help and support in order to be able to breastfeed, especially during those early crucial days in the hospital, when both mother and baby are still learning how; the attitude and encouragement of the hospital staff, from the doctors and pediatricians on down to the PCAs and nurses’ assistants, is absolutely crucial.

For a long time, breastfeeding education and attention has been given short shrift, but thank goodness things are starting to change—from much-publicized public nurse-ins in places like Toys R’ Us to the Massachusets ban of hospital distribution of diaper bags loaded with formula coupons and advertising. The hospital where I am currently doing my clinicals (a public new york city hospital) has recently created a new policy where formula is never placed in a baby’s bassinet when the baby is brought out to the mother, even if the mother is breast and bottle feeding. If the mother wants formula, she has to specifically ask for it. Small steps like that, but the hopefully the overall impact is much greater.

Mothering magazine recently ran a competition to create an internationally recognizable symbol for breastfeeding. The winning symbol, created by graphic designer Matt Daigle, can be seen at the top of this post. This symbol has been made part of the public domain, so it can be downloaded and displayed anywhere, by anyone. The intention is not to segregate breastfeeding mothers, or to designate specific places for breastfeeding, but to simply indicate that breastfeeding is welcome and acceptable on the premises. Hopefully we’ll start to see this symbol cropping up all over the place, in restuarants and malls and airports and libraries, movie theaters and convention centers, maybe even on subways and buses….starting with our public hospitals (I’m going to print out a couple of these and bring them to clinicals tomorrow).

You’d think that by now I’d be good at this whole advocating for women/ advocating for myself thing, but I’m not. It takes practice, and it’s really depressing when I’m unable to find the personal power, the chutzpah, the whatever it takes, to actually say what needs to be said. A case in point:

A few months ago, during the summer, when I was working in postpartum one night, I was taking care of a woman who’s partner seemed to be completely checked-out of their relationship. He refused to respond to the woman’s repeated attempts at engaging him and getting him to help participate in baby care, or even pay attention to her and the baby in the first place. Often as a nurse I get the privilege of teaching both parents so much about their amazing newborn, and about breastfeeding and baby care, and often the fathers are just as eager to learn and help as the mothers. Not so in this case. And it was almost pathetic, the way she kept calling his name over and over, trying to get him to look, to pay attention, to help, to see, while instead he watched TV, and then eventually rolled over, turned his back on his wife and baby, and went to sleep. I was rather shocked by it, and went out of my way to help the mother take care of her newborn that night, while the husband slept on. I think I was hoping he’d see my efforts and realize that a) his wife needed help and b) he was doing absolutely nothing, and then begin to help, out of embarassment if nothing else. This didn’t work, obviously. The husband didn’t stir throughout the night, didn’t help his wife with the 3rd degree laceration walk to the bathroom, didn’t get up to check on the baby when it was screaming through the night (and in fact, how in the world do you SLEEP with a screaming baby in the same room??). The mother was very needy, wanting to breastfeed, lacking confidence in herself and her abilities, and desperate for praise and attention. I spent a lot of time in that room, and she stayed up for most of the night, while her husband slept. I could imagine how exhausted she’d be in the morning, and was worried about how little help and support she’d receive from him, and it turned out that I wasn’t the only one who was concerned! The nurse who’d taken care of the couple the night before confirmed that the husband’s behaviour had been just as unsupportive during her shift as well, and that there was definitely something “not quite right” about the way they related to one another (or failed to relate). Couple this with the fact that this woman had a history of depression, and it was almost like we were staring at a major case of postpartum depression just waiting to happen.

So, what did I do about it? I mentioned my concerns to woman’s attending doctor the next morning, and was flatly dismissed as being ridiculous and out of line. The doctor told me he knew the husband well, and had seen him at many prenatal visits, and was sure that not only was the husband supportive, but that the woman would be fine. When I suggested that we call social work, he told me absolutely not. When I mentioned her history of depression, he again stated that he was sure she would be fine, and that obviously what I had seen and observed was not what was really going on. He defended the husband again, said that maybe he was just tired and worn out from supporting his wife through labor, and that was that. No consults were made. No referrals were given. I felt absolutely helpless, but the way consults work in my hospital, only a doctor can order them, not a nurse, and what could I do? And frankly, I’m not so sure this woman needed a social work consult anyway—she didn’t need WIC or public assistance or anything like that, she just needed support!

I turned my patient over to the day nurse at the shift change, telling her about what I and the other nurse had observed, and then I went home, feeling shamed and belittled by the doctor, and feeling hurt and angry and pissed off and frightened, and alternately wanting to scream at the doctor, but also somewhat wishing I hadn’t opened my mouth, so thoroughly had I been shot down.

And where is that woman now? How is she doing? Who’s checking up on her? Has her partner become any more supportive, or is she feeling like she’s all alone in the world, with a new baby, absolutely no help at all, and ready to climb the walls? Did we let her down? Did I fail her by not taking a firmer stance with Dr. Belittle?

We had a very moving lecture on Postpartum Depression a few weeks ago, and of course this incident with Dr. Belittle and the scary unsupportive husband immediately came to mind. I wish I had had this lecture before above said incident, instead of 3 months after the fact. It was really driven home to me just how poor our country is at recognizing this disorder, let alone offering the appropriate resources and treamtent to the women who so desperately need support during such a terrible, vulnerable time. And as a nurse who occassionaly works on a postpartum unit, I’m amazed that I, personally, in the role of the nurse (i.e. someone who is supposedly trained to recognize signs of this, and to intervene with the appropriate support and treatment when necessary)…I had NO idea where to send a woman like this. No idea how to get in touch with support groups or hotlines. No resources to give this woman. No idea of who to call. No idea what referrals needed to be made (and as a nurse, my ability to refer is limited, since nurses can’t make referrals, but as a midwife, it’s a whole different story). Neither did the other nurse. We both felt something should be done, but we didn’t know what to do. Hello?? Shouldn’t the hospital have provided us with info and resources for this very situation? Where are nurses supposed to get this information from if it’s not part of their training? Why aren’t these resources more readily available? While the idea of routinely screening women for PPD as part of a nurse’s training/ job (let alone a doctor’s!) is given lip service, in practice, it isn’t really that routine. Isn’t that more than just a little scary??

I think in general people are so uncomfortable with diagnosing and treating and accepting psychiatric illness that we’d rather look the other way and pretend it doesn’t exist, rather than confront it. And I think a lot of this also stems from the fact that so often as providers, we really don’t know where to send women so that they can get the help they need, aside from the truly drastic measures like psych consults and social work consults (a route which Dr. Belittle clearly didn’t want to take). Maybe the new postpartum depression bill that’s recently been proposed in Congress will help with recognition and treatment of PPD, because any help at all in this depeartment is sorely needed!

Anyway, to make a long story short, the lecture was fabulous. The presenter was an RN who had personally experienced PPD herself, and was incredibly passionate about the subject. She had references and resources coming out the wazzoo, and I’m now very pleased to be able to pass all of this information on to you, my loyal readers, as well as to know that next time I see something like this (as a nurse or midwife), I will know exactly where to send the at-risk woman. And I’ve started incorporating signs and symptoms of the Baby Blues and PPD into the teaching and educating I do when I’m working on postpartum. And, I’m kinda hoping I get another opportunity to bring an at-risk patient to the attention of Dr. Belittle, because not only will I now be prepared to tell him exactly where to go if he starts to belittle me again, but I also feel like have the tools I need to actually educate him. He wasn’t the one staying up all night with that woman. He should put more faith in a nurse’s judgement, because after all, we spend a hell of a lot more time with the patient than he does. Doctors of the world: ignore nurses and their insights at your own peril, because they see things you’ll never see during your 15 minute antepartum visit or your 10 minute rounding!

Every time I’m forced to stand up for myself, I get a little bit better at it: a little calmer, a little more grace under fire, and a little more articulate.

Postpartum resources:

1-800-PPD-MOMS

1-800-944-4PPD (4773)

Postpartum Support International

National Association of Mothers’ Centers

The Postpartum Resource Center of New York

In response to the highly publicized nurse-in at Toys ‘R Us a few weeks ago, Daily News writer Tracy Connor decided to conduct her own test of NYC’s breastfeeding tolerance by nursing her 3 month old daughter in a variety of public places around the city. You can read the entire article over at Hip Mama.

Crosstown bus: We board a M79 at midday, taking a seat opposite the driver. At the next stop, the bus starts to fill up and we get down to business.

The baby wriggles around, exposing a few inches of skin - and all around me, riders develop the kind of glazed-eye look usually reserved for panhandlers and the mentally ill.

Finally, one passenger pipes up, “Can you do that someplace else?” But she’s not talking to me - she’s barking at a man talking loudly on his cell phone.

When we get to the end of the line, the driver tells me I’m his first breast-feeder passenger. He’s not sure what the Transit Authority’s policy on nursing is, but he has his own. “I don’t see no objections to it,” he says.

Overall, it seems that most New Yorkers are pretty cool when it comes to public breastfeeding, although Connor’s nursing prompted an admonishment from a Babys ‘R Us worker, which the corporate spokeswoman was quick to point out went against store policy. Guess they learned a thing or two from their partner company, Toys ‘R Us, but it sounds like their workers could still use a bit more training.

So, I wouldn’t exactly say that I’m back, but I’m certainly around again, which is a start (although woefully behind on all the latest news). Moving is a drag, and this move has been a very long, drawn out process. Would you believe that most of our stuff is still in boxes??? We’ve spackled and then primed and finally painted our entire apartment; the painting is almost finished, but we still have a final coat of trimming to apply in the livingroom, and then the next chore is finding or building bookshelves to accomodate all of my books. And then finding me a desk, preferably before the start of the school year. Speaking of school, I’ve already been sent me my first homework assignment!! Good lord, it’s not even August yet.

Anyway, enough about me. Here’s an article (The Formula Follies) by Jennifer Graham from last friday’s Wall Street Journal Opinion page, nicely summing up the debate which surrounds the Dept. of Health and Human Services controversial breastfeeding ad campaign.

The Massachusetts Breastfeeding Coalition announced plans for a nationwide “Ban the Bags” campaign at the International Lactation Consultant Association meeting in Philadelphia last week. Dr. Melissa Bartick, the coalition’s chairwoman, has promised that formula marketing in hospitals won’t last. She adds: “We’d never tolerate the thought of hospitals giving out coupons for Big Macs on the cardiac unit.” So baby formula is not yet the new cigarette. But it’s already the new Big Mac.

In other news, at some point I’m going to have to write a (several?) long post(s) about the Birthing From Within mentor workshop I attended at the end of June, and which was, to say the least, a complete and total mindfuck, in the absolute BEST possible way. Longheld beliefs which I have been gradually forming for years were unceremoniously dumped on their heads. Paradigms were shifted. Walls were torn down. The end result has been a student who’s still somewhat reeling from the overall effect, but beginning to incorporate this brand new way of looking at birth into her world view. Lots of cool stuff to say on that subject, but it’ll take some time to write a post like that, and I just haven’t had much time lately (and things are still stewing and simmering and sinking in). But I’ll get to it, I promise.

New legislation was introduced last Friday by Senators Menendez (D-NJ) and Durbin (D-IL) which promotes increased research, education and access to screenings for postpartum depression for new mothers. The bill, known as The Mom’s Opportunity To Access Help, Education, Research, and Support for Postpartum Depression (MOTHERS) Act, also proposes grants to health care providers in order to better facilitate the delivery of healthcare to those suffering from postpartum depression. You can read the ACNM’s statement of support for this legislation here, and Senator Menendez’s statement on the proposed bill here. Postpartum depression affects 10-15% of all postpartum women any time from a month to a year after childbirth, and can be incredibly devastating to both the woman and her family, so a bill like this is an encouraging sign, and definitely deserves our support.

Have any of you seen the new ads yet that are being run on TV by the Department of Health and Human Services to promote breastfeeding? They’re a bit controversial. I was watching one of them with a co-worker this morning at work who had been unable to breastfeed her daughter, and she was quite incensed, stating that there’s already enough guilt associated with not breastfeeding without the government heaping it on, too, thank you very much. The ad showed two heavily pregnant women competing in a dangerous looking water sport where you basically run in place on a pipe in the water, with one of the women falling off towards the end of the commercial. The tag-line ran something like: you wouldn’t take such risks while you’re pregnant, why will you take such risks by not breastfeeding after the baby is born? Or something along those lines. The New York Times ran an article on this yesterday, and The Gothamist picked this up, too. From the times article: “Dr. Haynes, of the Health and Human Services Department, said, ‘Our message is that breast milk is the gold standard, and anything less than that is inferior.’ Formula ‘is not equivalent,’ she went on, adding, ‘Formula is not the gold standard. It’s so far from it, it’s not even close.’ ” Now, these are words I can 100% throw my weight behind, and I think it’s about time the government and medical community has taken a very firm stance on this! The US has always had low breastfeeding rates when compared to other developed countries, and I feel like much of this is cultural: as the Gothamist points out, our society is still a lot more puritanical than we’d like to think, and there are so many barriers in place which make it very difficult to breastfeed, such as short maternity leaves, very little breastfeeding support (often just those first few days in the hospital), the absence of breastfeeding rooms and support in the workplace, and societal messages which make breastfeeding women feel anything but welcome to breastfeed in public (Birth and Breastfeeding news has a good article on such barriers from the Journal of Pediatrics.) Maybe a strong government campaign like this is just what we need to make it very clear, once and for all, that breastfeeding is not just okay, but DESIRED, something which we won’t just tolerate, but ENCOURAGE….but even so, those are pretty strong commercials. I wonder if there’s a way to promote this message with just a little less guilt. Maybe showing women breastfeeding in the workplace, or standing up to their bosses who are asking them to not pump at work, or telling off someone who’s making it difficult for a woman to breastfeed in the park, or something that takes the pressure off of the mother, and looks a bit more at the environment that mothers must contend with when trying to breastfeed.

I’ve been working the past two nights, and absolutely loving it, actually. I’ve been on Postpartum, and have just had a lovely crop of women to take care of. Sadly, at my hospital, most women tend to keep their babies in the nursery all night, despite my best efforts to encourage rooming-in. And sadly, breastfeeding is not necessarily the standard, either; there are always a lot of women who choose to bottle feed, for so many different reasons, and while I am always very respectful of their decision, I always feel a bit sad about it. However, the past two nights, I have been very lucky—almost every one of my 8 patients was breastfeeding, or attempting to breastfeed, or else very eager to breastfeed, and desperately wanting to start just as soon as their baby gets out of the NICU. It was heavenly, and so much fun, although incredibly time consuming. There was also one room in particular where both women had chosen to room-in with their babies, and both were breastfeeding, and both had broken down the barrier of curtains that shields them from each other, and were actually talking (which is so rare! Often in semi-private rooms, the two women never seem to have contact with each other; they keep the curtains shut the entire time, and politely ignore each other.) There was such a lovely energy in that room. Both women were so excited about their babies, and about breastfeeding. I must admit—this quickly became my favorite room.

One of the women in this room had had absolutely no problem breastfeeding her baby during my first night of work: both of them were learning so well, the baby was latching beautifully, and I got to spend a lot of time with them, teaching the mother how to latch and unlatch her baby, teaching her that yes, her baby really can breathe okay, even when her face is pressed all the way against the breast, teaching her how to prevent sore nipples, and how to recognize that her baby is getting enough, and how and when to start switching breasts, and what to expect once her milk comes in, and the safety-pin trick, and all of the gazillion things I love to teach and explain about breastfeeding. And they were doing great! The mother was loving it, and the baby was looking incredibly content, and I thought all was well.

Then, when I returned the following night to take care of them again, I learned that the baby had slept all day long, and hadn’t eaten at all for the past 15 hours (even though she had had several wet diapers, which is always a good sign). I reassured the mother that the first few days of life are sort of erratic in terms of sleeping and eating, and that eventually she and her daughter would fall into a routine, but as the night dragged on, the baby became fussier and fussier, and we were unable to get her to latch despite our best efforts, and despite the baby’s apparent hunger. Every time we put the baby to the breast, she would become absolutely hysterical, and then it would take several rounds of rocking and patting and sometimes walking with her to calm her down enough to try again. I couldn’t figure out what had happened! The night before, they could have been the poster couple for La Leche League, and then, one night later, it was a completely different story. The baby was hungry, and latching well enough, but every time she latched, she would just hang on the breast, refusing to suck, or else suck once or twice, and then grow hysterical again. I kept reassuring the mother, who was rapidly losing her confidence and her sanity, and we kept trying. I would leave the room to take care of my other patients, and come back to find the mother still awake and the baby still screaming.

Finally, finally, around 5:00 am, at our wits end, I suggested we try the side lying position, since we’d tried everything else and none of it had worked, and boom! I don’t know what it was about that position, especially when the other positions had been working just fine the night before, but all of a sudden, everything clicked again. The baby latched right away, calmed down immediately, nursed for at least 35 minutes, and then fell straight asleep. The mother got crampy from the nursing (which is also always a good sign that the latch is good, and that the baby is sucking well), I gave her some Motrin, and then she fell asleep too. They were absolutely adoreable sleeping together in the same bed after being up all night together. I pulled the curtains around them and shut the door and made sure that no one disturbed them.

And I know she’s not my baby, and this woman, prior to working with her for the past two nights, is a complete and total stranger to me, so you might say why do I even care so much? But I can’t even begin to tell you how happy and relieved I was that everything is going so well for this pair, and that the baby finally had such a good feeding, and that the mother didn’t end up losing her faith in herself, and in her body’s ability to feed her baby. The immense sense of satisfaction I felt as I left work this morning was indescribeable. It’s so nice to have such lovely patients, and to do work that you believe in so passionately (such as helping women breastfeed). I’m so lucky to love my job (well, love certain aspects of it, anyway), and to be able to feel like I’m making such a difference in people’s lives. Yes, I am on a breastfeeding high. Today, life is good.

Now here is a diaper product it seems like I can really throw my weight behind: Flushable diapers! What a neat idea: putting the solid waste where it belongs, in a toilet, rather than a landfill. Another environmentally friendly alternative to disposables, and perhaps these diapers are even a bit better than cloth (and certainly use less water, for those of us who like to conserve). It’s hard to know for sure, but it does seem like this company has done its homework: they’ve accounted for their environmental impact, they’ve tested their product on 6 different US toilet brands, they’ve followed these diapers through the waste management system as well as conventional composting, they’ve made sure that the companies they work with operate under fair labor laws, and truly seem to care about kids, diapers, parents and the planet. Neat! And really refreshing to see. I’ve always assumed that when I have a kid eventually, s/he is going to have a cloth-diapered tush, but now, who knows….maybe s/he’ll wear flushables. Check it out!

Don’t you just love it when birthing or breastfeeding or babies makes it to the front page of the New York Times? I do! Go check out today’s front page (well, the online front page, at least). There’s a very fun article there by Nina Bernstein about the diversity of colic remedies for new babies—as diverse as the population of this city. (You have to register to read the article, but it’s free). Go go go!

And speaking of postpartum, guess where I ended up working again last night? Still haven’t seen a birth for weeks (boo, hiss), but I did get to do some great breastfeeding education with four women in particular. There is so much to teach when it comes to breastfeeding, though, that sometimes it’s incredibly frustrating, because you never feel like you have enough time to cram it all in—adequate hydration, and how to know that the baby is getting enough, and how to latch and unlatch, and reassure the mother that the baby is breathing just fine, and how to care for sore nipples, and how often to feed, and for how long, and when to switch breasts, and how to position the baby. You would want to spend at least an hour just talking about breastfeeding alone, but you have eight patients at a time, and inevitably three of them need pain medication and a third is asking for another ice pack and the fifth wants to get out of bed for the first time since her cesarean, and the sixth needs another IV bag hung, and breastfeeding always seems to get short shrift. However, I do try to spend as much time as possible on it, even at the expense of my break, or my charting, because I really believe that if a woman and her baby can have positive breastfeeding experiences while they’re in the hospital, they’ll be able to go home with so much more confidence, and not abandon breastfeeding for “something easier”. And it’s true, breastfeeding does require a lot more work than bottle feeding, especially in the beginning when both the mom and baby are still learning how, but the benefits are so obvious (granted, I am quite biased, but even so…do formula-fed babies ever look even 1/4th as blissed-out and contented as the breast-fed babies?? I think not!). By the end of the night, three of the babies were latching beautifully, with exactly that look on their faces. And I must be doing something right, becuase one of the couples even asked if I was willing to moonlight on the side and give them some lactation support at home in the coming weeks, which is an offer that is actually tempting (although the next question is…how much do you charge for something like that?).

However, the fourth woman I worked with had an adoreable little guy who kept insisting on sucking on his lips and tongue, no matter what we did. In fact, his tongue actually curled up towards the roof of his mouth, so that when you opened his mouth, you couldn’t see the roof of it because his tongue was always in the way. We tried so hard to get him to open his mouth by stroking his nose and lips in a downward motion, and then trying to get the breast in his mouth, but he never opened his mouth wide enough for that because he was always busy sucking on himself instead. The few times we were able to get his mouth open, his tongue was always in the way. At best, we were able to get his outer lips around the areola, but that was it. I feel certain that if we could have just gotten him a little taste of the breast, he would have been hooked. He was obviously hungry, but was self-conforting by sucking on his lips and tongue. I spent over an hour with her trying to get him to latch. Does anyone have any suggestions for how to get a baby like that to actually open his mouth? I think I’ll post this on a breastfeeding message board as well and see if anyone else has any tips either. I’m usually pretty good at helping women get their babies to latch, but he really stumped me. Gotta learn more. First, though, gotta sleep. Good night!