I got an interesting email from genuinely fearless lactation consultant Valerie this morning, posing the question: when helping new mothers who are attempting to breastfeed, where should the line be drawn between encouraging positivity and realistic practicality?
Occasionally in the hospital setting I will run across a situation when maternal anatomy makes clear that breastfeeding will not be easily accomplished. (To a lesser degree, there are situations such as “late pre-term” babies, tongue tie, or just uncoordinated suckle on the part of the baby – all of which make the startup a bit more complex.)
I find myself struggling between wanting to give a realistic picture of what may be required to give breastfeeding a chance vs. sounding too discouraging.
The most recent situation encountered yesterday that inspires my question: A mom I was trying to help has the type of nipples that do not easily compress for a baby to latch onto. The best way for me to describe them is that they are “fibrous” or feel almost like scar tissue. Little to no flexibility and a wide diameter so not easy for a baby to learn to latch onto. She had attempted with her first child briefly. Interestingly, there was even a charted feed with this child post delivery. (I highly doubt this child was latched at all based on my assessment of her nipples!) The primary nurses rarely touch a mom’s breasts or nipples so seem largely unaware that this type of nipple is not going to be easy to latch onto or that they even exist!
This mom had come in intending to do “both” (bottle/breast). This can certainly complicate a one or two day old baby’s willingness to feed in the average situation – depending on ease of latch and volume of formula given. (I know that some people call it nipple confusion – I think the baby is not confused at all – - bring on the milk!) But her prior experience had her knowing that things were unlikely to be simply “latch and feed” so she knew what she would likely need.
Once the baby was awake and interested enough, it becomes easier to assess whether the baby was capable of latching – at least at this feed. In this case, as soon as I touched mom’s nipples (with permission granted I saw that this would be no quick fix or a “just wait for the baby to wake up” fix. We tried a nipple shield for a few minutes without much success. I offered some suggestions to the mom about what options would be available in the short term – such as pumping – since the milk was coming – latch or no latch. With no milk removal, the supply would go. She affirmed that with her first child, she did experience engorgement.
I left the decision up to her as to whether she would like to begin pumping and / or continue to try on her own or with my help at successive feeds. (She had already given two bottle feeds since she’d been unable to latch baby on her own.) She had gone to the WIC breastfeeding class and seemed to want to try again with this child. I encouraged her to think about what she’d like to do if the baby continues to be unsuccessful in latching, and I would be happy to help her when she called. (Did not want to have her feel pressured at that moment – and wanted her to have time to think about it.) I don’t think she’d thought about pumping for bottles – even short-term – so I mentioned that some women do this for as long as they felt it was working for them. (Again – my personal opinion on this is to educate moms about how to do it, and acknowledge that it is often cumbersome and tiring – but possible for some moms who want to.) But even my suggesting this at this point made me wonder if I am indicating that I don’t think latch looks promising….
So – bottom line question. Do most moms want a realistic picture of what may complicate the breastfeeding success curve in the early days? Or that it may actually be impossible to latch a baby until the baby is possibly weeks old? As an LC, I certainly cannot predict what will happen, but sometimes it is obvious that success is not going to be quick or easy. I struggle between wondering if I should be realistic about what will likely happen without ending up being too discouraging in case the baby makes a liar out of me.
Besides making me wish I’d had a lactation consultant like Valerie in the hospital where I gave birth, this email made me think. If you had some physical condition which **might** make breastfeeding challenging, would you want to know beforehand?
Now, I think it’s pretty obvious where I stand on this; I believe forewarned is forearmed, and it is one of the reasons I write this blog, and encourage you all to share your stories every Friday. I’ve learned so much about lactation problems in the past 2 years, and as any regular reader of FFF can tell you, these issues are real, relatively plentiful and seldom talked about by medical professionals. In many cases, the problems aren’t insurmountable, but when a woman is a few hours postpartum or a newborn is losing precious ounces by the hour, it’s hard to find a calm resolution. Going in with knowledge of what you might be facing could help you be in the right state of mind, with the right folks on your team; you could do your research and not be at the mercy of whoever is on call from the LC team that morning (because god knows, it probably won’t be Valerie).
On the other hand, there’s that whole power-of-positive-thinking thing. Maybe ignorance really is bliss? If it’s a problem that may not even turn out to be a problem, could worrying about it do more harm than good?
Considering how many of us had physical impediments to lactation, I think we’re a perfect sounding board for any professional pondering these issues. So I’m asking you, FFFs – what do you think? If you were the woman in Valerie’s story, how would you prefer she handle the situation? Harsh realism, blind positivity, or something in between?