Pillow Talk

Last month I blogged about how many hospitals undermine breastfeeding while paying lip service to the “Breast Is Best” slogan.  Recently I had an example of how this happens.

I was at Weill Cornell visiting a former student.  Her 2 day old baby had been born slightly premature and was still hospitalized, though mom had been discharged.  We sat together in the Waiting Area as she began to get the hang of nursing.  

Do you remember getting the hang of nursing?  It doesn’t happen immediately for everyone, even with help.  The door to the waiting area opened and closed a dozen times as people came and went, and each time, I saw her eyebrows knit together and her shoulders squeeze up and forward as if to provide a modesty shield.  Most of the moms I meet work up gradually to the idea of nursing in public; this new mom had to do it on Day Two because there was no private place for her.  She was hyper-aware of every random person who sauntered into the waiting area, including the coughing toddler who turned up the volume on the giant television screen. Scooby Doo was blaring.  The chairs were narrow and hard.  There was no stool to rest her feet on.    

I went to the nurse’s station to ask for a pillow to help position the baby.  When a baby is positioned correctly, he gets plenty of milk and the mom will not be in pain.  That is called:  breastfeeding working.  Squeezing the mom into a lousy office chair where she can’t get comfortable or latch the baby may as well be called:  why not give up now?

When I asked for the pillow, the nurse looked at me with an expression that said, “Honey, this is not a hotel.”  She let a long pause go by, a long, very awkward pause, as though to shame me for asking her to do an errand.  Finally she said, “I’ll look.”  After a long while, during which my client tried her best, contorted on the lousy chair, the nurse returned saying, “We don’t have any.”  

I said, “You don’t have a pillow for the mother of a hospitalized two day old baby?”

She started to walk away, and I said, “Can we get a blanket then?”

There was no blanket either (of course, formula was available, though; the baby had been given it at almost half her feedings.  Hospitals that aren’t Baby Friendly accept free samples from formula manufacturers.  No one donates free samples of breastfeeding pillows, comfy furniture or kind, gentle support people).  

In the end, we got a bed sheet, which I rolled up to form a not-big-enough bolster.  My client showed tremendous courage and perseverance; she tuned out the people coming in and out and managed to get the baby nursing well, and talk to me about her birth, all while squeezed into the lousy chair in the lousy room.

She was brave and determined, and I admire her enormously but seriously?  Why should she have to be so heroic?  It is heroic enough to cope with an unexpected premature birth.  It is heroic enough to have a new baby, period. You shouldn’t need to be heroic to get the baby fed.

What if she’d been too anxious to tune out the noise, too exhausted to deal with the uncomfortable chair?  What if she’d just been a normal woman, not especially brave or persistent?  The “best” practice is to persevere at nursing, but honestly, the logical choice for this mom was to give up once the toddler started coughing and the nurse couldn’t get us a pillow.  Not because breastfeeding is so impossible; breastfeeding isn’t impossible at all!  But the hospital setup was making it awful for her.  The hospital setup was making it seem more provocative, more difficult and much more complex to manage than it needs to be, so it became something to surmount.

She was tired, worried, and uncomfortable.  New moms tend to be, even when things are going well.  But being tired, worried and uncomfortable makes you less able to cope with a loud room, no privacy, no pillow, endless logistics.  Why are we supporting hospitals that ignore that?  We can talk endlessly about breast being “best” but when we set it up that you have to be a superhero to do it, we are setting people up for failure.

Here’s what we should have instead:  

  • A private, sunny Nursing Room for new moms.  It should be separate from the waiting area for loved ones of laboring women.  
  • The room should be stocked with whatever you might need to nurse a baby:  comfortable chairs, foot stools, a water cooler, and props for breastfeeding moms — pillows, etc. You shouldn’t have to ask.  Just like in a bathroom you shouldn’t have to ask for a sink as well as the toilet, yk? (Can you imagine if you went to the bathroom and there was a toilet but no sink?  And that if you asked for a sink they said there was one, but it was way down the hall, around the corner, past the elevators and through the fire doors?  And on the way to the sink you passed ten signs reminding you that hand-washing was “best”?)
  • No TV, and a good soundproofing door so that the frantic noise of the hospital isn’t a constant distraction.

oh, and of course:

  • personnel who are knowledgeable and trained in normal infant feeding, and who can grasp that a new mother who wants to feed her hospitalized baby, needs to be cared for.

All hospitals should be Baby-Friendly.  Let’s get on that.  Until that is the standard, though — ask for what you need.

"Breast Is Normal"

Here’s a really interesting recent piece by Ceridwen Morris on the “Breast Is Best” slogan.  We’ve all heard “Breast is Best” for years, but, come to think of it, doesn’t it sound a little too “goody goody” to you?  Do you really need to be “best” at everything?  Some breastfeeding folks point out that calling breastfeeding “best” makes it seem like an extra special A+ you might not feel you need to go for, instead of what it is:  the normal way our species feed our young.  You give birth and your breasts get milk.  Whether you use them or not, we are mammals.  

But once we describe breastfeeding as plain old “normal,” what does that make formula?  When we call breastfeeding “beneficial,” formula feeding sounds “normal”.  If breast is normal, formula is:  worse.  Inferior.  Not as good.

I know this is a touchy subject, but before you click “unfollow,” let me finish.

Here's another article I saw today, noting that 96% of US hospitals fail to support, or undermine breastfeeding. 96%!!  No, hospitals don't say “Don't Breastfeed!”; they undermine it with inconsistent and misinformed practices, and by not implementing WHO's 10 step plan to become “Baby Friendly.”

It matters. Moms trust hospital caregivers and assume the hospital staff gives appropriate, state-of-the-art feeding advice.  But when moms are discharged without establishing breastfeeding, or having been given inconsistent or misinformation, many go on to wean, saying they “couldn’t” breastfeed / didn’t make enough milk /  etc.  Often they don’t realize the whole endeavor was sabotaged in the first days after the birth, by misguidance, inconsistent advice and inappropriate practices in the hospital.    

Then, moms who’ve weaned feel criticized by pro-breastfeeding advocacy that describes breastfeeding as “normal” or formula as “inferior.”  And we all dance around, trying not to hurt anyone’s feelings.  

Here’s the thing.  We shouldn’t hurt Moms’ feelings.  There is no use making any new mom feel like crap about herself, or suggesting that breastfeeding is the be-all-end-all, or that there is no place in the world for formula, or that it’s evil.  There’s a place for formula.

We need to support mothers’ choices, and respect their individual situations.  We don’t support them when we get sidetracked on a “did she or didn’t she” discussion of infant feeding, or act like mothers who formula feed are weak of character or inadequate.  But we also don’t support them when we pretend breastfeeding isn’t the normal way human young are meant to be fed, species-wide. 

Instead of Mom On Mom Criticism, here is where to focus our energies instead:  We MUST change what happens in the hospital. Hospitals’ newborn protocols are a crucial element of breastfeeding outcomes and all but 4% are failing.  Why are almost no hospitals “Baby Friendly”?  The answer has to do with money and time.  To be “Baby Friendly,” a hospital cannot accept free formula samples.  It must develop a comprehensive breastfeeding policy.  It must provide staff training.  It costs.  And if formula is “normal” and breastfeeding  ”extra-specially beneficial” then, that cost seems too much to bear.  Especially since  most exhausted and overwhelmed mothers will blame themselves if breastfeeding doesn’t work, and most won’t turn back to the hospital, saying, “How could you have failed me in those early days when my baby and I were fragile and needed your help, support and information?”

Why are any of us giving our business to hospitals that fail us in *any* area of care?   Write to your hospital and request that they become “Baby Friendly.”  If you are pregnant, take a prenatal breastfeeding class with your partner.  If you’re in NY use this website to look at breastfeeding outcomes in your hospital (scroll down to find the percentage of babies who are “fed exclusively breastmilk” as the AAP recommends).  If the breastfeeding rates are low, bring contact info for an IBCLCwith you to the hospital when you go into labor.  You may well not need her, but if few babies leave your hospital exclusively breastfeeding, why would you trust what the maternity nurses tell you about breastfeeding?  Consult with an expert when you have questions.

Breastfeeding is not simply a matter of what fate has in store for you.  You, your partner, and your support people are factors in the outcome.  Get educated; ask for help; reach out when necessary.  Reach out to the right folks.

P.S. For those in NYC:  Only two hospitals are “Baby Friendly”:  Harlem Hospital Center and NYU-Langone Medical Center.