Belly Tales

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).

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!

A friend with a colicky baby has suddenly begun to swear by this method of colic massage. First decent sleep she’s gotten in weeks, apparently! Who knows, maybe it will work wonders on your own colicky baby too. Check it out.