Monday, May 30, 2011

learning about breastfeeding

A young midwifery student who I will call 'B' wrote to me:

Today I had work on the postnatal ward, and I had one of my "What would Joy do?" moments, as I had a particularly hard case to deal with, well for me it was hard.

I was caring for a woman who had a baby girl at term. There was some concern about possible infection, so baby was admitted to the newborn nursery soon after birth. I found the mother in her bed crying. I found myself having to be 'with' her in a very human, tangible way that I find hard to put into words.

After having a talk and her calming down, I wanted to help her with breastfeeding. The issues I saw for this mother were:
a) separated from her child
b) bottles and formula
c) sick baby
d) the fact she had only expressed once since her baby had been moved to special care 24 hours before and had minimal skin to skin/ feeding attempts since.

I showed her how to hand express, showed her how to use a pump, and helped her attach her baby in the special care nursery.

It was just one of those cases where I especially wanted her to succeed in feeding, which was what she desperately wanted too, and I wonder if there is anything else I can do for her?

This is an all too common scenario that student midwives face. I congratulate 'B' on the way she has been working through her thoughts in this situation.

A key to supporting this mother and baby are to understand breastfeeding from the baby’s point of view, and to help the mother to see that perspective too. Babies want milk; they want it in abundance and from their mothers' breasts. Any artificial substitute is inferior in the baby's mind, as well as being inferior from a nutritional perspective.

A student midwife working in a hospital has very little authority or ability to change the culture within the unit. Did that baby really need to be separated from her mother? Were all the medical processes that followed the separation necessary and helpful? ...

The ideals of the Baby Friendly Health Initiative, or the Mother-Friendly Childbirth Initiative, empowering women as mothers and promoting bonding, breastfeeding and health are not very useful to a person like 'B' working a shift in a postnatal maternity ward. 'B' needs a strategy by which she can impart hope and encouragement to the new mother until her child is returned to her care.

As soon as baby is well enough she will be looking for her mother's milk. It is usually possible to revisit the unhurried, skin-to-skin experience as could have happened in those magical hours after birth, when a baby intuitively seeks and takes milk. The midwife who is confident in understanding a baby's approach to breast feeding will also be 'with woman' in that natural process.

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