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The Nursing Mother's Companion, Fifth Revised Edition

Nursing Mother, Working Mother

Breastfeeding and Human Lactation

The Breastfeeding Answer Book

The Breastfeeding Book

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Maternal, Neonatal, and Women's Health Nursing

Eat Well, Lose Weight While Breastfeeding

        This is where lactation consultants and educators become a crucial part of a new mother’s hospital stay--your village, in a sense.  “At Cedars, we see every mom that comes through,” says Epps.  “Unless she says to us, ‘I’m going to bottle-feed,’ and even then we spend time with her so she can make it through engorgement.”  She describes an average day on the floor.  “When the census is high, we can hit as many as 80 new mothers in a day.  We spend 45 minutes to an hour discussing positions, how a baby latches, various aspects of managing a newborn, how to soothe and comfort, how to burp.  While the baby’s nursing, we teach for about 15 minutes more.”  Epps and the other lactation consultants were recently asked to write a course in lactation for hospital professionals, using this standardized “latch tool” model.  “It’s a lot of information for women to absorb so soon after delivery,” she says.  “But there’s hardly a woman alive who doesn’t immediately shift, like gears in a car, as soon as that baby’s born, because the need to know how to feed your baby is the number one concern of almost every mother on the floor.” 
 

            “I really want women to know they can nurse their baby,” says Wade, who has worked with hundreds of thousands of mothers and babies in his career.  “There’s a very minute number, maybe 1 in 20,000, that have severe problems with nursing.  I’ve been able to get almost every baby on the breast; it’s a reflexive action.  That means most of our effort needs to be helping moms with babies get a latch-on that’s good, healthy, effective, and not painful.  Your brain and your DNA just produced that baby, and your hormones are there to make milk.  The baby is very intelligent and survival-oriented and we don’t give enough credit to our little ones.  They actually have the ability to nurse without you doing anything, if they’re given correct access to the breast.”

        Wade explains how formula was invented in the late 1880s to provide nutrition for orphaned babies, but by the early 1920s, a number of manufacturers in the U.S. had started to produce it as a business.  “Some very astute marketing people understood there was a real movement of women into the workforce, and they used that opportunity to create a sense of need.  They also advertised formula to poor women as a way to modernize themselves.”

        Slogans like Nestle’s “Better than the Breast,” were particularly damaging.  “Formula companies have gotten themselves so entrenched into health care that people actually see them as part of the team,” says Corky Harvey, M.S., R.N., C.L.C., and co-owner of The Pump Station in Santa Monica.  At Santa Monica Hospital, where she is a lactation consultant, she constantly takes down posters about how formula with DHA makes babies smarter.  “Lactation educators are like salmon swimming upstream,” she says.  “Once, I put up a sign about breastfeeding in the nurse’s unit, and the next day, somebody had written in big red letters, ‘Tell them to bottle feed.’”

        Harvey recommends women become “the captain of their ship.  Be educated before you go in about how to latch a baby on, and particularly, how to know the baby is transferring milk.  If your baby is not making progress to the breast in the first 24 hours, protect your milk supply and begin the pumping process until you’re able to get the breastfeeding resolved.”  She says babies should be coming to the breast every 2-3 hours.  “That will drive your supply.”

        Says Epps, “The most important thing for a woman who wishes to naturally breastfeed her baby in this culture, is to get as much information as possible.  Just as you informed yourself about labor, know what to expect from your hospital routines, what you may encounter post-birth.  Then write a birth plan that stipulates you are to keep the baby with you, that you are to breastfeed, and that you want the necessary assistance, for whatever hospital you’re in.  Get your M.D. to put it into your chart as an order.”

        Harvey suggests, “Call your local La Leche League for a breastfeeding class.  Call Medela 1-800-TELLYOU to find a local lactation person.  Most hospitals have classes, most Lamaze teachers would know where to attend a class.”  She reiterated it has to be “a solid breastfeeding class, somewhere in the realm of 2 1/2-3 hours, there’s no way you can cover this in 20 minutes.”

        Also, discuss breastfeeding with your doctor.  “I think part of the problem is that even if it’s a day after the birth, we’re almost getting there too late,” says Winter.  “The OBs need to be working with their pregnant ladies to help them have the kind of births that are going to facilitate breastfeeding, and the OBs have to be behind breastfeeding 100%, putting those babies to breast for a good two hours at the birth.”

        Which brings up the issue of medicated births.  Inducement and epidurals have become such a standard way of delivering babies in the hospital, many women accept this as normal.  “Induced labor is not a normal labor,” says Harvey.  “Research shows epidurals affect babies.  I’m not saying it shouldn’t happen, but the truth is that a lot of medicated births in the hospital don’t nurse well.  The moms get off to a poor start, then they go home with no support and we have this downward spiraling.”

        “We’re a nation of, if anything hurts, take something,” says Gurmukh.  “There’s no advantage in pain, that’s the tendency of Americans.  But in ancient teachings, spiritual teachers put their students through tasks that challenged them, into what we call “keep-up energy.”  That’s why, in my classes, we have the 3-minute “keep up” exercises.  I’ve had many women say ‘why not take drugs, it’s easier.’  Or, ‘I’ll try nursing, if it doesn’t work, formula is close enough to mother’s milk.’  And you say, that’s not true, and you start educating them.  Then they begin to get in touch with their instinctual, primordial knowingness.”

        Harvey sees America as a culture in transition.  She and her business partner, Wendy Haldeman, were asked to create a training video for Santa Monica Hospital’s nurses.  She compares what’s happening now to the inclusion of fathers in the delivery room.  “People were not choosing a certain hospital because they didn’t let fathers in, they’d go somewhere else, and it hit the hospital square in the pocketbook.  So a new policy came from the top:  ‘We’re letting fathers in, find a way to make it work.’  Then once the fathers were in, the nurses found out it actually helped!”

        “As mothers, we’re the change makers,” says Gurmukh.  “I’ve seen a tremendous change in hospitals, in favor of mothers and children and families.  And not because a hospital brought it up, but because we demanded it, as though we were customers.  If you’re at the Four Seasons and your sheets are dirty, you’re not going to say, ‘Well, I can’t tell them that.’  You’d be on the phone, what’s the deal here?  Yet at a hospital, we think they own us and they set the rules, the trends, the standards.”

        “The major issue in community hospitals and teaching hospitals,” says Wade, “Is that the doctors are not of one medical group, they’re independent practitioners using the hospital in an uncoordinated fashion [when it comes to breastfeeding].  HMOs have a fair level of good educational input over a lot of providers.  So one of the issues we’re addressing at the state level is to begin other institutions.”  He cites the newly-formed Women’s Health Division in the Department of Health and Human Services, which is funding research grants and providing money for studies in all 50 states.

        “The number of people who have successfully breastfed [in the U.S.] since 1969 has gone up by about 800%,” says Wade.  “But it’ll take another 20 years of those kinds of improvements to make sure that more than 50% of all women working in the healthcare force will have positive breastfeeding experience.  You’ll find once it reaches the 50% threshold, women will counsel women correctly, and it will be positive-to-positive.”

        Winter gives her phone number on weekends and off-hours to only her breastfeeding clients.  “What will make a huge difference,” she says, “Is to increase the training of the nurses and decrease the ratios of patient-to-nurse.  [In public health], it’s going to take more home visits or phone consultations than we’re used to.”

        “There’s a health care crisis in our country,” says Epps, “So in spite of the enormous demand and need, hospitals are cutting back.  Once we have the nurses trained in the latch tool program, we’ve been told to expect cutbacks off the team.”  (Cedars also recently closed its outpatient lactation clinic.)

        “Probably the most fundamentally difficult issue is that, in medicine, like the government, when budget crunches come, training or education is always the first to be cut,” says Wade.  “And it goes back to our kids, whether in schools or health care.  Primary preventive medicine such as breastfeeding takes a commitment of the whole culture--social consciousness and culture--to make it effective.  We’ve had 80 years of unbundling [with breastfeeding] and it will take us 50-100 years to rebundle it again.”

         “I think what we have to do, all the way down the line with change,” says Gurmukh, “Is to come from an open heart, and knowing there’s not a mean-intended person in any hospital, they’re just on a track, like we’ve been on a track through many stages in parenting.  The way in is not to roll up our sleeves and show our biceps with these nurses, but to use tender loving care, in order for change to happen.”

        “Breastfeeding made being a mother easier,” says Winter.  “The only thing I want to think about at the end of my life is my breastfeeding days.  Doctors and nurses aren’t any different than anyone else in the community, and if they had more personal experiences, they would be more promoting.”

        Concludes Epps, “Trust your breasts, they work.”