A little more dolce with the leche, por favor

Woody is again having a nice and boring day. We continue going up on the feedings, and by tonight he should be getting 100% of his nutrition through his stomach, as his nutrient feed will be replaced by a simple saline solution to keep his broviac stent flowing. We are happy with this. As of late last night, Woody was weighing in at just under 800 grams, which translates into 1 lb 12 oz (or so), which is pretty great. I also think it is very funny how his weight gets converted to me by various nurses. "He was up 40 grams, so now he's 1 lb 10 oz" is what Nurse J said to me the other day. I asked what that translated into for total grams and she didn't know.

One area of care that I am currently not that happy about has to do with an incident that happened yesterday. Maggie had been given a packet of information regarding lactation, and was told about a consultant that would visit her upon request. So she asked if this person could come visit, which she did yesterday. I wasn't there, so what I am reporting is blatant hearsay, although I did have much of the story confirmed by Woody's nurse as well, so I think it must be accurate. I am also taking this as an opportunity to vent a bit, so be warned.

Maggie has never gotten to actually breastfeed, of course, because Woody has had a ventilator tube in his throat since shortly after being born. But we are well aware the breastmilk is the best food for infants, and so we (I am using the highly presumptive first-person plural, even though I not only have not done any breast pumping, but also find this convention pretty annoying as it relates to the declaration that "we're pregnant!") have been pumping since day 2. It's not so easy to keep the milk going when it's always pumping and never any of the touchy-feely aspects of breastfeeding, and Maggie wasn't sure how much she should be pumping, and what volumes of milk she should expect, and stuff like that.

So the lactation consultant comes in, and Maggie explains her concerns, and this boob starts lecturing her about how she's not been doing it right because she hasn't been getting up in the middle of the night to pump and because she doesn't have very much volume, she is not doing very well at it. Moreover, she intoned ruefully, women generally have their maximum milk volume in by two weeks after childbirth, so there wasn't too much hope for Maggie. In short, Maggie was pretty crushed after this, and the nurse even told me that she had intervened on Maggie's behalf during this lecture, because the "lactation nazi" (apparently this is a common pejorative among certain nurses, or so I have been led to believe) really was being pretty mean to her.

Maggie has been highly anxious about the whole pumping thing anyway, and this has further set her off. I have reassured her as well as I can, and primarily because of the following facts, which the "expert" apparently failed to note:

• First, the boob is mostly used to dealing with full-term mothers, and it seems pretty obvious that her advice has limited usefulness for Maggie. Take, for example, the point about most mothers having their milk in by two weeks after the birth-- hello? Maggie hadn't even gotten to the six month mark, and pregnancy hormones work on the milk ducts for nine months+ in a normal pregnancy. It's no wonder she's lagging a little bit, and I really doubt that she won't be able to increase the milk supply.


• Second, the doctors were pretty clear with her about getting a good night of sleep, especially with the HELLP and c-section to recover from right afterwards. She's deficient as a breast pumper because she follows her doctor's advice? Shame, shame, lactation "expert"!


• Third, it is my understanding that lactation issues are as much (or more) art as science, and each woman is different from another. One of the things that we do understand is that milk production is a matter of supply and demand. The demands for milk have not been up to the level that a full-term baby requires, so is it any wonder that she doesn't produce to that level yet?


• Fourth, it is also fairly well understood that milk let-down is made much more difficult by stress. Being only able to lactate into a pump is one thing. Having a sick preemie in NICU is another. But being chewed out by the lactation quack is utterly inexcusable for this reason alone.


• Finally, this person ignores the most salient fact, which is that even at Woody's full feeding levels, she produces more than enough for him already (even though she, yes, has an output that falls into the 'low milk production' range). If we just get her production up gradually, by the time Woody's ready to actually breastfeed there should be no issue.

The only reason the boob came in was because Maggie requested it, and her dire predictions and shameless tut-tutting do not help. I have modestly interposed myself as Maggie's new lactation consultant, and have ordered her to ignore all advice from the milk "expert". We increased the frequency of pumping sessions yesterday, and lo! and behold! she has, less than 24 hours later, already jumped in her production by a considerable amount. Two week maximum my ass.

I am probably going to write some kind of a letter to the administration of the hospital about the incident, but am not settled on exactly what tack to take; I am a little wary about making myself too much of a pain to the people who have to watch Woody. Although I must say that my loud advocacy about not poking Woody too much last week did make a difference, even though I offended a couple of people in the process.

(And as a final aside, I will note for the record that I am not above taking questionable credit for even something as small as getting Woody fewer pokes, whether it was my complaining that led to that result or not. Hey, I didn't carry him, I don't get to pump, I gotta have some kind of role, right?)

**Late Update-- Maggie made the change to increased frequency of pumping, and check out the results. What a boob!**