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Monday, April 20, 2009

How late is too late to re-lactate?

I have previously wrote an unfortunate post, an example of a mother who brought in her 2 month old for me to fix the latch and milk supply. I have seen a few of these types of dyads, since, where I know right from the start (often before I enter the exam room), I am wasting my time; I know the baby will never latch and I am doubtful the milk supply will increase. Sometimes I can even tell from attitudes and what is said via the phone, non-verbal clues, and what's written on the new patient forms. Some just want the correct information to see if it's possible. I try never to give up on anyone.

This past week, I saw a 2 month old who needed help latching and who's mother's supply had dwindled. Mostly he was being fed formula by bottle. While I couldn't promise a fully latching breastfed baby, I thought I could significantly help her milk supply by reinforcing positive attachment parenting skills, her nutrition, and herbal and prescription galactogogues. I thought her baby might latch when the milk supply increased.

So what's so different about this mother with a 2 month old and the previous mother?

For one thing the babies behaviors are different. In the optimistic situation, the baby is rooting and turning towards the breast and showing signs of being very frustrated at not being able to latch. The mother, likewise, was also frustrated that the baby wouldn't latch. In the other circumstance the baby had no clue what a breast was for and totally disinterested.

In the hopeful situation, the mother interactions with the baby was totally different and probably most likely accounted for the difference in the baby's behavior. Mom was responsive to the baby, she was emotionally sensitive to the time loss in breastfeeding and the birth plans that went awry. She took her shirt and bra off to feed. In other words, she was comfortable with skin-to-skin. She was mostly practicing attachment parenting all along and feeling the loss of not being able to provide for her baby. She didn't have an argument and a pity story in retort to my every suggestion. She came in open minded for information. She did not expect me to wave a magic wand. She expected to make the effort herself after receiving individualized guidance. I also really liked her interaction with the baby when I peeked in to the waiting room. I would have not guessed what her reasons for coming in were.

On to another point. A LLL Leader referred her to me. This mom had never been to a LLL meeting. The information LLL meetings provides about mothering through breastfeeding is so important, especially when breastfeeding is NOT working. I can provide medical guidance, but the mother-to-mother support comes from LLL. She had tentative, hesitant plans to attend her local meeting that I inquired about. I've been to enough LLL meetings to anticipate how awkward it would be to go in and bottle feed and didn't want this to deter her.

So I said, "I imagine it will be really hard to sit through a LLL meeting and feed your baby with a bottle."

She had also anticipated this and told me how she planned to excuse herself for the baby's nap, the bathroom or whatever when it came time to bottle feed.

I feel so strongly that mothers need the information provided at LLL and I feel they will glean so much just by observing the interactions between other mothers and babies that she needs to be upfront with why she is there and STAY. I prepared her for what to expect. There is always introductions first and she just needs to come right out and say that until her milk supply comes in she needs to feed her baby with supplements and a bottle. Honesty, I anticipated, should get the support she needs.

I can't pin-point an exact age where its too late to make the effort to breastfeed. I am always ready to give a mother with an open-mind the correct and individualized information, but there must be internal motivation.


Mama K said...

This is helpful information, Denise. Thank you! Watching the mama for clues would be a good skill to develop. And I like your suggestion for the bottlefeeding mom at the LLL meeting: Honesty. Hope they are good to her. I bet they will be.

Katherine said...

I am a birth doula and one of my first recommendations to mothers that I serve who want to breastfeed is to attend an LLL meeting, or several if they have more time before their baby is born. Something about being around other women who are comfortable and skilled at breastfeeding their babies I think does wonders for expecting mothers. At the very least this lays a foundation for where they can go if/when they need help and guidance (even if they have a doula). Thank you for your blog!

Lauren said...

I enjoyed this post. I imagine that it would be very difficult going into a LLL meeting with latching/supply issues and having to resort to a bottle. I've seen these mothers come into meetings and get support.

She may feel more comfortable if she came a little bit early and explain the situation to the LLL leader (if she's not the same one who has been helping her on the phone).

I hope she comes and is able to get the support she needs. :)

womantowomancbe said...

It was part of my home-birth midwife's "requirements" that I attend my local LLL meeting at least once before I gave birth, so that I would be familiar and feel more at ease there, should I need them. I didn't; but knowing how many women *do* have problems, I think it is a very wise course of action to take.


noelani said...

When my fourth adopted child was placed with me, she was 6 1/2 half months old. I was still nursing my 2YO and really wanted to nurse her. She had spent most of her life in the hospital and had issues with both her physical and emotional health. I was told that a baby over 4 months could probably not be taught to nurse, but I tried, anyway. At first, things did not go well at all. I applied everything else I knew about attachment parenting and made a great deal of progress with her. For months, I tried to be happy with that, but I couldn't do it. Finally, I decided to consider every aspect of her experience of bottle feeding and then tried to make small changes toward breastfeeding. The day before her first birthday, she became a nursing baby!

Since then, I have been in touch with other adoptive moms who wanted to get older babies started breastfeeding and needed encouragement. Some of their children have been well beyond infancy when they began breastfeeding. The results have been tremendous, especially with children who have experienced a great deal of trauma and/or deprivation in their early lives.

I would encourage any mother who has an interest in re-lactating to go ahead. It may take a lot of patience and creativity, but it can be done!

Denise Punger MD IBCLC said...

noelani, Thank you for your tremendously encouraging comments on my blog today. I love your persistence! I may have to bring your comments to the top of my blog in their own post!

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