labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Friday, December 14, 2007

By The Book

I have come to the conclusion that an obstetrics nurse can handle any type of postpartum assignment so long as there aren't major breastfeeding issues to attend to. This will probably piss off a few people, but too bad. And I am not alone in feeling this. I was just having this conversation with some of my fellow staff nurses and we have agreed that breastfeeding can make or break our day.

Here's why: picture a 30-something professional woman having her first baby. She has read all the breastfeeding books, has gone to a breasfeeding class prenatally, consulted privately with a lactation specialist, and has herself completely able and ready to breastfeed once she's given birth.

Lo and behold she has her baby and immediately puts her baby to breast. It goes well and she is happy and confident. And then her baby hits the post-birth adrenaline crash and decides to sleep for hours and hours. She tries waking her baby according to all the books and lactation manuals every 2-3 hours but baby just isn't interested.

The meltdown begins....

Her nurse tries to reassure her that this is normal, and baby will nurse again. There is nothing she is doing wrong. But the books said that the baby must nurse every 2-3 hours or will lose too much weight, become jaundiced, and dehydrated. Despite reassurance, her anxiety level goes through the roof.

Finally baby latches to the breast, and in order to make sure the baby is latched properly, she pushes the top of her breast/areola down and ends up breaking the latch. She does this over and over, despite the nurse suggesting that pushing her thumbs down may be interfering with the latch. Baby becomes frustrated and frantic from the constant latching and unlatching, and so starts screaming. She starts crying.

There is such a fine line in these types of situations. As her nurse, you want her to be able to breastfeed with confidence, you want to help and reassure her, but how can you delicately say "Relax, this will work!"? And how do you get her to stop feeling guilty about her family members telling her that her baby seems hungry and how could it possibly be ok to not just give some formula?

This is so frustrating. Really. I am very pro-breastfeeding, don't get me wrong. But after 7+ years of obstetrical nursing, I've seen a lot of breastfeeding. My personal experience has lead me to believe that those who approach it with a relaxed attitude and the ability "to go with the flow" (no pun intended) do so much better from the start. The mother's who get worked up when baby hasn't nursed by the books and create an atmosphere of tension and anxiety end up with the "poor nursers".

Come to think of it, I don't ever remember assisting an 18 year old first time mother with a breast pump, or teaching her how to "finger feed", syringe feed, or use an SNS system.

Can you tell I have been working postpartum the past few shifts?


Nine Texans and friends.... said...

I 100% totally agree. Not that the women who are super-'prepared' are bound to fail but IME, the mom's who just believe they will breastfeed, know a few basics and go into it with a 'go with the flow' attitude do much, much better. The ones who know about all the possible problems and impediments seem to be the ones who always end up with them. Makes you wonder about self-fulfilling prophecies. Mom is worried 'what if I don't have enough milk?!' and lo and behold she ends up quitting at 3 weeks because she didn't "have enough milk".
I was one of those naive younger moms. I was 20 when I had my first baby. I read a TON on pregnancy and childbirth but almost nothing on breastfeeding. I was breastfed, my sister was breastfed, all my nieces and nephews were breastfed.. In my world, mothers nursed their babies and that was that, I didn't know that I was supposed to 'prepare' for it. So I had my induced 42+ week labor that ended in a C-section, didn't see my daughter until she was almost 4 hrs old, had had demoral and an epidural, I'm sure dd had some glucose water in the nursery (breastfeeding is sure to fail, or so I would have thought had I read the books) nope. Picked her up, latched her on and that was that. Aside from some sore nipples we were good to go and she nursed exclusively for the next 4 months.
I feel for women that find breastfeeding challenging, feeding ones baby should be enjoyable and relaxing not frustrating and tearful but I do sometimes wonder how many problems would be at least, less intense, if mom's had a little more belief in the process and a little less information overload.

Anonymous said...

Too bad all post-partum nurses don't have the same attitude. When my infant slept "too long", I was told I had to feed my baby or it would be taken to the nursery and fed formula.

Rinna said...

On the other hand, all the information about the benefits of breastfeeding may be the deciding factor on whether the mom will persevere to breastfeed despite the difficulties.
I know that it's what kept me going. I can totally relate to the 30-something professional woman (though back then I was the almost-30something ex-professional) and I was totally overthinking breastfeeding, specifically the latch and positioning. It really made for a difficult and painful first 3 months but because of all the information I had, formula supplementation was pretty much non-negotiable.
Without the info that I had, I probably would have caved at the first growth spurt/cluster nursing. All my friends did. And none of them exclusively nursed past 4 weeks.
Information at times is a big headache but I am glad I had it. :)

Tonia said...

Oh, I totally agree! I was so relaxed with my second and he would sleep for 4 and 5 hours between feedings. However, with my first, I truly didn't get the bfing help I needed from the nurses at the hospital. My nipples ended up cracked and bleeding and I had to use a nipple shield for 3 months. And although I went on to have a successful bfing relationship for 14 months, I still think the nurses should have listened to me more and not just assumed I was a first time mom who didn't know what I was doing. At least that is what it felt like. I was still relaxed and not concerned with time, but with pain and my concerns were not heard.
But I definitely agree that if you are relaxed it will be so much easier and successful

Jess B said...

OMG! If I could only tell you all the fights my DH and I have had over "the book said..." ARGH! I feel your pain. I'm one to follow my gut, he follows the book. I can only imagine how trying it is on you as a nurse.

Labor Nurse said...

I am surprised that the comments so far have agreed or sympathized with me. I thought for sure I was going to hit a nerve with some breastfeeding mom's who had a rocky start.

Michele in Michigan said...

When I admit a new mom to our unit, one of the first things I ask is, "Have you read a lot of books about breastfeeding?" When they nod, I point at the baby & tell them "Well, the Peanut hasn't read ANY of them and he's never had to use his mouth to eat."

I then tell them that the baby's skills may vary from feeding to feeding--that mom might even look at the baby & exclaim "You act like you've never done this before!" Especially after that first "perfect" latch. I tell them that the biggest favor they can do for themselves is to "Cut yourself some slack." This is all new to everyone & it will all work out.

Even if things are rocky, I touch mom's shoulder & gently tell her, "You were BORN to do this...You guys will be just fine"

You hit the nail on the head--the more wound up mom is about breastfeeding, the more difficulty she will have. I spend a LOT of time calming these moms down.

Julia said...

I had a difficult start to Breast feeding - painful, painful latch, sore and cracked nipples, with a 37 week old, smaller baby, who wanted to eat all the time. Luckily, I also had an overabundance of milk, so I never really considered quitting. I read a fair amount of books - after baby was born to try and find a way to get him latched that didn't kill my nipples so much, but before only had what I had learned in nursing school. I don't know if I was over-thinking it or not. I was also pretty stressed, because my pregnancy and birth had not really gone as I had wanted, so was hung up on at least getting the breast feeding right. Around 3 weeks (once he hit his actual due date), things started to improve a lot. Experience? A bigger baby? I don't know.
What I found amazing was the difference quality of some of the nurses in assisting with the whole process. Some of the nurses, especially the lactation specialist, could pop baby on, and no pain at all. I felt like others were about as good at it as I was (i.e. sucked).

Anonymous said...

I was 23 with my first. The thought that someone "couldn't" bf hadn't occured to me. My mother, grandmother, greatgrandmother, aunts etc... had bf. I saw a big section on bf in a baby book and couldn't imagine who would want to read all of that. I had never watched a baby feed from a bottle and thought the cans in the baby isle were something to do with nappy rash. BF went fine. We had colic problems and my (Canadian) inlaw's kept coming around with formula. I didn't know how to prepare a bottle and it all looked intimidating. Besides she had an overflowing diaper genie and with all that screaming she couldn't be hungry. Who screams like that when they're hungry? Sometimes, ignorance is bliss.

Ethel said...

I was a mid 30's ex-professional woman with my first, who was relatively quiet after the c-section. It was very frustrating! I thought the baby would know, the lactation nurse was frustrated too, we tried all kind of techniques to get him to latch on, but he just couldn't or wouldn't. Finally the postpartum nurse gave me a nipple shield and my new boy latched on, stayed latched on and nursed well. The lactation nurse tsked about that and said I'd have to wean him from it as soon as possible. Well, 12 months later when I weaned him from nursing he also weaned from the nipple shield.

Of course my oldest now is going to OT for sensory issues in self feeding. Sometimes the baby really doesn't have a good feel for nursing and the baby is the one who needs help. Certainly his little brother had no problems! But I do think we women who over think what our body knows to do get in the way of our own bodies. Like failing to progress (me), or even having issues with conception. We need to trust our bodies more and think a little less about things.