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.