Thursday, February 26, 2015

The Unexpected Shower Guest




INT: SMITH-JONES RESIDENCE in Kensington. Afternoon.  A baby shower is underway, with stylishly dressed women sitting in a semicircle around DR. MARTHA SMITH-JONES, who is clearly in her third trimester. A huge pile of pastel-festooned gifts is in front of MARTHA, who is opening a large flat box.

MARTHA: 
This is from Sarah, eh?

She takes out a yellow onesie, as all the women coo. She turns it around to show off the back, which has a duck face on the bottom. The women squeal.

SARAH:
 I do wish you’d let us know whether it’s a boy or a girl. It’s so hard to buy everything in gender neutral yellow, or purple, or green, or white, or . . . Well, you know what I mean.

MARTHA:
 It’s a mystery to us, too, on purpose. We’re totally fine with being surprised, and besides, who knows how they might identify in the futu-

She trails off, distracted by a telltale whooshing sound outside their window. Only a few of the partygoers notice the sound, and seem undisturbed by it.

MARTHA: 
Excuse me. I  . . .  think we might have a late arrival.

She hoists herself up off her chair and walks with effort towards the front door, clearly with equal parts apprehension and excitement.
TISH:
 They’d better have RSVP’ed, yeah?

The women go back to chatting amongst themselves.

MARTHA takes a deep breath, opens the door and sees the back side of the ELEVENTH DOCTOR, who is fussing with a gift bag. He wheels around. MARTHA marvels at his transformed appearance and style, not sure what to make of it.

DOCTOR: 
Well, look at you. Martha my dear. I heard the news and just couldn’t pass up the chance to travel back 6,237 years and drop by for some well-wishing.

MARTHA: 
It really is you.

DOCTOR:
 You look so . . . different!

MARTHA:
 Likewise.

DOCTOR:
 Hm? Oh, oh yes, right. My extreme makeover. (He steps back with a flourish.) What do you think?

MARTHA:
    . . . Quite fetching. I  . . . just wasn’t expecting. I mean, I am. Expecting! That is. As you can surely – won’t you come in?

She steps back from the door and gestures him in. As he enters the living room, all the heads turn to stare at him. He waves amiably if awkwardly.

MARTHA:
 Everyone, this is the Doc . . .tor John Smith,

DOCTOR:
 Hello.

TISH (skeptically):
 Dr. John Smith? So, he’s a . . . relative of Mickey?

MARTHA:
 No, no, just an old friend. Colleague.

SARAH:
 Speaking of Mickey, this IS supposed to be ladies only, Martha! You didn’t even want the father here, much less old flames. (She giggles)

MARTHA (flustered): 
Not a flame at all, just a friend.

DOCTOR:
Very old. 

TISH:
 Suit yourself, it’s your shower. But I only have enough sticky toffees for those who RSVP’ed.
 
She exits to the kitchen, two other women following with wine glasses in hand.

DOCTOR: 
So, I brought you something. Made you something actually.

MARTHA:
 Really? You made something for me?

DOCTOR:
 For you and little Stella.

He jovially pats her belly. The ladies gasp. Martha looks stunned.

DOCTOR:
Ohhh. You – you hadn’t gotten there yet. Right. Well she turns out to be just super, reall-

MARTHA gestures to stop and shushes him.

DOCTOR:
 Sorry, right, got it. ANYWAY, here.

He holds the bag out in front of him.

MARTHA: 
Can’t believe you did this. Thank you.

She smiles and sits down to open it. She pulls out a nipple-shaped contraption with flashing lights, wires and electrodes extending from it.  She and the party guests are all stumped.

MARTHA:
Um, wow! It’s, um. What exactly is it?

DOCTOR: 
I call it the Tracking Incremental Totals Breastmilk Infant Transfer.

MARTHA looks blank.

DOCTOR:
I know, a bit cumbersome, even for the brightest of you humans. So you can just go by the acronym.

MARTHA (pauses to think):
  . . . Oh no.

DOCTOR:
 That's right. The TITBIT.

He beams. MARTHA is now completely nonplussed.

PARTY GUEST: 
So, what’s it for? What’s it actually do?

DOCTOR:
 Here, allow me.

The DOCTOR begins fiddling with the TITBIT, unwinding wires and starting to set it up as he talks.

DOCTOR:
 You see, I knew you’d want to breastfeed, since you surely know it’s the biological norm and the optimal start for your baby.

He places electrodes on various places on mom, looks around and grabs a throw pillow to place in her arms as the “baby”, places electrodes on it as well, then goes to place the nipple shield component on her breast. There’s an awkward pause. He then hands it to Martha to place herself, which she does, skeptically.

DOCTOR: 
But I read that early cessation of breastfeeding is attributed largely to lack of maternal confidence in her supply, and not knowing how much milk their baby is actually getting. So I thought, why not develop technology that can demonstrate both! The TITBIT here measures flow of milk, volume in the mammary gland, corresponding volume in the infant stomach, and maternal hormonal levels as well.

He sets up a switch that goes *DING*

DOCTOR: 
Brings back memories, eh? Then, all that lovely data connects to an app [he grabs MARTHA’S phone off the side table and hands it to her] so Mum can follow the whole flow of the feeding, right on her mobile. Not unlike the monitors they use to track contractions at the hospitals when you’re in labor! All right there in a readout.

He steps back to admire his handiwork, very self-satisfied.

DOCTOR: 
There you have it.

There is a long, uncomfortable pause as Martha and the guests all look at each other. The Doctor rocks back on his heels. 

DOCTOR: 
So, accolades now?

MARTHA: 
It’s  . . . I know you mean well, and I can tell you put a lot of –

PARTY GUEST:
 Oh, I’ll say it. I know he’s your friend, so I’ll say it. Dr. Smith, I appreciate that what you meant to do was encourage Martha, but honestly, all that contraptions like this do is undermine a new mum’s confidence. Doing things like weigh-ins at home before and after feedings, just creates an obsession with numbers, and makes mom start doubting everything. Mums need to trust themselves, and if something seems to be going off the normal path, they need real support, not a mechanical measuring system spitting out numbers she can’t make sense of.

YET ANOTHER PARTY GUEST:
 I thought the diaper was the breastfeeding measuring system.*

ANOTHER PARTY GUEST:
 Exactly. In most cases that’s the only one you need! I’m a lactation consultant at Martha’s hospital, and while pre- and post-feed weights can be useful information – and only if it’s done with a VERY accurate scale, which is unlikely to be in a layperson’s home – but it’s only one part of a very complex picture. Just giving mums the raw numbers doesn’t give her any idea how to put them in context. And in most cases, she doesn’t need to anyway.

The guests all murmur their agreement. The DOCTOR is taken aback by the conversation, occasionally looking like he’s about to interject, but thinks better of it each time, and continues to listen to them.

STILL ANOTHER PARTY GUEST:
 And numbers aside, using a nipple shield is already an intervention, isn’t it? And one that can interfere with breastfeeding if it’s not actually indicated in their situation? Why would you introduce one in a contraption like this, for no good reason?

YET ANOTHER PARTY GUEST: 
What about the sensors supposedly reading milk volume? It’s like he has no idea how human milk is synthesized – which is constantly adapting and changing.

SARAH:
 This won’t be the last such invention we see, I’m afraid.  I actually attended the MIT Hackathon in Boston last fall. Many of the brilliant engineers wanted to "fitbit" breastfeeding, exactly like this device. I spent all weekend telling them NO. And then explaining why this would actually hurt breastfeeding. They had a hard time understanding the concept, and I can imagine we will see lots more devices like this in the coming years. Sigh. Let's hope the innovative breast pump ideas I saw work better than these feedback devices.**

YET ANOTHER PARTY GUEST (gesturing with her wine glass): 
Quit trying to biohack breastfeeding, technology overlords!

The guests all raise their glasses.

DOCTOR: 
Not overlord, actually, Timelo-

MARTHA shakes her head vigorously at him, and he zips it.

1st PARTY GUEST: 
If you really want to create something that helps nursing mums, why not hook up with Human Milk for Human Babies to create an app that will match milk donors with babies who are in need?

STILL ANOTHER GUEST: 
Yeah, or what about an app that connects mum to her community and helps coordinate all the support she needs? Meals, errands, a load of laundry, I would have loved that in those early postpartum days.

YET ANOTHER PARTY GUEST: 
Or if you really must invent a wearable device that measures something, make it measure the amount of time the mother and baby spend skin to skin. That alone is so powerful and so overlooked, since there’s no way to make money off it. Well, YET, I suppose.

SARAH: 
Another area that could use some help is making at-breast supplementers a little more user-friendly, so that in the cases where supplementation is truly needed – again, hopefully with professional guidance - mums have an easier time with doing so at the breast. But it needs to be minimally invasive. Not like this nightmare. [She gestures at MARTHA, then looks at the DOCTOR.] No offense.

DOCTOR: None taken, none taken, but I . . .

TISH enters with a tray of sticky toffee cupcakes and her two friends.

TISH:
 Here we are, everyone. [To the DOCTOR] I think there are some Jaffa cakes in the pantry, if you’d like.

MARTHA starts taking off the device and placing it back in the bag.

MARTHA: 
Come on, I’ll get them for you.

She rises from the chair and walks to the kitchen, the DOCTOR following.

DOCTOR: 
Is that all true, what they’ve said? What do you think?

MARTHA (rummaging around in a cupboard):
 Doctor, you know I adore you, more that I even should. Even with the bowtie. I appreciate you wanting to do this for me so much. You mean so well. But they really are right.  

DOCTOR: Well, I just . . . I wondered about, you know. You’re not particularly, um.

MARTHA turns around with a packet of Jaffa Cakes.

MARTHA:
 I’m not particularly what?

DOCTOR (looking around, avoiding her gaze):
 Not, well, I mean relatively. Compared with, I mean . . .

He notices a portrait of a Rubenesque woman on the wall and gestures to it.

DOCTOR: 
With, say . . . and you, not that there’s anything wrong. You’re, you’re quite comely, but, I mean, rather petite and . . .

He gestures quickly and bashfully at her chest.

MARTHA:
 Oh Doctor. That? (She laughs, looking at her bosom.) Breast size has next to nothing to do with supply. Women with cup sizes even smaller than mine can produce more than enough milk quite well. It's supply and demand, as long as babies have plenty of access and everything else is proceeding normally.

DOCTOR: 
Really? I mean, that’s wonderful of course. But really?

MARTHA: 
Really. (She hands him the packet of Jaffa Cakes.) Think of them as being bigger on the inside.

DOCTOR: 
Marvelous.

MARTHA:
 All that unbelievable intelligence, all those hundreds of years in that spectacular head of yours, and yet you somehow missed that little, uh, tidbit of information.

DOCTOR: 
Well, it doesn’t happen often, but when it does, I am happy to stand corrected.

He bows, takes a bite of cake and then looks suddenly crestfallen.

DOCTOR (through a full mouth): 
But now I have no gift for you and Stel- er, the mystery fetus.

MARTHA: 
Oh, it’s quite alright, just coming here at all was such a nice ges –

DOCTOR: WAIT! I’ve got it.

He turns and runs back through the living room, past the cupcake eating guests who watch him fly by.

DOCTOR: 
Beg pardon, won't be a moment . . .

TISH: 
Awfully rude.

He departs. We hear whooshing.  Martha walks to the front door and waits. We hear whooshing again. The DOCTOR races back up, slightly winded and hands her another bag.

DOCTOR: 
There we have it. Go on.

MARTHA cautiously opens the bag and takes out a tiny fez.

MARTHA:
 I . . .

DOCTOR: 
Cool, isn’t it? Now available in size Cute as well.

MARTHA:
 It’s absolutely both. Thank you.

She reaches out and squeezes his shoulder. He pauses and then hugs her in return.

DOCTOR: 
Well, universe calls, as always. Best of luck. Dr. Smith-Jones.  And abundant breastfeeding.

MARTHA: 
And best of luck to you, Doctor.

DOCTOR: 
Oh, and if you ever need someone who speaks Baby to translate . . .


He waves, hops back into the TARDIS and is gone. She walks back into the party, smiling. 

____________

* Quote by Pauline Gnesin, on Anne's personal Facebook page
** Quote by Lori Bond Atkins, on :LACTNET Facebook group discussion (links in quote are my own addition)


Tuesday, December 23, 2014

Elementary, Mrs. Watson



INT: WINCHESTER PUB, Early evening.  SHERLOCK HOLMES and JOHN WATSON are settling into a booth with two full pints. INSPECTOR LESTRADE walks over to the booth, pulling on his overcoat.

LESTRADE
Bang-up job again, you two. As per par for the course. I'll head down and book the scumbag. I never did get what he was doing with all those bendy straws, though.

SHERLOCK
(keeping his eyes on his mobile as he types in rapid-fire)
Of course you didn't. Your mastery of rote procedure and protocol in no way prepares you for the kind of incisive insight I bring to the table. I would have thought by now that was more than clear.

LESTRADE rolls his eyes.
JOHN
Check the blog later, he surely means to say.  Join us for a round? Mary's on her way to meet us.

LESTRADE
Take a raincheck if you don't mind.  Cheers.

JOHN raises his glass. SHERLOCK  raises one hand in a wave, without lifting his eyes from the phone. As LESTRADE exits, he passes MARY WATSON as she enters the pub.

LESTRADE
Evening Mary. Dynamic duo's in the back corner there.

MARY
          Oh, thanks Greg. But, you're not staying then?

LESTRADE

Nah. Got some rote procedures to master at the station.

He smiles wryly and continues on his way.

MARY
          Oh. Well, oh. (Calling after him) Bye then!

She walks back towards their booth and waves as she approaches.
JOHN
Mrs. Mary Watson.

JOHN smiles warmly. MARY kisses JOHN on the head as she takes off her coat and slides in next to him.

SHERLOCK
(eye still glued to his phone)
How is the wee bairn, Mary?

MARY
Oh fine, fine, good. Asleep! Nursed down just before I jumped in the cab, Mrs. Hudson’s got it all under control, as always. So, I got your texts! Sounds like another case wrapped and sorted? 

SHERLOCK
Indeed. Do join us in a celebratory gesture.

MARY
          Don’t mind if I do!

She gestures to a waitperson, who approaches with a notepad and an expectant look.

MARY
          Pint of stout, thanks!

JOHN
(after a momentary pause)
What? Wait. ‘Scuse me? Waiter?

The waiter returns, brow furrowed.

JOHN
(clearing throat)
I’m sorry, my wife, terribly sleep deprived, new baby, you know how it is, I’m sure. Anyway, I’m sure she meant to say she’d like a club soda. Or maybe some tea. Would you like some tea, love?

MARY
          I’m quite sure I’ll take the stout, thank you.

JOHN
But Mary, you’re, um (trying to keep his voice down, clearing his throat again uncomfortably), you’re . . . (whisper) breastfeeding.

MARY
          And?

SHERLOCK looks up from his phone and observes. The waiter attempts to hide his growing impatience.

JOHN
But, you can’t, I mean you shouldn’t, I mean, isn’t it, I mean . . .

MARY
(returning her gaze to the waiter)
          Pint. Of. Stout, please.

The waiter nods and walks away.

JOHN
          Okay, clearly I’ve, uh,  missed something here.

SHERLOCK and MARY
          Clearly.

JOHN
          But, you’re breastfeeding!

MARY
Yes, as you said. I am. I’ve done almost nothing BUT breastfeed for weeks on end, actually. Love it though I do, I’m ready for a wee drink.

JOHN
I just – I didn’t think that was allowed, is all. You were so careful not to have even a drop while you were pregnant. You and the midwives told me all about that.

MARY
          Yeah, I was. And behold, I’m no longer pregnant.

SHERLOCK
          Surely you’ve observed this rudimentary fact.

JOHN
I do have a grasp on that bit of obvious, yes, thank you.

MARY
          Well, so it’s completely different now.

JOHN
It is? You don’t care that the alcohol going to get into your milk, then?

MARY
But that’s just it. Now that the baby is born, it’s completely fine to have a drink or two. All the experts say so. It’s not really going to even reach the baby, much less cause any bother.

SHERLOCK
          She’s correct.

The waiter returns with her drink. MARY takes it and raises her glass.
MARY
          Cheers!

SHERLOCK raises his glass in kind and clinks it to hers.

SHERLOCK
Cheers to you and the bairn. And his well-meaning but underinformed dad.

They each take a hearty swallow. JOHN watches in exasperated befuddlement.

JOHN
So you support this, too, then, mate?

SHERLOCK
Why wouldn’t I? It’s perfectly logical.

JOHN
Go on. Enlighten me, then.

SHERLOCK
Very well. The Thomas Hale guide, considered to be the authoritative source on lactational pharmacology  - meaning medications and other substances in human milk - states that “mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.” In other words, as soon as it’s out of mother’s bloodstream, it’s also out of her milk.

MARY
And that’s pretty much exactly the amount of time a baby will go between nursing sessions, about two hours or so.

SHERLOCK
Mmm. There you have it.

JOHN
Okay. Okay, well, wouldn’t it be better for mums to, what’s it called, pump and dump? Just to really get it out of her system, be on the safe side?

SHERLOCK
Certainly not, don’t be ridiculous.

JOHN
Why is that ridiculous?

SHERLOCK
Tell me, Dr. Watson, when YOU have to sober up, do you need to drain a liter or two of blood, to get it out of your system?

JOHN
          Don’t be absurd.

SHERLOCK
Equally as absurd for a lactating mother. Pumping does nothing to speed the metabolism of alcohol. The only reason a mother should ever pump related to drinking is if she plans to be away from her infant for an extended period of time, but the point of that is to maintain her supply in lieu of any missed feedings, not to somehow detoxify her milk. All that is needed is the passage of time.

MARY
Right, I read that on Kellymom. Great resource, by the way, all the information there is based on evidence.

SHERLOCK
          My favorite.

JOHN
You. Have a favorite breastfeeding website.

SHERLOCK
NO, my favorite type of information. Research and evidence. Further, Dr. Jack Newman, an MD who specializes in lactation, shared the results of a breastfeeding mother who once analyzed her own milk and cited the findings on her blog. See for yourself.

SHERLOCK pulls up a website on his mobile browser and hands it to JOHN.

SHERLOCK
“The alcohol content in breast milk immediately after drinking is equivalent to a 0.0274 proof beverage. That's like mixing 1 oz of 80 proof vodka (one shot) with 2919 oz of mixer . By the way, 2919 oz is over 70 liters. Two hours after drinking one (strong) drink the alcohol has disappeared from the sample. Completely harmless to the nursing infant.”

MARY
0.0274 proof. I heard there’s more alcohol present in fruit juice. Not that we’re giving the baby fruit juice yet, but the point remains.

SHERLOCK
Not to say that mothers should be getting falling down drunk and then caring for their children, of course, but at that point it is a safe parenting issue more than anything else. A drink or two, spaced out over several hours, seems to be just fine.

MARY
But if you’re still feeling concerned, the best timing for a drink is right after a feeding -or even during the feeding - so there’s plenty of time for metabolism to do its thing. And I’ve just come from doing exactly that!

JOHN
(giving the phone back to SHERLOCK and throwing his hands up in defeat)
Alright. I get it. Bottoms up, Mrs.

MARY smiles and squeezes his arm affectionately.

JOHN
(to SHERLOCK)
Just how the hell do YOU know anything about sodding lactation in the first place, anyway?

SHERLOCK
Well I do take an interest in all things relating to our species. And the means by which we feed our young is a defining characteristic of all mammals, after all.

MARY
It’s where the term “mammal” comes from in the first place.

SHERLOCK
Quite right. The very nomenclature of our biological classification.

SHERLOCK clinks his glass to Mary’s again and takes another drink.

SHERLOCK
Also I rather like babies.

He takes another swig of his drink.

SHERLOCK
Don’t tell anyone.

MARY
Your secret is safe with us.

JOHN
For now.

MARY gets her own mobile phone out and begins showing off photos of the newest addition to the Watson family.


FADE TO BLACK.


*****

Elementary, Mrs Watson
by Anne Tegtmeier
December 2014 Picture via Huffington Post



















Wednesday, December 11, 2013

Battlestar Galactagogue: On Fenugreek and Other Products for Perfect Production

Pop Quiz: Assuming physiological normalcy for both mother and infant, a healthy milk supply depends on:
a) Making sure mom goes through a batch of lactation cookies at least once a week.
b) Getting the best tincture from a health food store.
c) Drinking 4 cups of breastfeeding tea blends every day.
d) Obtaining a prescription for Domperidone.
e) None of the fracking above.
Following on my recent theme of nursing support in the age of social media, breastfeeding support products are more easily available than ever before. How is this going for us?  Have we, with all our good intentions in making galactagogue products more widely available, contributed to the (apparently growing) perception that mothers can't have a normal milk supply without teas, tinctures, cookies, and pills?

First off, what is a galactagogue?

Defined: Ga·lac·ta·gogue: gəˈlaktəˌgäg/ noun. 1.a food or drug that promotes or increases the flow of a mother's milk.  Common and popular herbal  options include blessed thistle, fennel, and the most famous reindeer of all: Fenugreek.  Drop into any mom's forum, and you'll see that every thread discussing supply will inevitably include recommendations for various galactagogues, in drug (i.e. Reglan or Domperidone), food (oatmeal for all), and herbal forms, fenugreek being by far the most well-known.

A brief stroll down the aisle at New Seasons, a local Whole Foods-like company in the Portland area, revealed these options:



So, here I go with another post in which I preface with a disclaimer and close with a hedging qualification. Let me be clear: There is nothing at all wrong with galactagogue use when needed! I cannot stress this enough. Part of the very reason we have such a diverse array of options for galactagogues in the first place is because women in vastly different cultures in a variety of ecosystems all over the world have sought them out and passed them down through generations.

The world is very different now - so many undeniable improvements, and yet the matter of marketing as a major force in our collective psyches is a critical one. Let's think about this: how does formula marketing actually function? The most effective formula marketing depends on insidiously undermining women's confidence (I discussed this here and then illustrated it here, a la Mad Men). Is the promotion of galactagogues as something lots and lots of women are likely to need really that different, purely psychologically speaking?

It IS different in some crucial ways because it's not artificial infant milk, of course, and ever moreso because it's not as though well-intentioned companies like Motherlove are engaging in underhanded tactics like slipping samples into gift bags of hospitals. And they possess nowhere near the financial oomph that massive corporations like Abbott wield. My point is not their intention, but the effects on us as a community of mothers. What overall effect does the promotion of galactagogues (whether from professionals, peers, or by the company itself) have on attitudes toward breastfeeding? We collectively need to ask ourselves if this is helpful.

Boiling it down, is it helpful for us to have so many mothers believing that A) they cannot produce a normal supply without purchasing and consuming a product or products, even really high-quality ones? Again, taking a peek into any peer support forum is guaranteed to provide multiple examples of galactagogue recommendations flowing as freely as an uninhibited milk ejection reflex. And possibly even more damaging, is it B) helpful for mothers with genuine low supply to be taking them (haphazardly in many instances, i.e. all-fenugreek-all-the-time) without addressing or even identifying the underlying issues?

And as one learns more about herbal galactagogues in particular, you can't help but notice that most herbs function by supporting the health of the mother, working with whatever underlying condition may have caused or contributed to her low supply in the first place (many of the most effective galactagogues work primarily on the digestive system, for example, the very core of maternal health). Low supply doesn't just happen randomly to moms who are unlucky; there is always a reason. But just as with the matter of breastfeeding advice in general, the most critical point is to tailor the plan to each dyad, and to use when NEEDED.

Again I find myself on the horns of a dilemma. I am truly glad and grateful that a variety of galactagogues are so readily available when mothers need them, and often in such good quality and variety. And yet. I want to discuss all of the above, with pros, peers, moms, and companies too, but I also want to convey this bottom line:

Moms, you do not have to take galactagogues Just Because. Not as a preventative measure, not even "just in case."

So say we all.*

P.S. Yes, I am hereby claiming the Battlestar Galactagogue name as my very own, especially if I decide to create my own herbal blends as part of my future practice. I CONTAIN MULTITUDES.

P.P.S. Aside from galactagogues, there are many other 'helpful' products being marketed to breastfeeding mothers which have a very much related effect, as corporations recognize this category of mothers as a largely untapped group and try to figure out how to profit off of them. (This sounds terribly cynical, I realize.) Take the recent Milkscreen products as merely one example.  Since I like to drop in on Babies R Us et al once in a while to keep in touch with the latest products that are widely available - and thus the marketing moms are being exposed to -  I may address these other products in a follow-up post.

*Not actually speaking for all. Just geeking.

Monday, November 11, 2013

Help Me To Help You: The Promise and Pitfalls of Peer Support in Social Media

Macierzyństwo, 1905 by Stanisław Wyspiański

This is quite the time to be a new breastfeeding mom. Support for breastfeeding has never been more abundantly available, especially when it comes to social media forms of it. There are multitudes of message boards, there are blog followings with regular, lively discussions, there are lactation support websites with many different specialties - and then there's the juggernaut (you see what I did there) that is Facebook, of course. Breastfeeding discussions come up regularly on fan pages for various bloggers and organizations, but the liveliest action by far is in the groups, whether open, closed, or secret. I have no idea if anyone has ever tried to get a ballpark idea of how many Facebook breastfeeding-related groups there are, but there have to be hundreds if not thousands.

So this is great, right? It's what we've always strived for, yes? Nursing moms helping one another, spreading positive promotion of breastfeeding, cheering each other on by the dozens, this is living the dream. In many, many ways, absolutely yes! But in some other ways, well . . . it gets complicated.

I'm part of quite a number of different groups and boards, some of them breastfeeding specific, others more about parenting in general. I witness and sometimes participate in breastfeeding-related threads on a daily basis, and have been doing so for years. You know that saying "The more you know, the more you realize you don't know?" The deeper I've gotten into my lactation science program at school, the quieter I've gotten on those threads. Note my long period of radio silence on this very blog; it's definitely related. Partly due to being absurdly overcommitted, fer sher, but part of it is also due to a growing realization of my own limits.

In the boards and the groups and the pages, within any given breastfeeding thread, there's an ever-variable mixture of totally great advice, utterly terrible advice, and advice that could maybe, possibly, perhaps be good - IF we had a hell of a lot more information about the mother and baby at hand. All this comes with a liberal serving of emotional support- never something to be discounted; at times it is what the mother needs more than anything.  And ALL OF IT IS MEANT TO HELP. But when it comes to even the seemingly-simplest of nursing issues, how can moms possibly sort this all out? Sometimes they'll get lucky and go with advice that happens to be sound, and all is smoothly resolved. But sometimes, not.

Let me see if I can illustrate this with an example. In my Advanced Case Studies class a few terms ago, one of our texts was the excellent book "Case Studies in Breastfeeding: Problem-Solving Skills and Strategies" by Karin Cadwell and Cynthia Turner-Maffei. In it was an table that sums the social media support dilemma up perfectly.

As part of learning the Eight-Level Lactation Consulting Process, a chart was laid out with six different dyads, labeled A through F. Eight columns listed the various steps: 1) History, 2) Assessment, 3) Symptoms, 4) Problem Formulation, and so on.  The interesting part: Column three was identical in every case. "Mother describes hard breast with shiny skin; breast larger than normal and warm to the touch; breast pain."

Every single mother presented with the exact same symptoms. And EVERY SINGLE ONE OF THEM had a totally different underlying cause, with a different strategy devised to address their issue.

But in (totally well-intended!) online situations, many sympathetic moms will read the presenting symptom and only know their own individual, unique experience of that symptom. That experience might be relevant to the mother at hand - and it also very well might not. And sometimes moms simply want to share their own stories in return, which is also a very valid need - but conflating that with offering advice is treading into very tricky territory. This was an insight shared with me by Jennifer Tow, and I think about it frequently when following such conversations. It can be so hard for both storyteller and advice-seeker to know whether the shared story has any practical relevance to the situation at hand.

Case in point: Fenugreek might very well have helped your supply, but it is absolutely not appropriate for every woman, nor is it a panacea for supply issues in general, which can range from simply turning around some poor management in the early postpartum period to very complex physiological conditions.

Lactation pros are sometimes present on such threads - and it is worthwhile to note that they are often the ones offering the LEAST advice of all. This may be partly for financial reasons, partly for liability concerns, but primarily because they know full well just how individual each case really is. Without a maternal health history, information about the birth itself, a feeding assessment, an oral evaluation, and any number of other relevant pieces, the full situation is incomplete - and that's not even getting into the options for how to actually address the issue (once it is actually identified) with a comprehensive care plan. The variables are endless and the details always, always matter.

I think lactation professionals have been reluctant to bring this matter up because seriously, the good intentions of everyone ARE so deeply felt and appreciated, and who wants to be the Scoldsy McBuzzkill who rains on the peer support parade? Honestly, where would we even BE without peer support? The progress we as a society have made in reclaiming breastfeeding has everything to do with it, and we owe an immense debt of gratitude to the founders of La Leche League, the most famous breastfeeding peer support group of all time. LLL began as peer support, continues as such, and is AWESOME for it . . . but there's a fourth L in that organization that makes all the difference in the world. Every meeting is facilitated by a Leader. Some meetings need more active guidance, in others the mothers need very little input, but that guidance is there for a reason.

For the most part, I write this post not because I have solutions to propose, and certainly not because I think lactation consultants should be the only persons allowed to speak about breastfeeding (because how paternalistic would that be?), but because I want to open this up for discussion. Let's talk about this. IBCLCs, moms, other perinatal professionals, breastfeeding peer counselors. I truly believe that unless the formula companies have become so devious that they're willing to plant undercover undermining minions on message boards ( . . . actually, let's not rule that out altogether), every mother posting in groups and boards is doing so mainly because they genuinely want to help. This is not an easy topic to discuss, but I think it's time.

How can we best help each other to help each other?



Thursday, February 7, 2013

First Blood, Then Milk

A reading from this week's Breastfeeding Politics & Policy class stopped me in my tracks, for obvious reasons.
"I think she looks like you," [the lactation consultant] says with a wink.

"I'm adopted," I say blankly. It's a telling response. I'm so accustomed to discounting the physical resemblance people claim they see between me and my own mother that I forget Faith and I are related. Even though I have the episiotomy stitches to prove it. Which, right now, are hurting me a lot.

Lisa studies me for a while.

"So am I," she replies slowly. Then she shows me a picture of her own (breastfed) daughter, now eight years old. Bright eyes, mile-wide grin, she looks like a miniature version of her mother.

And that's when I know it is no accident that Lisa has devoted her career to helping mothers forge abiding, biological bonds with their babies. Nor is it any accident that I desire this relationship so deeply. Your body out of mine. From my body into yours. First blood, then milk. These are the living threads that weave mother and child together. As much as I love my adoptive mom, this bond is a connection we never had. And as for the unknown woman who gave birth to me, we were lost to each other before I was even as old as Faith is now. And for about the twelfth time today, I begin to cry.





Another rumination of mine on adoption:



Sociable