When Things Don’t Go as Planned

One of the hardest situations for me to be in is the one where breastfeeding just doesn't work out as planned for a mother and her baby. And if it is hard for me, it is obviously infinitely more difficult for the family that is experiencing it. But sometimes, despite the best intentions, it comes to an end much sooner than anyone wants. Other times, breastfeeding continues, but not in the way the mother had planned. My role in that situation is often one of a realist. I am in the home, I know the history, and I see everything the mother is experiencing, in addition to a hungry newborn. Many times, I am just confirming what a family already knows, but needs to hear from a professional who they feel can see the whole picture objectively.

But can a lactation consultant be objective? Aren't I supposed to encourage exclusive breastfeeding and do everything I can to facilitate that? I like to think I can do both - be objective and encourage breastfeeding at the same time. It is probably my neonatal ICU background that often reminds me that the most important thing is that the baby is fed. Hopefully, the baby is breastfed or fed breast milk. Ideally, I want to educate women and give them reasonable options, so that the choice is theirs, according to their experience and desires, not mine. I want them to be able to achieve their breastfeeding goals, whatever they may be and however different they may be from another woman's. When I have the privilege of being invited into other people's homes, I always try to remember that people are having me there to receive an honest assessment and opinion of their unique situation. And with that, I believe I owe them a customized, reasonable and realistic plan.

So, why doesn't it work sometimes? Most often, I think it is because help arrived too late. I think if women knew how important the first few days are in establishing a good milk supply, they wouldn't wait to seek advice. But what if you have had an unexpected C-section, have a toddler at home, and a house full of helpers/guests? Sometimes, a woman can only do so much, especially if she has had major surgery herself. Some women have all that happen and more but still have an abundant supply, yet don't want to nurse, and call me to help them stop. Life is not balanced sometimes.

Milk production actually starts around the 14th week of pregnancy when hormones cause the ducts and lobes to proliferate (think bigger, tender breasts). This continues until the 28th week when the second phase of milk production causes colostrum to be produced. This production only continues if the breast is adequately stimulated and emptied after the delivery of the placenta, and colostrum will be gradually replaced by transitional milk. Production of mature milk usually begins around 10 days after delivery and by about 4 weeks, if all is going well, a mother's milk supply is well-established.

If the baby is not nursing frequently and efficiently, is causing damage to the mother, or is losing weight, a board certified lactation consultant should be contacted immediately. While none of those situations are ideal, they can be fixed. There are options other than suffering through it (which may lead to failure in establishing milk supply). The most important thing is getting that supply established early on. I can almost always get the baby to nurse well if the milk is there. But once the supply begins to decrease, and you experience the subsequent drop in hormones, it is a process that is very hard to reverse. 

Many times, I just can’t help moms to understand the importance of intervention early on. I can’t convey the need for the baby to nurse effectively, or for them to be pumping. They don’t want to hear that their plan isn’t working and I totally understand that. They believe that any nursing is good even if the baby isn’t getting milk or hurting them.  They exhaust themselves and the baby, insisting that they nurse, even if the baby is a preemie and not capable.  They refuse to pump with a hospital grade pump because they want to wait it out a couple of days and spare the expense.  They decide just to get two good solids nights of sleep and then start all over again.  These are the things I just can’t fix.  Breastfeeding is so time sensitive, and if you miss that opportunity in the beginning, you can’t get it back.  I wish so badly that every mother knew that!

In the end, breastfeeding is an extremely private decision for a family, and a unique experience between a mother and baby. Each case is different because the desires of and situations surrounding every mother and baby are different. It's what keeps my job so interesting and enjoyable. But if your goal is to breastfeed and you're concerned that things aren't getting off to a good start, contact a professional quickly. Those first few days can truly make all the difference.