Kittie Frantz

A friend called me recently to tell me how he was doing with his new diagnosis of lymphoma. He told me he felt the big mass in his neck first and then a smaller harder one the next week. The radiologist wanted to fine needle aspirate only the large mass as that would “Tell him more”.  My friend argued to have them both aspirated and checked for cancer. He was losing the argument.  Into the room walked the chief radiologist and asked my friend how things were going. He told the doctor about his strong feeling that both should be biopsied but the younger doctor disagreed. The older, wiser radiologist told the younger one, “In my years of experience, I have learned to listen to the patient’s concerns because they were usually correct.” Both masses were biopsied and, you guessed it, the smaller one had the cancer. My friend has just finished successful treatment!

In pediatrics, I have also learned to listen to the parents.  Some pediatric care providers feel that most first time parents are too nervous about every little thing.  It can be true. I knew a dad so worried about his baby getting enough milk that I taught him to listen for his baby’s swallows so that he would be reassured. He called me the next day to ask, “Are 357 swallows per feeding adequate?”  He had made it more difficult by counting them and recording them when I was trying to ease them both into relaxing because baby was doing fine! On the other hand, if a parent says, “ I don’t know why,  but I am really worried about……” I take that as a direction to look carefully. If I find nothing, then I move into the reassuring mode, but I have learned to examine and question fully when I hear a sentence begun that way. Sometimes I will ask a parent, “What does your gut say?”

Even more importantly when the child tells his parents to take him to our pediatric office to be seen…. well, we learned that you had better work fast as the child has an inner sense that something IS wrong. The child is most likely right on the money. Children usually don’t like the doctor’s office but they also know it is where you go to get fixed. So when they WANT to go there, we take it seriously.

So, how does this work in breastfeeding?  Moms beginning to breastfeed their first baby are very worried that they won’t do it “right”.  This can cause a lot of anxiety as there is a lot of “how to” information out there about different methods of attachment. Moms seem to naturally blame themselves if there is any difficulty.  Their nipple doesn’t protrude enough (looks fine to me). Their breast aren’t big enough (looks normal to me).  They don’t eat right (diet history normal)  They aren’t using the “latch” technique properly (and want me to watch and correct it).   I have learned from Tina Smillie, MD to let the baby do it.  ( Baby-led Breastfeeding: The Mother-baby Dance  can be viewed on www.geddesproduction.com).   When I tried that in my own pediatric practice, the babies all did it and the moms would exclaim, “He did it! He got there and knew where to go!”  “She is so smart! My nipples don’t hurt when she goes on by herself!”  This went a long way in raising mother’s confidence as mom realizes that she is part of a dyad and not the only one with performance issues. This created a dramatic turnaround in the mother/baby breastfeeding team.

Now for the mom who comes in with breastfeeding problems. After she tells me why she is here to see us, (sore nipples, baby’s weight is low, etc.) I will ask her. “What do YOU think is happening?”  Often she will say that she saw someone else for help or all her friends/family say that she must have “low milk supply”. It is all her fault is what she is internalizing.  So I will ask again, “What do YOU think is happening?” She will take a considerable pause and then sometimes say, “I don’t think he is feeding right.  It seems different than my friend’s baby.”  ” She sucks differently than my first baby”   Bingo.

Moms who come with sore nipples often will say “I was told in the hospital that I was attaching him wrong.”  Or “All my friends say that I should learn to attach him deeper.”  Again, “What do YOU think is happening?”, I will ask her.   She will often then describe how it feels such as “It feels like he is biting.”  or “It feels like he is on my breast kinda loosely.” Aha!  She KNOWS what is going on. Then it is up to me to discover what is going askew with the dyad. Since I am a pediatric nurse practitioner, I go for the baby. The first thing I do is watch what the baby can do on his own. Can he do it?  Or does he get there and not attach. This is very telling. Sometimes he gets there and attaches and problem solved. If not, I usually find that the baby is not suckling well……..sans the biting feeling, poor weight gain or sore nipples. (See how to asses a newborn’s suckling thoroughly in my distance learning course on DVD www.babysperspective.com)

But why is he not suckling well?  That is the elephant in the room! In my exam I have found lots of causes. For sore nipples I look for a pain source in the baby: fractured healing clavicle, torticollis, plagiocephally to the point of a misaligned jaw, intestinal discomfort, reflux and so on. I look for mechanical problems such as tongue tie or clefts in the mouth. 36-37 week gestation babies are not known for suckling prowess and yet the mom has begun to internalize that it is HER fault/problem.  However, she intuitively deep down knows what is wrong………….and so she wonders about the baby.

As you can see by my previous blogs, I did not become a nurse practitioner before I became a mom. I remember being a new mom and feeling totally scared even though I was the eldest of six kids and did a LOT of babysitting. It is a very vulnerable time for a woman. The family practice doctor we used had one nurse/receptionist. She told me at Heather’s one year well baby visit that, “Well Mrs. Frantz, you certainly get the prize for the mother who called our office the most with questions during your baby’s first year.” I realize now that I was calling for “gut reassurance!”.  Fight on moms!  Follow your gut instinct until you get the right answers.

AND NOW TO BECOME A TEACHER

During the course of working, I became involved with other projects.   My children were older and one away at college when UCLA Extension asked if I would become part of their teaching team for their new lactation educator (CLE) program in 1982.  This unique course was the first lactation educator course in the nation and became the leader in training all those who wanted to enter the lactation field. The six member teaching team went at least once a month to many states all over the USA to teach this course.  The program expanded later to a lactation consultant course.  My expertise on the team was the practical, clinical aspects of lactation and breastfeeding.  I drew from the experience of working with mothers and babies in the outpatient setting for the previous twenty years.  I met so many enthusiastic women ( and a few men!) who wanted to make a career out of helping nursing mothers.  So…. I was now a teacher……………….and would have made my school guidance counselor proud. Yet again.

A few years prior to that, University of Southern California (USC) asked if I would be the attending in a newly formed Breastfeeding Infant Clinic in order to teach the pediatric physician residents lactation management.  I  did that one morning a week beginning in 1979… again a teacher.   We saw mostly Hispanic families in this clinic and I tried to learn Spanish. Breastfeeding is part of the culture but often got derailed with the cultural view to do “las dos cosas” or to give both breast and bottle of formula from the beginning.  The residents and I solved any problems the mothers had with breastfeeding in hopes that they would do only that.  Much has been studied about this cultural belief in starting breastfeeding with formula added and sadly not much of a solution to change this paradigm has been found.

In time, after 10 years, UCLA ended their Lactation Educator and Consultant courses as there were many fine such courses across the US. Then, in 2006, USC asked me to resign from the clinical pediatric private practice and come on board as full time Clinical Instructor in Pediatrics for the Keck School of Medicine at Los Angeles County University of Southern California Medical Center.  So at the age of 63 when many consider retiring, I switched careers and accepted.   Now I enjoy teaching very bright, newly minted, physician interns on the newborn service.  I focus on how the physical exam of the baby is a key to predicting breastfeeding success and integral as well in managing any lactation problems that come up. Graduates of our Pediatric and Med-Peds Residency program are incredibly efficient in managing lactation with their own patient population. The continuity clinic in which they do their well baby practice boasts of 61.5% of the moms are still doing some breastfeeding at 6 months of age. These physicians will be an asset to the lactation community wherever they decide to practice after residency.

This USC job took me out of the post-discharge experience and on to the inpatient newborn service where I learned how the newborn progressed and developed in the first few days of life. I was taken under our RN’s wings in learning what their job entailed on the post postpartum ward, labor and delivery and the NICU.  Such a different perspective and broadening of my knowledge/experience base.  Any criticism that I ever had of what happens in the hospital after delivery vanished.  I was asked to develop the 20 hour course for all of our nurses and to teach it so that our hospital was designated Baby Friendly in 2012.  I had nothing but respect for the openness of the nurses who had been there for 20 or 30 years and were willing to embrace new ideas.

Lets backtrack a little. I am a multitask-er so while all of this was evolving I became involved in film back in 1986. When I realized that most breastfeeding films done in the 1970’s and early 80’s were negative and most made by formula companies, I decided to try and make positive breastfeeding films. It was so much fun and awakened the creative teaching side in me.  The feedback from moms was that they really learned to make breastfeeding  easier. And so my little film company, Geddes Productions, was born. www.geddesproduction.com   I have produced 12 films that are currently on the market and with the other language translations that expanded to 30 films. Moving into the 21st century we now have them streaming on the “video on demand” section of the website.

When I was practicing in the Santa Monica pediatric office, the doulas would often come with the parents and the baby.  They sat in on the first well baby exams and were very much a part of the questions the parents asked. The doulas in our area asked me to teach them a class on breastfeeding and the baby’s perspective in the care giving that they do. Some doulas felt that what some parents were asking them to do for them was dismissive of the baby.  They felt conflicted and I agreed with them.  In 2004, I designed an 18 hour course as I was really enjoying the teaching role. I taught the course during three full days and really learned a lot from the doulas and baby nurses about what was REALLY happening in the homes after delivery.  Soon the class filled with midwives, IBCLCs, nurses, OTs and dieticians. We filmed the last class and this became the popular distance learning course entitled THE BABY’S PERSPECTIVE.  Be a part of this lively discussion as you view each three hour DVD.  www.babysperspective.com   (CEU contact hours and CERPS available)

I have had quite a diversity of experiences in lactation from the outpatient perspective to hospital inpatient postpartum, labor/delivery, NICU as well as my own home visits plus wisdom from the doulas. Truly a well rounding that has enhanced my teaching role.

So, school counselors from the 1960’s, I became it all … housewife/ mother …   secretary at an airline …   nurse    …  teacher. —  AND the physician’s role as a nurse practitioner  AND somewhere in all that I also became a  film maker. I can truly say that I got to do it all. I didn’t start with a business plan (that non planning makes male folks crazy). It just happened to roll out through the years. This year West Aurora High School inducted me into the Distinguished Alumni Hall of Honor……………..I was embarrassed but smiled to myself because I fulfilled all of their expectations for the female student of my era.

My thought?  Believe what you will.  I believe I was guided by the Holy Spirit.  God knew my marriage would end and He prepared me ahead for a means to support myself.  God gave me each of those gifts through experience and a wonderful insight for babies along the way.  It is a privilege to use these gifts in helping parents and physician residents to catch the wonder of how He created the amazing dyad of breastfeeding and nurturing babies. So my future blogs will share some of the insights that I have been taught and fun stories along the way.

THE PEDIATRIC NURSE PRACTITIONER……………A PHYSICIAN’S ROLE AT LAST

Right after graduation in 1973, my children’s pediatrician, Paul Fleiss, offered me what he called “a mother’s job.”  I stared at him baffled. “A mother’s job” he explained was an RN in his office that arrives after her kids leave for school and gets home before they arrive back home.  No nights, no weekends and the same hospital pay.   As if to make sure I took the job, just as this was offered, ……..my husband lost another job.  So off I went to work as a nurse.

After a year in his pediatric office, Dr. Fleiss said, “I am wasting your talent here.  You need to go back to school and be a nurse practitioner.”      “BACK TO SCHOOL!!”  I thought, no way!!   He wrote out a check and said, “Go to University of California, Los Angeles (UCLA) or you’re fired.”  Talk about tough love!

And so the thoughts started up again.  UCLA, UCLA, UCLA……..I surrendered again but faster this time, applied and was accepted into the next class.  I was probably accepted because I was one of the few applicants who applied with a preceptor all arranged!  Doing the program along with everything else… being a wife, mother and La Leche League (LLL) leader was hard.  I memorized as I traveled on the freeway to the Harbor UCLA campus, 40 minutes each way.  I was so absorbed in memorizing that I kept getting speeding tickets!   Finding more skillful ways around my learning disorder, I ended the course with an overall 92. I took the very first Pediatric Nurse Practitioner board certification exam ever offered in the nation and passed.

Dr. Fleiss’ practice was an eclectic mix of Hollywood at the time:  lower socioeconomic families, the MO Town record crowd and a few celebrities as well.  Dr. Fleiss put me through my paces for every baby/child exam I presented to him and had me hit the books that night for every diagnosis we made that had not come up before.  My breastfeeding zeal ran right into the “non-La Leche League” families who were semi-committed to breastfeeding.  He taught me “A little breastfeeding is better than no breastfeeding at all.”   I developed the importance of the baby/child while positively reinforcing the parent’s growth in discovering that child of theirs under Dr. Fleiss’ example. These  stories deserve their own post and I will do that later.

I worked for Dr. Fleiss for a few years as a nurse practitioner in his Hollywood practice until I was offered a job in 1975 doing the pediatric well child care in a birth center in Culver City, California with Dr. Victor Berman.    Dr. Berman’s practice was a more middle class group of families wanting a natural childbirth and definitely breastfeeding. In those two beginning practices I got to see breastfeeding instead of only handling breastfeeding concerns over the phone as I often did with LLL moms.  I discovered that women who were not sore held their babies differently than those who did have sore nipples.

I began to share what I learned with new mothers and it worked to solve their problems!  I even presented the concept at a pediatric congress in Israel in 1980 which led to my first publication (and the Breastfeeding Techniques That Work! handout).  Accepting a job closer to home in 1979, I joined Dr. Rick Johnson’s practice in Pasadena, California. Dr. Dave Tappan and Dr. Bill Sears joined us over time.  I was independently seeing 500 mostly middle class families within that collaborative pediatric practice for the next ten years.  It was truly a physician role.  As a pediatric nurse practitioner, I finally came close to the dreamed of role of the physician at last. Breastfeeding evaluation was naturally a part of every well child visit. I resigned as a La Leche League Leader after 20 years in 1983.

At that time my husband left our family and being a single mom, I was grateful to accept a position In Santa Monica, California with Drs. Gurfied. Wasson, Varga, & Tardio at Tenth Street Pediatrics in 1989. That practice was challenging in dealing with an entirely different socio-economic patient population.  While explaining to one new mom about how easy it was to breastfeed because you could take your baby anywhere.  She replied, “What do you think I have a maid for?”   I adapted to this new group of patients but found myself becoming more of an advocate for the baby. Inner city and middle class moms were so different in how they viewed their role and the baby.  Over time the moms in this practice began to proudly tell me they were “a hands-on mom” as compared to some of their friends. Cool. Our practice became “the breastfeeding place” and I was there for 17 years.

FROM SECRETARY, AIRLINES TO NURSE

I didn’t “marry well” as my mother would have politely put it and my husband was often out of a job while trying to put himself through school.  Whenever that happened I had to step in and go to work to support the family.  I managed to learn how to maintain breastfeeding with my second and third child while being a working mother and the youngest breastfed until she was 4!  The working mother was more of an oddity back then.  I often took jobs as a secretary or receptionist.  One of the secretary jobs was for TWA airlines in reservations……..so  the 1960’s school push to send girls to secretary or airline careers sort of came true for me in those working years!

It was when my youngest was 4 that my husband got a good steady job and I could leave the work force.  Happy was I to be able to stay home!  Being mother to my children was a joy and I hated to have to leave them to go to work.  While doing the dishes one day a strong thought came over me to go back to school.  My immediate response was, “Right, with my learning problems? No,” I argued.  The thought prevailed.  I woke to it, fell asleep with it and I couldn’t shake it.

During that prior year as a La Leche League leader, I had given a guest lecture to a class at California State Los Angeles University School of Nursing on the topic of breastfeeding.   To quiet the voice, I phoned that contact to inquire about entering the nursing program.  “Oh, you’d be a great nurse!” she replied.  It was my dream of being a doctor but maybe a nurse was close enough.  Following her direction to the admissions office, I applied and was turned down for admission.  They couldn’t admit me because I had flunked out of pre-med at University of Illinois.  I was actually pleased to be able to quiet the “go to school” thoughts until the admissions counselor said, “Valley College will take anyone. Why don’t you try there?”  All the way home I heard, “Valley College, Valley College, Valley College”

So armed with my University of Illinois “flunked out” transcript, I went to Valley College hoping they would turn me down.  I was actually pleased with the letter that arrived denying me admission until I read the last paragraph.  “If you wish to contest this decision, please meet with Dean Lewis on Friday at 3pm”    Dean Lewis, Dean Lewis, Dean Lewis… began the thought.  I determined to say nothing to Dean Lewis as I took a seat in the chair in front of his desk.

“Well, let’s see,” he began.  “It has been 10 years since University of Illinois and a lot of life happens in that time.  I will admit you for one semester.  If you get anything less than a B, it will be your last semester here. Do you want to accept that?”

I shook his hand, went out to the grass of the quad, sat down and surrendered.   I realized it was futile to fight where I was so obviously supposed to go………..to be the other 1960’s school-suggested career for girls…….., a nurse.

I took Psychology, Sociology & beginning Chemistry.  Having failed Quantitative Analysis and Qualitative Analysis chemistry at the University of Illinois, beginning Chemistry was easy.  I got two A’s and a B.  To overcome my learning disability I figured out I could memorize if my body was moving.  To keep the knowledge in my brain, I had to use it constantly.   And I found if I read for short periods, then got up to put a load of laundry in and then back to reading, that worked too.   As an adult I’d found a way around the challenges my learning disability.

I completed my prerequisites and applied for the nursing program.    I was told there were hundreds of applicants and only a small number of spots available in the nursing program.  I was told my chances were slim.  I just smiled as I wasn’t in charge of this journey.  I was in the next class. I remember thinking on the first day of orientation, “What am I doing here?”

I found I was good at the clinical rotations but slugged through the nursing theory.  If it made sense, I was all over it, but if it didn’t, it was harder to remember.  At graduation the other young grads asked me what hospital I would apply to?  “Haven’t thought about that yet,” was all I could say.  When I did look at hospitals, I was offered night shifts.  I knew that wouldn’t work for my family.  So I found myself a nurse but why had I done this?  Where was I to go next?

I am going to start my blog with how I got started on the road to lactation teacher.  I call myself “the accidental lactation teacher”.   I’ll go into more detail in other posts, but this is roughlyhow it came about. For those of you who like biographies as I do, the shaping of the blogger is defined here.  I’ll have to post it in several sections, though, as its turned out longer than I planned.  

           CHILDHOOD INFLUENCE TO HOUSEWIFE AND MOTHER

 I was born in Portland, Maine in the early 40’s and my mother breastfed me for 7 months.  The way she told it, the Naval doctor insisted all the Navy wives breastfeed their babies.  At age 2, my family deployed to Trinidad during WW II.  Mothering was different in Trinidad.  Everyone breastfed and it was all I saw when I saw babies carried on their mother’s hips and breastfeeding all over the island.

Once back to the US, my Mom breastfed my 5 siblings.  At 16, I was sent to my aunt’s dairy farm in Minnesota to help her with unexpected twins born in the middle of summer haying season.  You city dwellers won’t know what a crisis that was for a farmer’s wife.  Needless to say my job was to make their formula from scratch, sterilize bottles, do the bottle feeds 24/7, wash the diapers and bake noon pies for the big meal for all the farm hands. My Aunt had to milk the cows, feed the chickens, do the laundry and make the huge noon meal for the farm hands.  I learned two things:  (1) bottle feeding formula was A LOT OF WORK! Work that I never saw my Mom have to do and (2) I can’t make good pie dough!  I came home from that summer exhausted with a decision that any babies I had would be breastfed. I now buy ready-made pie dough.

After reading Tom Dooley’s biography in junior high school, I wanted to be a doctor, and work with the indigent in another country, improving their health.  My grades were average and it wasn’t until my first year of college that it was discovered I had a learning disability.  I was enrolled in pre-med at University of Illinois and since I was on grade probation, they had me take a career aptitude test.  Now this was in the early 1960’s. It was common to steer young women to either grade school teacher, nurse, secretary, airline stewardess or housewife, certainly not medicine!  They told me the testing said I would make a fine teacher.  I was infuriated, took a heavy load of pre-med classes the next semester as a challenge, failed miserably, left school, got married & had my first baby…ending up……… a housewife.

While pregnant with my first baby, the doctor asked if I planned to bottle feed or breastfeed.  I remember thinking “what a strange question, breastfeeding was so much easier.”  I wanted a natural childbirth after reading Grantly Dick Reed’s book.  You know the one that says “animals don’t make noise in labor.”   I was doing a fine job of it too in the hospital  labor room when a nurse came in, told me she was going to give me a shot and before I could finish my sentence of “No, I don’t want……. it” I was knocked out by whatever she gave me.  I woke up having missed the whole birth.  I was angry and didn’t get to meet my daughter until the next day!

The nurse brought her in swaddled and while holding my child possessively she asked how old I was.  I told her, “twenty” and as she handed me my baby she said, “You’re too young to have any milk.”  She also gave me instructions NOT to unswaddle my child and left the room.  Again, I was mad.

Baby Heather and I figured breastfeeding out on our own in that room.  At discharge this same nurse handed ME a six pack of formula and gave my husband our baby.  I tried to give the formula back telling her I was breastfeeding and she said, “Don’t you starve your baby!”   I left the hospital mad and determined to breastfeed.

Once home I had sore nipples for two months and Heather had poor weight gain because she threw up every feeding.  I had a ton of milk so I just kept feeding her and she’d throw up and I’d feed her more and this went on round the clock.  I was determined to make breastfeeding work because the nurse made me angry.

 The doctor diagnosed Heather with pyloric spasms and joked about how tired I looked.  He said, “You must be exhausted having to sterilize all those bottles.”   “Bottles?” I asked him, “What bottles?  I’m breastfeeding.”

“Where are you getting all that milk?” he asked staring at my average sized breasts.  In the early 1960’s the prevailing opinion was to feed breastfed babies every four hours because it took four hours for the breast to build up and store enough milk to dump on the baby at feeding time.  What did I know?  I just fed her again right after she threw up. We know differently now.

The doctor prescribed Phenobarbital medication to relax Heather’s stomach valve, the vomiting stopped and she began to gain weight.  But I got engorged with the previous overproduction need eliminated and my nipples were very sore. I called my Mom for help but since she never had any problems breastfeeding so she had no idea what to do.  She did have some helpful advice though; she suggested I call La Leche League (LLL).  But I hesitated.  I didn’t want to bother those nice ladies.  Wasn’t it a club for happily nursing moms?  And I was still mad at that nurse so, being determined to succeed at breastfeeding without starving my baby, I waited until Heather had gained weight and the nipples stopped hurting before I went to a LLL meeting.

It was there I learned they could have and happily would have helped me.  Watching a two-year old climb onto the lap of the woman sitting next to me, unbutton her mother’s blouse & start nursing reminded me so strongly of my childhood in Trinidad where such natural parenting abounded.  I was hooked and went to many meetings.  Then in 1964, after the birth of my second child, I became a LLL leader and enjoyed helping moms over the phone and at meetings.  I found wonderful friendships that last to this day.  I loved it so much that when a nurse in the Watts Health Clinic (in one of the very poor areas South of downtown Los Angeles) called and ask if there was someone to come and do a LLL group amongst their predominantly African American mothers in the clinic, I immediately volunteered.   Perhaps it was the reminded comfort zone of being in Trinidad as a child, but I loved that group of women.  I loved their spirit and I learned so much about the challenges they faced and made wonderful friends.  Thus began the Inner City Project in Los Angeles.  I am told that it was the first peer counseling program in the US.  The project was funded by Dr. Lucy Rockefeller Waletsky and enabled woman all over the city to access LLL Leaders and mothers outside of their neighborhoods by telephone through an answering service.