Help is on the way with Mothers and Breast Feeding
Natalie Guillen/The New Mexican
Diana Del Mauro | For The New Mexican
5/9/2009 - 5/6/09
Don't let anybody kid you: Breast-feeding can be torture.
During those first weeks of nursing, unthinkable things can happen to your body. There's nothing like cracked, bleeding breasts — coupled with sleep-deprivation and a fussy baby — to make you question your commitment to operating a milk depot for your precious little one.
Some give up, while others suffer for too long.
"You feel so vulnerable, and it's hard for you to advocate for yourself," said Ramey Sallaz, who gave birth to daughter Phoebe at Christus St. Vincent Regional Medical Center in January 2008. "You're so dependent on everybody, and that's the hardest part."
Santa Fe is a place that celebrates breast-feeding. After all, it is home to Mothering Magazine, which espouses natural-baby lifestyles to the rest of the world. And there are good local resources available. But many new moms aren't getting the help they need, women's health specialists say. Advice from nursing staff is inconsistent. Mothers are leaving the hospital so soon after delivery that sometimes their milk hasn't come in, and they are forced to deal with the challenges when they are home alone.
Last fall, in an effort to address the lack of continuity in services, Mona Malin, a doula, or birth coach, and Joy Lanum, a nurse and board-certified lactation consultant, formed Santa Fe Birthing Community Resources. Recently, the cooperative launched a Web site — www.birthingcommunity.com — where mothers can find information about birthing classes, doula services, postpartum care, breast-feeding support, preemies and twins, herbal care and parenting. "I feel like people in different facets of care are starting to communicate more with one another and collaborate more," Malin said.
Still, for many, getting the right advice is hit or miss.
"The situation in our community is that we do have a lot of resources here, but a lot of women don't know how to connect with them," Lanum said. "Santa Fe is a good place to have a baby. It's a matter of getting more people connected."
Breast is best
The research is clear: Breast milk offers one-of-a-kind nutrition, with lifelong benefits for children. For mothers who are able to breast-feed, nursing also rewards them with health benefits, such as lower risks for breast and cervical cancer.
They are more likely to continue breast-feeding for the baby's first year of life — the recommended period of time — if they have knowledge about how their bodies work, proper support in the hospital, ongoing support after they go home and favorable conditions in the workplace, specialists say.
But even women determined to breast-feed face enormous challenges.
In preparation for motherhood, Sallaz read books, took prenatal classes, hired a doula, and after her doctor scheduled a cesarean section because the baby was breech (bottom facing toward the birth canal), she sought out a hypnotherapy-for-surgery class.
The delivery room was busy that morning. Nursing staff were scrambling to keep pace with a spike in births. (The number of babies born at St. Vincent increased from 1,500 to 1,800 in the last two years.) Phoebe was born at 8:48 a.m. Jan. 20, 2008, but all the suites for new moms and their babies were full, so she couldn't move from the recovery room until 4 p.m. There was no lactation consultant at the hospital then.
Phoebe had a hard time breast-feeding until the doula, Abby Bordner, brought a silicone nipple shield that helps babies overcome latch-on problems. After Bordner left, some of the hospital nurses frowned on the use of the device, saying it can cause problems such as low milk production. But Phoebe wouldn't feed without it. Then the nurses said her daughter's diapers were too dry. One nurse had Sallaz pump breast milk into a cup to be sure her supply was sufficient.
"They had good intentions, but the nurses all had different information," Sallaz said. "I was completely frazzled."
The doula then advised her to look at the muscle in Phoebe's jaw to see if she was actually swallowing while nursing. Sallaz began using the shield again, and her daughter responded.
"Luckily, I had other people to help me. Otherwise I don't think I would have been successful. It was discouraging," Sallaz said. "I just wouldn't want other new parents to have to contend with some of the circumstances we did."
Lisa Van De Graaff of Santa Fe says she verbally chased a St. Vincent nurse from her room after the nurse announced she was going to get a bottle of formula.
It was March 2008, and Van De Graaff was breast-feeding her daughter, Rose, while recovering from an emergency C-section. The nurse expressed concern about the baby's weight, but Van De Graaff was not convinced that formula was necessary. She fiercely refused it. The next day she consulted with the physician, who agreed with her. Rose went on to breast-feed exclusively for six months (minus one bottle of formula when her mother had stomach flu), and continues to breast-feed at 13 months of age.
Hospital protocols
Roughly 80 percent of babies born at Christus St. Vincent Regional Medical Center are breast-feeding by the time they leave the hospital, according to Barbara Garcia, director of Women's Services.
The hospital's goal is to "assure that all moms have the knowledge to make an informed decision regarding breast-feeding," Garcia said, "and are given the support to be successful."
But Joy Lannum says plenty of mothers "fall through the cracks." Either the nurses and lactation consultants are too busy, or patients are confused by the mixed advice they get.
As a part-time nurse at St. Vincent, Lanum understands what the staff is up against. A nurse might schedule a breast-feeding help session with a mom, then get called to the operating room for an emergency C-section, or arrive when the baby is asleep.
For nine months in 2007 and 2008, getting help was particularly hard on patients because the hospital had no lactation consultant on staff. Annie Lown had retired after 10 years in the job, and it wasn't until last December, after Lown returned part-time and trained Aviva Faust, that the hospital began providing lactation services five days a week.
In addition to hiring Faust, St. Vincent recently purchased a breast pump for every room on the Women's Services floor. In the past, the hospital had five pumps; now it has 23.
Lown, now back as a full-time labor and delivery nurse at St. Vincent, is also training the hospital's doulas and nurses once a year in an attempt to get everyone on the "same page" about breast-feeding technique.
"Moms can get really hurt," she said. "So a big part of what I do in my training day with the nurses is actually talking about how to help position the baby so that it feels better, and so that we can try to avoid the most common complaint: that nursing hurts."
But Lown admits that mixed messages are still an issue. "Once nurses are off on their own, they tend to do what they know; they give advice based on how it was when they nursed their kid," she said.
One of the biggest issues is when to give supplements.
Barring a medical reason, no formula is distributed unless parents ask for it, Garcia said. Nor do new moms receive free formula in diaper bags when they are discharged, unless they request it.
But St. Vincent nurses have standing orders to consider formula for a breast-fed newborn if the baby has lost 7 percent of its weight. Before giving a baby a bottle, the nurse is supposed to check many other factors, such as the baby's temperature (Is it over 99 degrees?), number of wet or dirty diapers (Is waste production down?), how often the baby is feeding, reaction to other soothing techniques (such as swaddling) and overall contentedness (Is the baby acting hungry and dissatisfied all the time?).
"What makes you think that?" is the first question to ask any nurse who presents a bottle, Lown said.
Since milk flows faster from a bottle than it does from a mother's breast — at first — a baby given a bottle might resist the breast the very next morning. According to Dr. Kathleen Marinelli, who wrote clinical protocols for the Academy of Breastfeeding Medicine and works at a "baby-friendly" hospital in Connecticut, "There are very good data out there in the literature that even one bottle in the hospital can affect the duration of a mother's breast-feeding."
And not only because the baby might prefer the bottle. Mothers who get the message that breast-feeding isn't that important might soften their commitment to nursing, which means that all the good things that breast-feeding does for mothers and babies are cut down to some degree, she said.
"We're supposed to be breast-feeding our babies; that's how we evolved," Marinelli said.
Many babies fuss like they wish they had more to eat. But most of the time, healthy babies don't need formula. What's available from mom's breast is usually perfectly matched to the baby's stomach, which is the size of a marble at birth. Newborn babies in the first 24 hours of life do fine on a few ounces of colostrum, a pre-milk substance that is high in protein and helps keep a baby's blood sugar up, she said.
"Because mom is tired or the baby is tired or she wants to sleep the night — those are not good reasons to supplement the baby," Marinelli said. "Because the baby is crying doesn't mean the baby needs more milk necessarily."
"Nursing like crazy" the first few days is key to overcoming pain, and it's also like priming the pump, because milk production is based on the principles of supply and demand.
"Helping someone in the early days really is primarily about building her confidence (so that) she doesn't quit before her milk comes in, and she has a chance to see a baby who is drunk on his mother's milk," Lown said.
There are some instances — cases of jaundice or diabetes in the mother — when supplements might be appropriate. But, in Marinelli's opinion, formula should be the last resort. Start with the mother's expressed milk, she said, and then try pasteurized donor human milk.
There are also strategies that work in other cases, even in cesarean births, that support nursing.
"Skin to skin in that first hour after delivery is really, really important," Marinelli said. "That's when the baby's going to root around and find the nipple, even if you don't do anything."
Babies who do best get eight to 12 feedings in the first 24 hours. For this to happen, mothers and babies need time alone.
"Some hospitals are too family friendly," Marinelli said. "Every other minute someone walks in the door. The mother leaves in three days, and the baby is not fed well yet."
Going home
While breast-feeding is a natural process, short hospital stays mean many new mothers go home before they are comfortable with their baby on the breast and before their milk is flowing briskly. They aren't sure what to expect, and they might not have relatives or friends who know what to do if the baby isn't latching on well.
"There's so much build-up to the birth, and then what? It may feel like everyone walks away. ..." Malin said. "It's very un-natural. Other cultures have a protocol in place."
Lanum meets long-suffering mothers who "bite their lip" and breast-feed, believing the myth that it is supposed to hurt. They call her with panic in their voices: "I was sent home (from the hospital) and I have a 5-pound baby and he's not eating and I don't know what to do."
To ease the transition from hospital to home, nurses should give a mother a plan for feeding her baby, Lanum said. "Some mothers have breast-fed once before they go home, and they don't really have a plan."
And, she added, "If it really, really hurts, then something's not right" and a mother should ask for help, because "it's not supposed to be painful for seven days."
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