Thursday, December 30, 2010

Tale of Two Births

Melissa Bartick, MD, chair of the Massachusetts Breastfeeding coalition, wrote a great series on breastfeeding in the US.  I recommend this article that describes two hypothetical births--one in a baby-friendly hospital and one not, because it shows how our society, communities, and medical system all come together to set a new mom up for success, or failure.

Friday, December 24, 2010

A higher level of barriers

In a previous post, I talked about the most common reasons moms quit breastfeeding: latching problems, breast refusal, low milk supply, and pain.   Looking back, I realize that I stopped because of extreme pain caused by latching problems from extreme engorgement and a frenetically, energetically hungry baby with a very strong suck.

United States Breastfeeding Committee commissioned a new report to help "combat the barriers to breastfeeding success."  It lists the major barriers as "hospital practices, provider skills, social and workplace support, and media and marketing."  These are the societal barriers that either cause or hinder solutions to the many personal or physiological problems (like pain) that new moms deal with when trying to breastfeed.

At the time my son was born, I felt that my hospital gave me good support, I think because I was so emotionally overwhelmed that I mistook good emotional care for good medical care.  (The hospital where Sam was born is not recognized as a Baby-Friendly Hospital by Unicef, though they did meet many of the Ten Steps.)  But with a year of hindsight, asking myself whether the medical services did the best they could for me and my baby, the answer is no. Here's why:
  1. There was one lactation consultant on staff at the hospital, but she was also a full-time nurse with regular shifts and only saw nursing moms in her spare time between rounds or as overtime.  During my stay at the hospital, I saw her once a day, and afterward, once a week.  What I needed was access to a certified lactation consultant round the clock while at the hospital (anytime I tried to nurse) and on call at home.  Initiating breastfeeding is an hour-by-hour challenge.
  2. The other nurses tried to help with breastfeeding, but their advice was, though well-meaning, inconsistent and not very helpful, except for the emotional aspect.   A commonly-cited article from the Journal of Obstetric, Gynecological, and Neonatal Nursing reported that "nurses have limited knowledge of breastfeeding, although no variable consistently predicted breastfeeding knowledge."  (Anderson, 1991.)
  3. The nurses gave Samuel colostrum mixed with glucose water, despite medical recommendations against glucose water to prevent hypoglycemia.  (Orr, 1997.) 
  4. One of my symptoms was edema, which made engorgement worse and latching extremely difficult.  The lactation consultant said the IV fluids I was given contributed to this, but I don't recall edema being one of the potential side effects of my pain treatment.  (Walker, 2000.)
  5. I expected my doula to see when there was a problem and help me find solutions, but her job was done after the baby was born, except for one follow-up visit.  Next time I will secure my own help (from doula or otherwise) for longer.
These fall under "hospital services" and "provider skills," I could also list other problems I experienced under "social and workplace support" and probably even "media and marketing."  What combination of problems did you experience, and which of the higher-level barriers (hospital practices, provider skills, social and workplace support, and media and marketing) did they fall under?

1. Orr, Edie and Crase, B.  "Hypoglycemia and the Breastfed Newborn." From NEW BEGINNINGS, Vol. 14 No. 4, July-August 1997, pp. 107-8
2.  Anderson, E., N, MS and GEDEN, E., RN, PhD, FAAN.  "Nurses' Knowledge of Breastfeeding."  Journal of Obstetric, Gynecologic, & Neonatal Nursing, Volume 20, Issue 1, pages 58–62, January 1991.
3. Walker, Marsha, RN, IBCLC.   "Breastfeeding and Engorgement.  from Breastfeeding Abstracts, November 2000, Volume 20, Number 2, pp. 11-12.