Your Secret Weapon for Breastfeeding Success

From the NPR Morning Edition, June 26, 2017

by Glenni Lorick, IBCLC

Yesterday NPR (National Public Radio) ran a fascinating story about breastfeeding mothers in Namibia. It is really worth taking a few minutes to listen to it.  It turns out that mothers there struggle with breastfeeding just like mothers in the United States do. They get sore nipples; they may have supply problems; they have to learn to breastfeed just like American moms do. However, they have a huge advantage that the vast majority of US moms do not have: a culture of breastfeeding.

The Grandmother Factor

This article explains in detail how the Himba people in the northern desert of Namibia have a culture that makes breastfeeding work. They live in mud huts, and babies are born at home, so there is no separation of mother and baby after birth for medical procedures. Their maternal and infant mortality rates are both high. For every 100,000 births, 265 mothers die, and or every 1000 live births 36 babies die. Obviously, I am not advocating giving birth in a mud hut as a solution to our breastfeeding problems. And even Himba mothers do struggle with learning how to breastfeed.

When 17 year old Bethany had her baby, her mother
supported her and taught her how to breastfeed.

But that is where they have the amazing "Grandmother" factor. Himba mothers actually go in the third trimester of pregnancy to the compound where their own mother lives. The new grandmother sleeps in the hut with mother and baby, even serving as an alarm clock to awaken the new mother and remind her to nurse. The grandmother teaches the new mother how to position the baby, how to help baby get the best latch possible, how to safely sleep with baby, and all the other little details necessary for parenting. The new mother remains with her mother for several months following the birth.

In the US we have a generation of great-grandmothers whose doctors told them that formula was the best way to feed a baby. Their daughters who are now grandmothers likely had no support for breastfeeding from either their mothers or the medical community. This lack of help often spelled lactation failure for that generation of mothers. Those who persisted are able to support their daughters in an amazing way, and usually those daughters benefit from their wisdom.

A grandmother who can help with breastfeeding is a treasure.

But there is another glaring obstacle that mothers in the US face. They are expected to jump right back into the routines of life within days or weeks after giving birth. I have worked with mothers who had to return to work or school as little as 2 weeks after giving birth. They aren't even able to give their bodies time to recover, let alone get breastfeeding well-established. The scant 6 weeks that so many employers deem as "generous" maternity leave is actually the bare minimum to move a mother beyond the post-partum period. Employers who allow 12 weeks are much more in tune with what mother and baby both need.

Another big difference between our culture and the Himba culture is the normalization of breastfeeding within the society. There it is completely expected that mothers will feed babies at the breast. Although there is some supplementation with goat's milk when mothers don't have enough milk, it is not the normal way to feed a baby in that culture. In contrast, new mothers here often feel uncomfortable and embarrassed about breastfeeding their babies with anyone else around. We do not have a breastfeeding culture here where children grow up seeing breastfeeding as the normal method of infant feeding.

Lessons We Can Learn from the Himba People

So how can we take this information and use it to increase breastfeeding success among US mothers? I see several ways in which we can learn from the Himba culture.

Skin-to-skin contact during the early days is
critically important for Mother and Baby.

1. Mothers and babies should NOT be separated at birth for any reason unless there is a genuine medical reason. Many hospitals have implemented policies to protect the Golden Hour because the evidence clearly points to improved outcomes when mothers and babies have this uninterrupted time together immediately after birth until after the first feed. 
2. Mothers and babies should have as much skin-to-skin contact as possible in the early post partum period. Research shows that this elevates hormone levels which increase mother/baby bonding. It also helps milk come in faster and increases the rate of breastfeeding success.
3. Mothers need to go home to somebody who will take care of them as they are learning to care for and feed their babies. This person needs to be supportive of breastfeeding, ideally having breastfed herself. Mothers need several weeks of this encouraging care and support. If a supportive grandmother, sister, aunt or close friend is not available to fill this role, a postpartum doula is an option. A Nurturing Moment actually offers a postpartum support package that provides some of this kind of ongoing support to new moms who don't have a grandmother/sister/friend to help out. It is very interesting to note that in the NPR broadcast yesterday morning they actually mentioned IBCLC's as an alternative for mothers who don't have "the Grandmother factor."

   

   India has a mandated 6 month maternity leave!

4. Our lawmakers need to get serious about providing a minimum of 12-16 weeks maternity leave to employees. As a small business owner, I understand the hardships that can cause, but as a lactation consultant, I see daily the hardships caused by the lack of adequate maternity leave. Research as well as the experiences of mothers and companies in the rest of the world have clearly shown the benefits of making sure that a strong maternal leave policy is implemented across society. 
5. From their earliest days, children need to see breastfeeding as the normal way that babies are fed. Children's books should feature pictures of babies nursing, not getting a bottle. Mothers should try to expose their children to other breastfeeding mothers, explaining that this is how babies are designed to be fed. Science classes at the elementary level should include breastfeeding in their curriculum when children are learning about mammals. At the secondary level, breastfeeding should be included in instruction about reproduction and family planning. A breastfeeding culture is built by one mother and baby at a time normalizing infant feeding at the breast. I am optimistic that together this generation of mothers can make that happen!

Will It Ever Get Better? Depression and Anxiety in Mothers

by Alicia Schuster-Couch, guest blogger

Over five years ago when my first baby was born, I expected to be a happy mother with a happy baby. And, why shouldn’t it all be happy and great? Seemingly, parents’ posts on social media portray pure happiness and joy surrounding their children. Movies and stories are filled with tales of mothers being completely fulfilled and satisfied with motherhood. And  well-intentioned friends and family endlessly reminded me to enjoy every sweet moment of babyhood. Unfortunately, I was struggling as a new mother. More accurately, I felt like I was drowning. My baby was perfect but I was not. The guilt of not being perfect, of not enjoying every moment, of not being satisfied only served to exacerbate my depression. I never felt like hurting my child, but I frequently wondered if she’d be better off without me and sometimes thought about how much better everyone’s life would be if I ended mine.

How could this happen to me? I have a masters’ degree in counseling and years of experience in mental health. How could I be suffering so badly? When I went to my six week follow up OB appointment I had planned to bring up my feelings. Unfortunately, I was met by my overbooked and rushed OB who quickly wanted to make sure that my stitches were healing, wanted to talk about birth control, and needed to rush out the door. I also wanted to tell my husband, my friends, my family, my old coworkers that were still in the mental health field, but I couldn’t. I didn’t have the courage to tell anyone. I felt embarrassed. So, I retreated into isolation with my baby and wondered if I would ever get better.

Of course I got better, but it was a painful journey. Now with three babies and one pregnancy loss under my belt, I feel strong and have a sense of contentment. I did get depressed again after my second child, but not as severely as with my first. Then, when I was devastated by the loss of my third pregnancy, I reached out for help (finally!) and was quickly able to get back on track after some counseling. Thankfully, after my third baby I didn’t have any clinical depressive symptoms. I still don’t know what I’m doing half of the time as a parent and feel like I’m winging the roller coaster ride of motherhood. But, thankfully, I’m out of my depression. Now after my journey through depression and anxiety as a parent of young children, I feel compelled to use my formal education and professional experience to try and reach out to other mothers who may being sharing my past struggles.

 I frequently wondered if she’d be better off without me and sometimes thought about how much better everyone’s life would be if I ended mine.

I was surprised to find out that post-partum depression is the number one complication of pregnancy. There are higher incidences of post-partum depression than preeclampsia and gestational diabetes. How many times did your health care provider check your blood pressure? Check for swelling in your feet? Screen your urine? And, remember that tasty beverage you had to choke down to screen for gestational diabetes? Now, how many times did you get a mental health screening? How many conversations did your healthcare provider have with you about mental health or about treating mental health complications? Although all of the above mentioned screenings are important to your health and your baby’s health, I find it odd that we are screening mothers for preeclampsia and gestational diabetes, but not for depression, or anxiety, or other mental health diagnoses. Moreover, if you are one of the few that were screened by your healthcare provider for depression or anxiety, did they provide adequate referrals and follow up? After three births and one miscarriage, I never once had a conversation about my mental health with an OB, nor did they ever offer any referrals to mental health treatment. I am not bashing OB’s. They have a challenging job and have an enormous amount of responsibility when it comes to the physical health of not only mother, but baby as well. However, I think there is a dangerous void in screening for mental health. I’m not sure why there is a huge gap in offering mental health services specifically to pregnant women and to mothers. Nevertheless, this very vulnerable population deserves better.

I could write pages and pages of all the variables that contribute to mental health disorders in pregnant women and mothers. There are organic factors and family history; there are interpersonal and social factors, and many, many more. Regardless of the cause, it’s painful. It creates difficulty in accomplishing day to day tasks. It creates difficulty in parenting children. It can facilitate isolation, guilt, intrusive thoughts, and a litany of other symptoms that make life a struggle. Just like words can’t adequately describe love or joy or grief, I don’t think that words can actually capture the pain of living with a mental health disorder while concurrently trying to care for a baby or child(ren).

So, what are some important things for pregnant women and mothers to know about mental health? Let me quickly break it down into symptoms, treatment, and prevention. For the purpose of this article, I’ll stick with depression and anxiety, although I realize that some mothers experience other mental health symptoms.

Symptoms of PPD

What does depression look like? It’s not as simple as being sad. Sometimes people who are clinically depressed show symptoms of appetite changes, sleep changes, fatigue, low self-esteem, difficulty making decisions, feelings of hopelessness, feelings of irritability, thoughts of harming themselves, and decrease in pleasurable activities. Now, some of these are a natural part of having a brand new tiny human move into your house, but these symptoms cause problems when they are pervasive and do not seem to get better. Anxiety can look like perfectionism, excessive worry, intrusive thoughts, panic attacks, and obsession. Neither of these symptoms lists is provided with the intent for you to diagnose yourself with depression or anxiety. They are simply some of the common symptoms associated with depression or anxiety. If you feel like you’re experiencing some of these symptoms, I hope that you seek a professional diagnosis so that you can receive proper treatment.

Treatment of PPD

Treatment for depression and anxiety begins with a diagnosis. To receive a diagnosis, you’ll need to visit with your health care provider or with a mental health provider. Mainstream treatments include therapy and medication. I believe that treatment should also include education because after all, knowledge is power. Other important factors during treatment include nutrition, exercise, social support, and self care. These treatment factors are ones that should also be considered for prevention. Although it’s impossible to prevent a mental health disorder if you are predisposed to it, there are things that you can do to insulate yourself from the blow of having a mental health disorder. I am not a nutritionist or a personal trainer, but I do know that a healthy diet and regular physical activity make a world of difference. In our era of processed and dyed foods there are a lot of things in our food that negatively impact our bodies and have an effect on our biochemistry. Therefore, it’s important to eat a healthy and varied diet. Exercise is also important. I’m not recommending that you get an expensive gym membership or start training for a triathlon, but it is important to be active. This can mean going for a walk or jog in your neighborhood. This could also mean gardening, or riding a bike, or playing with your kids outdoors. We know the importance of Vitamin D (sunshine) on our physical wellbeing and the importance of hormones that are released through exercise. We all know how important nutrition and physical activity are, but it can be difficult to be motivated to partake in those healthy behaviors if you’re overwhelmed with depression or anxiety.

From RockYourormomes.com

Another important treatment factor is self care. What is self care? It is whatever it means to you to maintain your wellbeing. For some women it can be reading or writing. It could be yoga or meditation. It could be a glass of wine and your favorite television show. Self care is completely subjective and individualized. The important point is that self care is crucial. Your kids and significant other and life are demanding of you; nevertheless, you also need time to decompress so that you are able handle day to day stressors.

Easy enough, right? Nutrition, exercise, self care, social support, and therapy will set you up for a healthy and happy life. I realize that this is easily stated advice. I know how hard it is to just get one of those things on the list done. I also know that when you’re wading through the mud of depression and anxiety, all of those things seem totally impossible. It seems like you have no options, no time, no motivation, and no money to make any of those things happen. All of those feelings of doubt are normal and even expected. However, if you find yourself struggling, I hope and I pray that you can find the courage to reach out for help. Whether you reach out to your significant other, your sibling, friend, or professional, please reach out. Once you reach out you can begin to release the burden that you’ve been carrying around. You can begin to make a plan to address your symptoms and make your life enjoyable. I once wondered if things would ever get better for me. They got better, much better and I’m confident that things can get better for you, too.

I just want to acknowledge that this article does not capture the depth of mental health issues in pregnant women and mothers. The article needs to be ten times as long to adequately address all of the issues. For instance, I didn’t even address issues relating to the role that trauma plays. I didn’t address thoughts of harming others or thoughts of harming your baby or many of the other symptoms that mothers experience. This was meant to be an introductory overview of the issues. If you feel like you want to learn more about mental health in pregnant women and in mothers, please contact me. I’m a local counselor who is passionate about helping mothers and their families. I think mothers deserve better and more comprehensive treatment.

My name is Alicia Schuster-Couch and I am the owner of New Leaf Counseling Services of the TN Valley, LLC. I can be reached by phone at (256) 755-4599 and by email at alicia.newleaf@gmail.com . I am passionate about working with women to help them achieve their goals. I am currently an Associate Licensed Counselor (ALC) under the supervision of Liz Howell, LPC-S. I hold a Master’s degree in Professional Counseling from Texas State University and two Bachelor’s degrees in Social Work and Women’s Studies from New Mexico State University.

Please feel free to contact me or another professional if you feel like you need help. I wish you peace and grace.

Surviving Postpartum Depression, Round 2

By Teresa Fleischmann, Guest Blogger

Have you ever experienced something terrible and assumed you had “paid your dues"? Despite all of my head knowledge about the likelihood of experiencing a postpartum mood disorder a second time, my heart was convinced that my first experience was a fluke. There were warning signs. With Ian I had struggled through miscarriage, infertility, difficult pregnancy, traumatic birth, and he was my first baby. After having an amazing delivery with my second child, my daughter Cora, and experiencing no anxiety or depression postpartum, I figured “been there, done that!” What I failed to recognize, was that every pregnancy and postpartum experience is unique.

In August of last year, 2015, I gave birth to my third child, Luke Jeremiah. To be completely honest, I was not super excited when I found out I was pregnant again. After the birth of my daughter we knew our family was not quite complete. We could see God revealing to us that there was another child in our future. Unfortunately, in 2013/2014, we suffered two consecutive miscarriages, with the later one requiring a D&C. Seeing that second line on a pregnancy test had become terrifying, instead of exciting, as if I was just waiting for something to go wrong. I remember telling my doctor that if we lost this one, I was done. My faith had become fleeting, and I was not sure how much more I could take, emotionally, or physically.

God is Faithful and Luke grew healthy and strong. Aside from the annoyance of Gestational Diabetes, my pregnancy was complication free. Delivery went a little awry when I experienced a repeat shoulder dystocia (I had that with Ian as well), but by and large it was nowhere near as complex or traumatic as my first birth. Luke came to us at a hefty 8lbs 15oz, and instantly I knew our family was complete. The first few days at home where enjoyable, but on day 3 I felt the onset of anxiety, OCD and insomnia. I quickly filled my Lexapro prescription, and within 4 days, I was sleeping well again (at least as well as you can with a newborn!) My husband and I clumsily settled into our new life as a family of 5.

Several weeks later, when Luke was 6 weeks old, I got very, very ill. It’s a long painstaking story, but in summary,  I had a stomach and intestinal parasite that led to a bacterial infection. I could not keep anything down, and within 2 weeks I had lost more than 30 pounds. I looked sickly; I was weak. My muscle was deteriorating. The doctor threatened to hospitalize me. It was scary. The stress on my immune system caused me to break out in the shingles. I quickly started spiraling downward. We decided it was time to ask my mother to come stay with us to help with the kids. She got there just in time.

Have you ever experienced something terrible and assumed you had "paid your dues"?

Within a few days of her arrival, the intense insomnia began. I started having flashbacks to my postpartum period with Ian. I became terrified and detached. My anxiety and OCD became more crippling, and my antidepressant wasn’t cutting it anymore. By the time we put all of our “if the crap hits the fan again” plans into place, I was experiencing full blown paranoia and horrible, horrible intrusive thoughts.

My psychiatrist added an antipsychotic medication to my treatment plan, and within a week or so I became stable. My mom stayed for about 6 weeks to help me get my feet back under me. I attended weekly counseling sessions diligently, and my AMAZING support system of family and friends surrounded me and helped in any and every way possible.

I would be lying if I didn’t admit that it is hard to fight the stigma. Hard to admit that I experienced a Postpartum Mood Disorder again. Hard to swallow antipsychotic medication. Insanely hard to remind myself that those horrible, horrible intrusive thoughts were not my own. But, alas, it is only a stigma. I have battled a real, miserable, horrible, monstrous beast named Postpartum Depression AGAIN, and by the Grace of God and the help of my support system, I have come out victorious!

If you or someone you know is experiencing a Pregnancy Related Mood Disorder, please reach out for help. Fight the stigma. Fight for your family. Your family needs YOU! With the proper treatment plan you absolutely will get better!!

I am so very thankful for the two following resources. Both provide free materials, information and social support for women and their families.

Postpartum Support International           www.Postpartum.net

Postpartum Progress                     www.postpartumprogress.com

Teresa Fleischmann is a volunteer at home wife and Mom. She is a Postpartum Anxiety, Postpartum PTSD, Postpartum OCD & Postpartum Depression survivor. She founded the Huntsville Postpartum Support Network providing in person and online support to women experiencing PMADs. If you are a local mom in need of online support, you can email your request here. She is also a state co-coordinator for Postpartum Support International, and co-leads an annual fundraiser for Postpartum Progress called Climb Out of the Darkness. You can register to join her here athttps://www.crowdrise.com/teresafleischmann-COTD2016/fundraiser/teresafleischmann

How NOT to Help a New Mother!

by Glenni Lorick, IBCLC

You'll find some constructive ways to help a new mom here!

A few days ago I was helping a new mother nurse her baby as she recounted how a friend had come by her house while she was still in the hospital and "cleaned up." She expressed her aggravation that her friend had moved important papers, misplaced things she needed, and totally rearranged stacks of baby clothes that she had carefully organized. She never asked her friend to clean up for her; in fact, if her friend had simply taken a moment to ask if it was all right to straighten up, the new mother would have said, "No, thank you."

She isn't the only ANM mother who has experienced the frustration of "Help" that causes problems.  One mother said,  " I had a friend come and help clean up my house right after my baby was born and 'file away' in the closet the only card I had with the pediatrician's phone number. I went into hyper panic mode when I went to find it and couldn't."


Another mother relates what happened to her this way:  "When our son arrived at not quite 38 weeks, we were in the middle of cleaning and organizing so hubby's  family came to 'help' while we were in the hospital. Yeah, the living room, kitchen and bedrooms were 'clear' but no one dusted or actually cleaned, and they merely moved everything into our guest room which was piled up with whatever 'didn't have a place' to them. And paint cans, shoes and a few other items were just put outside on our deck....in July. Ruined a pair of shoes my late mother gave me...ruined leftover paint...Took us over a year to 'fix' the mess and find things. Over two years later I still find things shoved places and I fuss at my dh who reminds me who the REAL culprits were. This time I am making sure everything is spic and span, and if they want to help, then they can actually CLEAN, not move our stuff to 'help'! They also helped with stocking the fridge, but this time I will also have a detailed 'what we keep or need in the house' list since hubby is gluten-free, and last time we ended up with foods that neither of us ate." She adds that no one actually came to help AFTER their son was born, and it would have been nice to have some help then!

Check out these terrific suggestions

It seems that grandmothers are the worst offenders (Note to self, remember the Grandma Rules at all times). You won't believe some of the problems grandmothers have caused: "My mother washed all our kids' laundry while we were away on a weekend trip...she was so proud that she "finished off" the small bag of ecosprouts we had hanging out in the laundry room(she had no idea we only used it to launder cloth diapers)! The only problem was we then had nothing to wash the dirty diapers we brought home from the trip!"

Another grandmother offered kitchen help that wasn't so helpful: "My mother kept unloading my
dishwasher and if she didn't know where something belonged, she would just pick a place that made sense to her. Took us FOREVER to find the colander!"

A third mom wrote that " My mom does this every time she visits. The worst thing she ever misplaced was the week before Christmas. I had bought my husband a new wedding band and had it engraved. She 'put it somewhere safe' without telling me and couldn't remember where she put it! Thank goodness I found it on Christmas Eve buried in my HUSBAND'S underwear drawer!"

How CAN You Help?

Obviously with so many moms expressing frustration caused by well-intentioned helpers, we need to figure out what you CAN do to help a new mom. Some safe options include food preparation (be sure you know if there are dietary restrictions), child care for older children, and running errands. The key is to ask the new mother exactly WHAT she would like  you to do. Remember that this isn't about you, it's about her and her needs.

La Leche League leader Stephanie Stenmark offers excellent advice to anyone who wants to help out: "Never move paper work, and always ask if you don't know for sure where they put something. Really just stick to laundry, wiping counter surfaces, bathrooms, vacuuming and mopping. Never try to organize someone else's belongings!"  

What is the best thing someone could do to help you with a new baby?

Post Partum Depression is NOT a Life Sentence!

By Teresa Fleischmann, Guest Blogger
The five year plan. That was our goal. Five years of marital bliss, complete with traveling, fun date excursions, late night movie theater outings and fancy dinners. Once we got all of the “fun” out of our systems, we would settle down and start our family. We quickly learned, as many have, that God’s plan was very different than our own.

When I was 15 years old, I found out that I had polycystic ovarian syndrome (PCOS). The doctor explained to me that because of my irregular menstrual cycle, and hormone imbalances, I would likely have a difficult time conceiving. At 15 it fell on deaf ears, but when my husband and I began trying to get pregnant, we were prepared for a lengthy process.  We were completely shocked and obviously ecstatic when we conceived our first baby just 3 months later. I was overjoyed! I remember finding ways to tell random strangers about my pregnancy. I felt different, and wondered if other people could tell I was pregnant.  I avoided caffeine, deli meats, perfectly pasteurized feta cheese, and treated the salad bar at Jason’s Deli like the black plague. We excitedly shared the news with our parents, but withheld the information from our siblings and friends wanting to wait until we cleared the “danger zone” of the 1^st trimester. 

One and a half weeks into our new found status of “soon to be parents” we experienced what too many parents have endured, a miscarriage. I was devastated. I felt inadequate as a woman, as a wife. My husband, Derek, and I handled the news very differently. He quietly, keeping himself busy in the garage, while I cried and got angry, not understanding why it happened, almost wishing I had just never gotten pregnant in the first place.  After a couple of weeks of awkwardness, feeling like society told us we must grieve silently, we came to a mutual agreement. As soon as possible, we would try to get pregnant again.

From Kids Health.org

As the months blew past, with one negative test after another, we decided to seek medical intervention. We were already aware of my PCOS, but were dealt another difficult blow when testing revealed male factor infertility. We sought the help of a reproductive endocrinologist, and after 2 years of infertility, which included Clomid, Femara, injectables and 5 unsuccessful intrauterine inseminations (IUIs), we decided we would take a break before one last pregnancy attempt with in vitro fertilization (IVF). The break was much needed. Sex on a schedule had become daunting, and my poor husband had a far too dramatic experience one day when he was stuck in traffic while attempting to deliver his precious, time sensitive, “specimen” to the lab. If you are local, and you recall seeing a fired up redheaded man frantically weaving in and out of traffic, shaking his fists in the air, trust me, you had NO CLUE why he was behaving so erratically! Looking back now, there were so many comical moments during that period of our lives. Well, at least they are comical years later.

This is where our story takes an incredible, miraculous turn. The morning that our IVF deposit was due, I found out that I was pregnant. Naturally. No drugs, no medical procedures, no scheduled intercourse. If my math is correct, it was a couple of drinks and some 4^th of July “fireworks”. This time we decided to shout it from the roof tops. We told everyone. We laughed; we jumped for joy; we cried tears of excitement and also relief! It seemed unreal, and to be honest, I was cautiously excited.

From March of Dimes 

The first half of my pregnancy went well. I somehow avoided morning sickness, and as a larger framed woman, I really enjoyed the freedom to wear horizontal stripes!  Toward my 3^rd trimester I developed preeclampsia, and at 30 weeks I was put on bed rest. The day of my 37 week appointment I went to the doctor and my blood pressure was 150/105. I was already taking 2000mg of blood pressure medication per day, so my OB decided it was time to have a baby. A few short hours later I was at the hospital being induced.

The birth plan that I had prepared was completely thrown out the window when I experienced complications during delivery. I had shoulder dystocia (which lead to an episiotomy and an insane 3 minutes of continuous pushing while a nurse palpated my abdomen) and placenta accreta (which caused hemorrhaging and the manual removal of the placenta by my doctor, which had also broken into numerous pieces.) My baby was born unresponsive, but by the grace of God, regained consciousness 19 seconds after delivery. He was born a hefty 8lbs 1oz, which was quite large for a baby born 3 weeks early! We named him Ian James (after his grandfathers) and our room was quickly flooded with family members who were head over heels for this adorable little boy.

From the Utah Dept. of Health Pregnancy Risk Line.

It wasn’t until later that evening, when our visitors had left and we moved into our recovery room, that we really had a chance to process what had happened. My doctor came and sat with us for a while, and explained both the shoulder dystocia and the placenta accreta. He joked that he was “getting too old for this” and in 20 years of practice he had experienced both complications on several occasions, but never together. We discussed how incredible it was that both Ian and I were completely healthy, and how 50 or 100 years ago we possibly would have both died, or at a minimum, I would have lost my uterus. I felt so incredibly blessed to be holding a healthy, happy little baby!

Our time in the hospital was enjoyable, and we had a constant stream of visitors. I was tired and sore, but also on cloud nine. We were discharged later than expected due to some complications from the circumcision, but we were so glad to return to our own home and our own bed. Our first night at home was hard. Ian slept so well that we had to wake him to feed him and I did not sleep at all.

Nursing was much more difficult than I expected and quickly became a chore. Ian was not gaining weight and scheduled feedings were not going well. I was committed to breastfeeding and had read all the books. Nursing sessions were taking more than an hour and it stressed me out that I didn’t know how much milk he was getting. I started getting irritable and couldn’t sleep. I was in a constant panic that he wasn’t getting enough food, and after four straight nights without a single minute of sleep I called my doctor’s office and told them I needed help. They prescribed me an anti-depressant, and the first night I took it I finally got a few hours of rest. The next day I felt like a rockstar, and even invited a friend over to chat and hold the baby. Unfortunately that only lasted for one day, and by that evening I was back to severe mood swings and insomnia. I was so upset with myself. I prayed and prayed for this baby, why was it so hard? Why did I have this feeling like I wasn’t good enough? Like I couldn’t take care of him?

From Thejoyofthis.com

Exactly one week after Ian was born I had my first suicidal ideation. It hit me like a smack to the face. I was nursing him in his room and out of nowhere I thought “Just do it, kill yourself. Derek can find a new wife and they can raise Ian together. It will be better for everyone that way.” Sadly, I also had thoughts of exactly how I would carry out the action. As quickly as the thought entered my head it also passed. I set Ian down in his crib and went and found my husband in the bathroom. I explained what had happened and told him he needed to take me to the hospital. We went to the ER, but decided, with the help of the my OB, a psychiatrist and the ER doctor that I would go home and attempt to take some sleeping pills to see if that helped. Lack of sleep can cause people to have crazy thoughts. That evening was a little better and I did feel refreshed. As the next day came, the mood swings returned, and so did the insomnia. One week later, I had another suicidal ideation, and after consulting my doctor, chose to be voluntarily admitted into the behavioral health unit of the hospital. I spent 5 days there, and was only able to visit with my baby for 2 hours each evening, in a supervised room. I began taking mood stabilizers, and was forced to discontinue nursing. I was devastated. To this day my heart is heavy thinking about the 5 days of his life that I missed. I still occasionally feel shame that I had to spend time in the hospital, but I remind myself that I am a better Mommy because of it. As a matter of fact, the alternative was leaving my child motherless.

After changing psychiatrists three times, regular counseling sessions, and coming off of mood stabilizers and back onto an antidepressant, my mood finally leveled off. My mother was able to go home (she lived with us for 3 months to help me care for Ian) and we were able to settle into our new life as a family of three. By the time Ian was 6 months old I had returned to my “normal” self. My final diagnosis was severe postpartum depression, borderline postpartum psychosis. I won the honor of being one of 2 patients with this diagnosis in the history of my OB’s career.

So, now that I have pulled you down into the dredges with me, let me offer up some hope. Jeremiah 29:11 says, “For I know the plans I have for you, declares the Lord. Plans to prosper you, not to harm you, plans to give you a hope and a future.” This has become my life verse. As I finish up this post, my now crazy 2 year old son Ian is napping in his room, and so is my adorable 9 month old daughter Cora. I was blessed with a second child (rather quickly after the first) and by the grace of God, I experienced an excellent pregnancy, a complication-free delivery, and most notably, I have not struggled with any depression! I am exclusively nursing Miss Cora, and am thoroughly enjoying being a mother of two. Postpartum depression is not a life sentence! It is also nothing to be ashamed of. If you are struggling with depression, please, please, please, tell someone, and get the help you need.

I may not ever in my lifetime know why I endured miscarriage, infertility and postpartum depression, but I do know that “God causes all things to work together for good to those who love God, to those who are called according to His purpose”. I also know that God specifically chose Ian and Cora as my children, and me as their Mother! Motherhood is not always glamorous, and at times is frustrating and just plain hard. But I promise this, IT IS WORTH IT! It is worth the pain of labor, the risk of complications, and even the deep, dark, misery of depression. This is proven to me daily in every smile, every coo, every giggle from my kids, and even in those shiny silver badges of honor on my belly!! 

Action Step 8: Continuity of Care

This is the third in our series of articles based on the the Surgeon General's Call to Action to Support Breastfeeding. The U.S. Breastfeeding Committee has suggested a specific focus for each day of August. Today we're actually looking at the focus from Wednesday.  The text below comes from Pages 45-46 of the Surgeon General's document.

Action 8. Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community. 

Image from Wikipedia

Upon discharge from their stay in the hospital, many mothers are unable to find and receive skilled breastfeeding support. Mothers often are left on their own to identify resources to help with questions and problems they may have with breastfeeding. Furthermore, hospitals, clinicians in the community, and community organizations typically lack systems to help connect mothers to skilled persons who can offer support for breastfeeding. Ideally, there would be a system to ensure that breastfeeding mothers and their infants would receive skilled support with lactation from informed and available health care teams. Hospitals, primary care clinicians, and community organizations share responsibility for creating such systems.

Implementation Strategies 
Create comprehensive statewide networks for home- or clinic-based follow-up care to be provided to every newborn in the state. Follow-up support for breastfeeding needs to be integrated into home visitation and postpartum care programs. Staff training in breastfeeding management would be fundamental to this care.

Establish partnerships for integrated and continuous follow-up care after discharge from the hospital. Communities often provide a variety of resources to help breastfeeding mothers, including peer support networks, breastfeeding clinics, lactation consultants, and support groups. Health care systems can ensure that their patients are informed about such resources and can facilitate connections to these resources. They can also help to strengthen or create these programs.

Establish and implement policies and programs to ensure that participants in WIC have services in place before discharge from the hospital. Community partners and key stakeholders, such as hospitals, lactation consultants, and other clinicians, can work with WIC to establish continuity of care for WIC participants who breastfeed their infants. In addition, WIC state agencies can collaborate with state hospital associations to identify key barriers to the provision of WIC services within the hospital setting. WIC state agencies and hospitals can partner to establish policies to ensure that WIC participants receive in-hospital
education and support for breastfeeding, including identiication of a WIC peer counselor and scheduling of follow-up support for breastfeeding by WIC staf in the community.

Getting Involved

We try to work as closely as we can with our local hospitals and physicians.  We deliver rental breastpumps to patients in their hospital rooms at Crestwood Hospital. Our Postpartum Support program is a tremendous resource for new mothers who don't have family nearby to help them after baby is born.

Our Bosom Buddies program is specifically designed to help WIC moms by providing them nursing bras. Furthermore, our sliding scale for lactation consultation services in our office ensures that no mother who needs help will ever be refused it due to her inability to pay for an IBCLC.

Does "Breast is Best" Create a Hardship?

Photo of PumpEase courtesy of  http://www.snugabell.com/

I just came across an interesting article posted in the New York Times in which Jane Brody attempts to use a recent serial  interview study from Scotland to prove a point. She says the American Academy of Pediatrics goal that women exclusively breastfeed for about 6 months is unrealistic and imposes undue hardship on mothers. She relies somewhat on her personal experience 43 years ago when she had her twin sons early by C-section and pumped her milk as they were being fed formula in the hospital. Obviously that wasn't a terribly auspicious beginning for Ms. Brody, and she didn't have the advantage of a supportive lactation consultant since the profession didn't exist 43 years ago. Her OB was quite supportive, but her pediatrician was not, and I must say that I really admire her determination to breastfeed her sons despite some incredible obstacles and without a strong support network.

However, the thing that concerns me the most is the perception of a continued lack of support for nursing mothers in the workplace. Federal law mandates not only that breastfeeding mothers be given break time whenever they need to pump, but it also says that employers with 50+ employees are required to provide a place for pumping that is NOT a bathroom. Many employers have made huge strides in accommodating nursing mothers; nevertheless, some companies may still be unaware of the legal requirement to support these employees. It is vitally important that the women who work in these companies make their HR people aware of their responsibility.

A Nurturing Moment actually has a special program in place specifically designed to help employers offer the best support available to mothers. The return on investment is incredible. Cigna conducted a 2 year study of breastfeeding employees and found that their workplace lactation program produced the following results:

• $240 million annual savings in health care expenses
• 62% fewer prescriptions
• 77% reduction in absenteeism

Mutual of Omaha had the following results with their lactation program:

• 83% employee retention after maternity leave (national average is 59%)
• Healthcare claims per breastfed newborn averaged $1269 compared to $3415 for formula-fed infants.

That leads us into a discussion of my second major concern with Ms. Brody's article. She asserts that there is no research to back up the claims of the medical community that breastfed babies are healthier. It looks to me like Mutual of Omaha has done some research that backs that up!(Mutual of Omaha. (2001). Prenatal and lactation education reduces newborn health care costs.Omaha, NE: Mutual of Omaha.) Furthermore, the AAP statement is backed up by significant research. In fact, it contains 151 citations to support it's recommendations. The Academy of Breastfeeding Medicine has also responded to the Times article with a statement calling for enhanced support for all nursing mothers. 


This isn't about Mommy Wars or "Milk Wars." It's about a public health initiative. The worst thing that anybody can do is use guilt in an attempt to motivate a woman to nurse. Guilt is a lousy motivational tool. It is even more awful for anyone, breastfeeding advocate or not, to make a mother feel guilty about her feeding choice once that choice has been made. Life is just too short for guilt! 


So what do we need to do? First of all, we need to make sure that all mothers have access to good prenatal education about breastfeeding. They need to know that it may be challenging. They also need to know where to turn if they do have any problems.  Next, we need to realize that, as one mother so aptly put it, "It takes a village to breastfeed a baby." (thanks, Elizabeth!) That village includes health care providers, community support groups, family, friends, and breastfeeding professionals.  Finally, we all need to strive to make the workplace more supportive for nursing moms. Are you in management? Do you own a business? Do you know someone who does? Find out what they're doing to help their nursing mothers. Ask questions before you get pregnant. If your children are older, then see what you can do to smooth the way for younger women. If we all work together, we can help more moms succeed and avoid a lot of unnecessary guilt.

ANM Postpartum Support

Recently we polled moms about their greatest need after the baby came home. The most common reponses were help with meals, cleaning, older children and breastfeeding support. Several needed someone to hold the baby so they could get a shower or get the rest they needed. If you have family living close by, you have a built-in support network, but in a city as transient as Huntsville, many people don't have any family nearby at all.

Over the last several years we've often had requests from moms for postpartum doula referrals. Unfortunately, there is a shortage of people willing to provide this service. We do have one local mom who is currently certifying as a postpartum doula, and that's great news. However, we've decided that due to the demand for this service, we would start ANM postpartum support! 


Melissa Florence and Glenni Lorick are both International Board Certified Lactation Consultants who will come to your home and provide all the support and provide all the support and help you need! Our services include the following:

• Professional breastfeeding support (including the use of a hospital-grade pump when we’re present)
• Instruction in and help with infant care
• Assistance with multiples
• Aid with maternal post-partum care

We will be  in your home and willing to help in any way we can as you adjust to life with a new baby. You can choose a package of 12, 26, 40, 58 or 80 hours, or you can pay by the hour.  The hours may be split up according to your needs over the first 8 weeks of your baby's life.  We will be with you for 3 - 8 hours at a time - you decide what you need and what will work the best for you.  

Whether you're a first time mom or you already have several children, you'll be so thankful for the personalized support that we provide. Best of all, you can actually put this on your gift registry and have your friends and co-workers give you ANM Postpartum Support as a present. It's a gift you will appreciate long after the early post-partum period is past!

Give us a call today at 256-489-2590 and mention this blog post for a 10% introductory discount!