Friday, June 09, 2006

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!**

9 Comments:

At 12:52 PM, Anonymous Grammie said...

When I was visiting you all a couple of weeks ago, the lactation nazi came in while Maggie was out of the room. I didn't like her attitude at all and realized immediately that she is (a.) not very bright since she can't adapt the advice she usually gives full-term moms and (b.) less than supportive. As an experienced mother who nursed 3 babies, I can tell you that a mom's body adapts to what the baby needs, which is a wonderful thing. Breast feeding is not rocket science--it's actually much more elegant than that. If Maggie pumped more, she would HAVE to pump every 3-4 hours or court a breast infection. When Woody gets bigger and she needs more milk, he will nurse more and she'll produce it. It's simple as that. If you need more advice, contact a member of the La Leche League or get their book (The Motherly Art of Breast Feeding, I think). It's a little over-spiritualized but the advice is very sensible AND it's given by women who've actually done it.

 
At 1:07 PM, Blogger judith said...

maybe in a letter to the hospital you might suggest that a NICU-specific lactation consultant could be very helpful to new moms and babies who have very different needs than those who have reached full-term. then it would be more "suggestion" and less "complaining" (not that i think complaints aren't warranted!)

 
At 1:15 PM, Anonymous Dad said...

You betcha... Being your father, I never nursed one child (much less the 3 your mother did) but I took more than a mild interest in the process and learned as much as possible (listen to your mother). And I concur with you on the issue of "father/mother pregnancy" or going through this parenting thing together. Sure, it's not as tough on your body as it is on hers when she's pregnant, but it's a special kind of tough to work through all kinds of experiences and process role changes and maturation in your heart/head WITHOUT the hormonal and physical impact of a baby inside you. You've obviously "bonded" (whatever that may come to mean) with W.X. -- I know you're looking forward to a little more payoff in the future as he progresses.

 
At 1:51 PM, Anonymous Aunt Susan said...

Okay I just have to chime in and tell maggie not to listen to the lactation specialists who all must go to the same school to be trained to make new mothers' cry. WOW! Who are these crazy people??? Nathan you are totally right about all your common-sense points. Tell her to ignore all of the boobs. One out of the FOUR lactation boobs I had was a kind person.

 
At 3:45 PM, Anonymous neuharth said...

Hobbs, you're doing what you have to do. In light of everything that has been going on, the last thing you need to deal with is an insensitive boob* making Maggie feel bad about something she has little control over. I think a big "screw off" to the boob* in order; however, I agree that it is best not risk ticking people off who might have some influence in taking care of Woody. Just follow your common sense points, and listen to the HHW (as I am observing that they are called).

By the way, congratulations on the Jeopardy try out. We should go to Fabulous Ferns to keep you on top of your game.

*In keeping with your inclination towards all things footnotes, I found it quite funny that you refer to the insensitive lactation expert as a boob.

 
At 4:29 PM, Anonymous The Copy Monkey said...

Nathan, just give Kelly and I the boob's name and address and there will be some avengin', monkey-justice style (ie flaming bag of poo on doorstep).

 
At 5:50 PM, Anonymous jared said...

Nathan no role? Pshaw! What about the all-important role of "historian"? Keep up the positive spirit via the informative prose bro.

 
At 3:54 AM, Anonymous Anonymous said...

Happened to "run across" your blog and love, love, love your apt description lactation nazi/Boob. When my wife delivered, the nurses at our hospital called them Nipple Nazi's. Hang in there, you'll get thru it. And thanks for the insight along with the info. Hank from San Mateo, CA.

 
At 1:04 PM, Anonymous Shelli W. said...

Yea Maggie! You doubled your milk output! I wanted to slap that woman and I don't even know her...or you. We are good friends of Steve and Sherry and have been praying for Woodrow and you two since Woodrow was born. Thank you for allowing us to feel connected to you and invested in his precious life. We are watching him grow every day and cheer with every milestone...and get frustrated with the inexcusable insensitive nature of some medical "professionals." (although I don't know that I would call the lactation "expert" a medical professional..probably not)
BTW - Jeopardy..I LOVE Jeopardy! Congratulations!
Shelli W. - Tulsa

 

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