Monday, April 23, 2012

Lactation Consultants and Preemies

I realized something the other day, after reading some article or blog post about breastfeeding support in hospitals. What I realized is that I didn't particularly like the experiences I had with most of the lactation consultants I met. Oh, they were perfectly nice people and obviously dedicated, but something just wasn't right. Three years later and I think I know what that was.

They didn't know preemies.

Or maybe they had plenty of preemie experience, but nonetheless brought the same one-size-fits-all solutions to every breastfeeding dilemma. The advice I received - and paid for - was the same that I found on the hundreds of websites I ended up visiting in my struggles toward exclusive nursing without EBM supplementation.

The gist I got from these lactation consultants (who I should say are in no way representative of ALL lactation consultants) was that preemie breastfeeding problems are the same as full term breastfeeding problems and should be tackled the same way. Not to mention the nagging implication that I was doing something wrong and was obviously terrible since, in the worlds of one of the LCs, "Everyone can do this."

Which, as I'm sure the experienced mamas out there know, is pure bull.

What I did not get from my lactation consultant led preemie breastfeeding experience was individualized attention that took P.'s prematurity into account or even her own pecadillos into account. Like her silent swallowing and lightning fast eating speed. Her tiny mouth vs. my honkin' rack. A weak latch that stayed weak for 18 months until she weaned herself, which saw me holding myself in silent offering at every feeding, from start to finish.

Whether these were preemie problems or just P. problems, we'll never know, but in either case, none of that seemed to matter to the women who did things like insist I repeatedly let P. go through the motions of the breast crawl. Conveniently forgetting that as a preemie, she ought to have been saving her strength. Or to just let her get hungry enough and she'll eat, as if that's how it actually works.

My guess is that what actually worked was simply time.

The time it took for P.'s muscles to grow. Time to develop the ability to breathe and swallow without aspirating. Time for neurons to develop and for reflexes to kick in. And let's not forget all that practice time and the time it took me to realize that yes, she was getting plenty in five minutes. Time that might have been better spent not going from lactation consultant to lactation consultant hearing the same advice... and the same little digs.


Lactation Consultants and Preemies

(Don't think that I didn't have any help, though. The NICU nurses - one in particular - were mostly amazing and had a knack for giving me confidence instead of taking it away. And a friend recommended a particular bottle that made easing off supplemental feedings so much easier since the nipple had a very breast-y shape.)

 

18 comments:

  1. Great post! I remember crying after one of the visits from the LC while I was trying to get comfortable with my lil 5 pounder... I was determined to nurse exclusively and the LC was very vocal in expressing her concern for the size of me vs. the baby's lil mouth. She nearly ruined, what turned out to be, one of my best experiences in nursing! Had he not been number three I may not have been so committed and may have worried that I was not doing what was best for Baby!

    Thanks for this post...
    Make it a great day!

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    1. Thanks for your comment! I don't know if there are just more people writing about them, but I've read more bad LC stories than good ones. I don't for a minute believe that there aren't great LCs out there - it just seems like I don't know anyone who's met them!

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  2. "Her tiny mouth vs. my honkin' rack." Thank you so much for a joyous laugh, for taking me back to the awkwardness of breastfeeding (which is NOT as natural as one might think), and for a lovely post.

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    1. You're so welcome! And so right - it's not all that natural or easy for a whole lot of people!

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  3. I actually don't know anyone who has had a good experience with a lactation consultant! I think by the time you get to that point, you're so frustrated anyway... it's just HARD. I know that they are all really nice people who are trying to help, but there are just SO many variables!

    After my 5th (and I've just been lucky enough to breastfeed them all... after a few close calls on not being able to because I'm not a big producer), a breastfeeding consultant came in the room and corrected me on my "stance" without even asking if I needed advice. It was really funny. She had only had one child... I'm sorry honey, but I know what my boobs do thank you :) But that is really the only experience I've had with one!

    Breastfeeding is HARD WORK though and sometimes it just doesn't work!

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    1. Amen!

      It's funny - I sometimes wish I'd trusted my instincts more. If I had had a bunch of kids before P. I think I would have said 'this is just how WE nurse' and maybe it's not by the book. Because we basically tossed the book out the window! Rules, schmules. It worked for us :)

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  4. The first time around with Ev was terrible. The nurses were terrible and the lactation consultants, aside from my pediatrician, were also terrible. I got the same feeling that I was doing something wrong from everyone but the PED. She was positive the whole time, she placed more emphasis on the milk I was able to provide already having been important, even if it was pumped, and less emphasis on the necessity that I put myself through emotional turmoil for the sake of natural nutrition. She kept saying how well I'd done already and most babies don't get that much, etc. which made me feel good about what I'd been able to accomplish, however it was done.

    With Del it just came together. We didn't have the torticollis/tongue-tied/flat nipple issues that I'd had with Ev. And I had muscle memory from all of the months I kept trying to get him on the breast. It also probably helped that I was eager to do something positive for her after the birth trauma. Emotionally, for me, I mean. I was so overwhelmed with guilt about her birth I didn't have room to feel anything other than sure-footedness about the breast feeding.

    I hope things work out well for you the second time around, lady.

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    1. You had a lot on your mind, and it worked to your advantage :) Love it!

      ...I hope so, too. And looking back, I feel pretty lucky because in the end, it all worked out for me and P., too. It just took 4+ months to work out :)

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  5. My preemie twins never latched. We had very informative lactation consultants that specialized in preemies. We even had a speech/occupational therapist who came in to help us. Unfortunately, while everyone involved was very, very nice; there was always this weird balance of pressure not to give up and the sense that we should just give up. Ultimately, I stopped trying while the girls were in the hospital for 6 weeks. I tried a little more when they came home, but it just never happened. This is one of the biggest disappointments I have faced as a mom.

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    1. I hope you found peace with it all eventually, Sandra! In our NICU, the number one rule was feed the baby/babies. That, I think, is why I liked the nurses better than the LCs - they were all for working at nursing, but also let you know that if it didn't pan out, there were plenty of options. Good options, too. I can understand disappointment, but I sure hope no one ever made you feel bad about it.

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  6. I had some of the same frustrations. One LC would say "you have to let her stay on the breast as long as she wants" and then the next would say "why on earth would you let her nurse for 30 minutes on one side? she's just using you as a pacifier, which leads to bad habits." The third would say "you have to do 20 minutes on one side, then 20 minutes on the other."

    It just felt like a lot of ultimatums, which were impossible to all meet, but if you mentioned having problems, then the ONLY possible reason was because you weren't following that particular LC's specific advice.

    Now I'm just bummed because I can't BF at all because of the medications I'm on due to the heart problems I developed after the delivery. I've been pumping (and dumping) but over this past month my supply has slowly dwindled. I have a follow-up with the cardiologist this Friday, and I'm hoping I've recovered enough to at least switch to BF-friendly medications. That would give me a solid month to re-establish my supply and bond with Juliet before I have to go back to work.

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    1. I am encouraged by the fact that I had a pretty successful time breastfeeding her in that first week before I was put back in the hospital. Plus, she still searches for a nipple when hungry, (no matter who is holding her), so I feel hopeful she'll re-adapt easily. I'm taking encouragement from multiple stories (including from my mom) of women who weaned, but then needed to go back to BF and were able to get their supply back up.

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    2. (However, that first bottle of formula that we had to give her when I was put back in the hospital and on medication made me cry. It still depresses me every time I have to pour my milk down the sink.)

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    3. If it's all right for me to offer recommendations, I'd say a hospital grade pump rental if you're not using that already, and pumping after every feeding (sucks, I know). With a store pump, I could only get about an oz. but I could literally fill a bottle with the hospital grade rental.

      And we had luck transitioning with the Playtex Drop-Ins Original Nurser - that's the nipple type that was recommended to me by my friend whose mom is, somewhat ironically considering this post, an LC. I think they helped nip nipple confusion in the bud. Now they make even more boob-like bottles, but they tend to be the expensive fancy kind like so: http://reliabrand.com/

      Anyway, good luck! And remember, that no matter how you're feeding your awesome girl now or in the future, you're still bonding :)

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  7. Oh how I think this can fill in the blank for many things...preemies are different. They are special. Not developed, not just small babies. E almost died from aspirating because she didn't have the coordination down but ate lightening fast. She is still on thickner at 2 and 1/2 years old. Preemies are different. I love this post for acknowledging that and for empowering other mamas who may be much earlier in their journey! So happy to meet you Christa. Thank you for coming by my SITS Day and so happy to have found you. <3 Shannon

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  8. Great post! All mommies can relate to that one-size-fits-all approach that some medical professionals have when it comes to our babes. It can be so frustrating, especially when your mommy instincts are telling you something different!

    p.s. I didn't know you had a honkin' rack. You keeping it under wraps ;-)

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  9. Everybody can do it? Complete bull! Like you, I found the NICU nurses so incredibly supportive. Those nurses deserve a medal for all that they do...from preemie care to emotional support.

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  10. Oh and may I add that by the 3rd I was so done with the LC's that when one came in and asked how I was doing I boldly told her I left the baby in the nursury for the 1st night so I could have one last night of sleep to recover from birthing a child and when she gave me the standard line "well now that she's had a bottle she might now want to nurse" I simply smiled and said "yes, she WILL want to nurse" and she does! I didn't see that woman again.

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