An Open Letter to the Lactation Consultant I Almost Saw

Dear Ma'am,

The incident I'm about I am about to describe took place almost 9 months ago, during the second week of October 2014. At the time, I was too overwhelmed by being a mother of a newborn to process what I was feeling, but now I have more clarity and wanted to write this so that, in case you or any of your colleagues across our nation or even the world came across this, maybe it would help you improve your services.

When I called you, my baby was 16 days old. I hadn't been able to breastfeed my older child, but wanted to try with this one. We'd gone through the colostrum stage and had all of the expected diapers for a newborn, but then once we moved on to the milk, he had not had a "regular" dirty diaper.

Days passed. I heard everything from, "It's nothing; lots of breastfed babies use up everything in the milk and only wet" to "He's constipated; use a suppository" to "Something could be very wrong." In my mommy heart, I wasn't concerned. But I trusted my midwives, and once we were closing in on one week with no dirty diapers, they strongly suggested that I call you.

They said that, if nothing else, we could have the peace of mind that he was eating enough, as you had a very delicate scale that could indicate as much. So Friday afternoon, I called you to see if you were available on Monday.

You suggested that you come Saturday, because you said that in all of your years of doing this, you'd never heard of such a thing. After I agreed to that, you said, out loud, "I have plans with my family all day tomorrow, but I could come out first thing in the morning and probably not miss too much."

ITEM #1: That was unprofessional. This is your job. When you suggest a meeting time, either make it work or don't and tell me you misspoke. I don't know you; we're not friends. I don't need to know that you might be blowing off things you promised your kids to fit me in. Incidentally, I would have been fine with Monday. I would have preferred Monday, as I take much more of a "wait and see" attitude with this kind of thing, unless something "tells" me otherwise. As it was, I was full of postpartum hormones, and whether you meant to make me sound like a burden, or like you were doing me a huge favor, your thinking out loud made me very anxious. And I was already feeling pretty icky, what with people telling me that I was being too complacent about my child's care. Again, this is a lot of "new mom" emotional stuff, but these are the women you chose to serve. You're getting paid. Please treat me with professionalism.

You suggested that you would come out at 8:30, and that you'd need about thirty minutes to set up your scale, so we'd do the weigh-in at 9:00. Then you said, "Don't feed him for about two hours before I get there." I almost laughed. At that point, pretty much all of my time was spent feeding him. I said, "I'll try! He wants to nurse around the clock, no set schedule, and he wails if I try to put him off" to which you responded, "If you feed him fifteen minutes before I get there, there's no point in my coming. I need to get an idea of how much he's getting during a full feeding." I didn't go into the fact that every fifteen minutes *was* pretty much a full feeding, as we were doing it. That wasn't really important. If you'd stopped there, I would have understood you, and it would have been fine.

But then you said, "Besides, you're the parent. At some point, you're going to have to let him cry, so you might as well do it now."

ITEM #2: When he's just over two weeks old? You're a lactation consultant! If anyone were down with demand feeding, I would have assumed it'd be you. Here's what was going on: 1) My son might or might not be getting enough nutrition; the last thing I want to do is make him fast for two hours if he genuinely needs nourishment. 2) He is crying about 60-75% of his waking/non-feeding time, no matter what I do. Even when I intervene. Even when I'm holding him. So when I can soothe him to keep him from crying, that's what I need to do. 3) Did I mention the postpartum hormones? I did not need a lecture. I know I'm the parent. And now that my baby is 9 months old, I do let him cry when he wants to nurse but it won't work, especially when I have other snacks to offer and know he's very well fed. But during those first few weeks, it's hard enough without someone taking a peremptory tone, especially because I tell you I want to feed my baby. Not smoke around him. Not leave him in his crib while I run across to Taco Cabana. I know this is what you do every day, but you need to remember that I'm a new mom. I need gentle care. Not scolding.

However, then you offered to do something kind. You said, "Tell you what, if you wake up around 6 and feed him, go ahead and text me, and I can come earlier."

I appreciated this, especially the next morning when we woke up at about 6:45 and, because we were co-sleeping and nursing all night, couldn't really remember when we'd fed last. I figured it'd probably been within the half hour to hour before that, so I texted you. I also wanted you to know that, guess what, he'd had his first dirty diaper that morning! (I cried. Seriously.)

You said, "Okay. I'll come at 8:30 instead."

Uh.

ITEM #3: Our appointment was supposed to be at 8:30. So coming at 8:30 wasn't early. It was on time. I thought, "I'm glad I texted her! I wonder if, because she told me 8:30, half an hour to set up, and we'll weigh in at 9, she thought or wrote down that the appointment was at 9. Whew!"

Then I thought, "Oh! Maybe she means we'll weigh at 8:30, so she'll get here at 8!"

I took Mal outside to sit on the porch with me, so that the rest of the family could get some rest. It was raining that morning, and cool enough to be nice. I don't remember there being any mosquitoes.

Mal started fussing around 7:45. I walked with him, and I bounced him. I assured him you were on your way. As the minutes slipped by, I realized you meant you'd actually arrive at 8:30, but I felt like we were so close, I could do this. You'd be there soon. You'd talk to me and maybe it would distract him. It was going to be fine.

Mal started crying for real at about 8:15.

At 8:25, I thought about our housing situation and texted you where you could park without having to pay. Then I watched, looking up and down the street, waiting for you. I didn't know what you were driving, but there were not a lot of cars out. I started waving and smiling to cars inching by like they were looking for something.

ITEM #4: At 8:38, you texted me, "I'm running about 15 minutes late."

I knew we were done.

I texted back, "Don't bother, then. I have to feed him."

Because, frankly, if you said you were 15 minutes late, at this point I was assuming you were half an hour late, and it was already late and my baby had been fussing for an hour, and I was done.

You texted me, "I'm driving in the pouring rain. Are you telling me to turn around and go back home??"

ITEM #5: I just told you I didn't want the consultation. You don't need to "verify" it by putting a guilt trip on me. I can see that it's raining. I've been out here for over an hour. You should have texted me before you ever got into your car. Clearly, you realized you weren't on time. Why not text me when you realized there was no way you'd be there at 8:30, even if it were just 5 minutes before?

In a few minutes, you texted me that you'd pulled over and were ready to talk. You highly recommended that we go ahead with the appointment, but I told you I'd already fed him. He was quiet. He was sleeping. He was content. I did the right thing.

And yet I felt bad.

So I offered to pay you something for your time.

Later, you texted me that your charge for cancellations was half of your fee, and that was a lot more than I'd planned to send you. But I was tired, and I was frustrated, and I didn't need the drama, so I had Chase send you an $85 check... for nothing.

You did tack on an, "Okay, well, feel free to call me if you have any questions."

Doubtful.

ITEM #6: If you're late for an appointment that involves something like withholding food from a newborn, your clients should be able to tell you that you need to reschedule without having to fork over cash for your tardiness. You weren't just late for the early you promised, you were late for the actual appointment, which you knew was going to be difficult enough for me, anyway. YOU were late. And I paid you. Bad form.

In conclusion, I'm sure you're great at what you do. I came to enjoy and, I suppose, expect a certain level of care because of my awesome team of midwives. They would not have affiliations with you if you were not competent and their clients did not like you. Maybe you were just having a bad week. I don't know.

But, again, you have chosen to perform a vocation in which you deal with new mothers. New mothers are emotionally as sensitive to their new world as a baby is to his. Everything feels over the top and scary and discombobulating. I did not want or need tough love at that point.

So, what was the problem?

In the end, I don't think there was one.

I know my kid's latch sucked (or didn't suck?... properly?), and that's probably one reason we had to feed so much and so often. He's still really bad at it, but whatever we're doing is apparently working.

Hope whatever you're doing is working for you, too.

Then and now. Think he's doing okay! Oh, and he likes vanilla almond milk!

A couple of thoughts a couple of days later (weeks, actually)

I started this blog post on Friday, September 26. Now you can see how much time I've had both for organizing my thoughts and for writing. But I'll finish these thoughts as much as I have the time to do, then go on with some other stuff if I can. Clock's ticking!

I've been thinking about two things the past two days (again, this was the Friday after Wednesday's delivery), and thought I'd share them while I have a moment...

1) I've read a lot about different venues and philosophies when it comes to birthing babies. And I've read a lot about how ultimately, the way you give birth doesn't affect anyone or anything in the long term. What I've realized having now had two distinct birthing experiences is that it definitely does matter. I don't think it's too important whether you choose to go to the hospital or have lovely pain-blocking drugs or do it at home with no help except your family, just that you are heard. I wanted something very specific, and even when it looked like I might not get it, I knew, at the bare minimum, that I had a team who had listened to me and tried to make it happen. I walked away from that experience feeling hugely different than I did after fleeing the omniscient, condescending doctors with whom I dealt before, during, and after Daphne's birth.

That said, I am out of the business of having babies (James is having a medical procedure done this week to ensure that), but if I had to do it again, I'd definitely go with a midwife and birth center birth again. The only thing I had at the hospital was an epidural, and I LOVED it at the time. But I ended up feeling like it put a wall not only between me and my pain, but the actual delivery of my daughter. I don't think everyone is like me, so I don't hold what I experienced up as gospel. I am just not a "baby" person, and I think I needed all of the endorphins and hormones I could get in that moment, in order to start an early bond with the kiddo. And birthing naturally did that.

THAT said, if my true labor pains had lasted 4 hours or 18 hours or even one hour instead of 9 minutes, I might feel differently. But altogether, it was blissful. Not having to fight to go home was a plus, as well.

2) I don't remember the second one. Sorry.

But here are a few random things:

The first couple of nights, I'd wake up, see Mal's head, and think/say, "That's my sweet little girl." Then the night I was dozing off (due to no caffeine) and he was so fussy, I asked James to take him for a drive. James stood there while I dozed off and crept out of the room, not realizing that Mal was about to come back into full-screaming consciousness after three or four seconds. I called James back in and said, "So, is that a 'no'?" He said, "I thought you'd fallen asleep." I said, "I DID. But I need you to take her out for a few minutes, because even if she dozes off, she's uncomfortable... and I KNOW he's a boy. I know it's a 'he.'"

When James and I talked about it later, I think I decided that in that particular brand of exhaustion, my brain goes to the only other time I've felt that tired, and it was when Daphne was a baby.

Mal has had two non-meconium dirty diapers, both on Mondays. He might be a once-a-weeker, and as long as he's comfy, I'm all for it. Our cloth diaper laundry duty will be so much simpler.

I have had to stop dairy. I don't eat much, mostly cheese, but it seems to upset him a lot. I'd stopped caffeine, too, because I was worried it'd given him a lot of energy the night I was worried he might be colicky. I don't think it was affecting him like that, but now that I've been off of caffeine for 5 or 6 days (and, yes, I'm still sleepy but no more headache), I figure I might as well go with it. I like caffeine. I don't think it's harmful. But when you have to take caffeine gum with you to Haiti because you're afraid they won't have enough for you, you might have a problem!

James is awesome. He is doing everything that he can do, and being so gracious about the fact that I sit on my backside for hours on end. Mal has only in the past couple of days let me put him in the bassinet to nap for an hour or so; until then, I (or someone else) had to hold him or he wouldn't sleep. We're out of groceries; I'm making ridiculous things for breakfast and lunch. James is stepping up his chore level, and getting things for me, and dealing with a baby we didn't plan to have in our bed, and is just generally wonderful.

Also, my sister and my friend Jana have been invaluable. Sarah came over yesterday and cleaned, and today she's going to pick up some stuff for me at the grocery store (but don't worry, Nana, I'll have a FULL list for you next week!). Jana has brought us two meals and took pictures of a sleepy (therefore not-as-cooperative-as-ideally) Mal so we'd have some newborn shots while he's still a newborn.

When James' mom and Pat were here, Patsy held Mal a lot and I was able to get some things done (apparently overdoing it, according to the midwives). And Pat also picked up supplies a couple of times. But it was at Trader Joe's, and I don't think she considered it much of a chore. :) We loved having them here.

There's a lot more, but Mal is waking up. Gotta go hold that baby boy.

The Birth Story (thankfully, it's a short one!)

After a tense last week, and staring into the eyes of having to go to the hospital for an induction if I didn't go into labor by noonish on Wednesday, September 24, I woke up at 6:00 AM with some lower back pain. I got up, and the pain kept cycling, starting in back and eventually being like a ring of discomfort around my entire lower abdomen.

Since James and I were to be at the birthing center by 9:00, I kept a "journal" from 7:40 until 8:40 and found that these contractions, different than but also including the Braxton Hicks contractions I'd been having for weeks, were coming about every 4-7 minutes and lasting for 30ish seconds. They weren't getting stronger, but they weren't going away, either.

At 9, we walked up to the Birthing Center. Natalie, one of the midwives, gave me a very delicious shake made out of orange juice, ice cream, and 2 ounces of castor oil, just to keep the contractions coming (they did weaken on the way up there, and then hit again pretty hard an hour later). She and Stephanie, another midwife, monitored the baby's heart rate, and then we waited.

I was uncomfortable enough that I couldn't lie down, so spent time on the yoga ball and birthing stool. James' mom and her best friend got there a bit after we did, so we visited and hung out. Then my sister and her two girls showed up, so we had a little party.

At around noon, the practice was in session and women were coming in for appointments. I was continuing to have consistent contractions without too much progress, and thought aloud that maybe they would let me go home to labor a bit. I'd already been told to feel free to move around the neighborhood, so Sarah went on a walk around the block with James and me. It was a gorgeous day!

Mackenzie and Hannah stayed with us most of the day, minus trips to McD's for food, and TJ visited with Daphne at the house. I didn't know it, but my parents had also come into town and were at the Nuthaus with D for a while, as well.

This was good, too... until it wasn't. I spent several contractions on my knees on the yoga ball, then realized that I was progressing very quickly. I was in enough pain that I told Stephanie the thought of an internal exam (which I hadn't had since last Friday when we did the membrane sweep) made me want to cry, but she told me we'd time it so that she'd set up and then I'd have a contraction, immediately lie down, and she'd do it super fast.

I was standing there and had a contraction while she was setting up, then she left the room as that contraction was waning. She came right back, but I started to have another contraction, and during that one, my water broke. I hurried up and lay down, she told me I was at 8-9 centimeters and still had a little way to go, so I asked if we could fill up the tub as I knew the pressure was going to become a lot more intense. Stephanie started the water, said it'd be about fifteen minutes, and I did the next three contractions or so on the birthing stool.

The tub wasn't full at that point, not even quite half way, but I HAD to try to get the gravity away as much as possible. Sarah told me that it was deep enough that I could submerge my belly, and it did feel SO much better.

But also, the next contraction I had was very down low and I could see why women say they feel like they have to use the restroom when they're contracting (I had consumed mass quantities of Castor Oil and did not have this problem).

It was 1:10 when I got into the tub, and it took another 5 minutes or so for the water to fill and someone turned it off. I had three increasingly-intense contractions, yelling out while thinking, "I'm not a yelling person! This is crazy!" And Stephanie would see me tensing up and remind me to relax, so I'd answer back snarkily, "I'M TRYING!" And she'd have to say, "I know. Just reminding you."

Here's the deal: I was only in the tub 9 minutes before I had the baby. I wonder if I'd known that going in, whether it might have been easier not to freak out during the pain. What's funny is that once he started crowning, it wasn't as bad as when the pain was further toward the back. Also, I was very fortunate in that, while my contractions were painful and exhausting, causing me a complete lethargy in my muscles, which were shaking with the strain of supporting myself even while buoyant, after every third contraction, I'd have a minute or so where they would abate enough for me to go back into my "sane" brain and relax before the next one started up.

The WORST contraction I had was probably the 4th to the last. Stephanie was getting things ready as fast as she could; I'd progressed super fast in like half an hour, so she'd run out into the hall to grab something, and I said to James and Sarah, "You need to go get her and tell her he's coming."

Stephanie came back in with a Doppler she could use in the water, and she said she was going to see if she could feel the baby's head. Well, I did not like that AT ALL and started screaming not only "the" word that got the kid in "A Christmas Story" in so much trouble, but "Please don't touch me! Stop it!" Like literally screaming hysterically.

Stephanie got very serious and shushed me. She said to stop screaming because it was a waste, but to keep that in and push it down to help the baby get out quicker. She also told me that I might want to lean back to help the baby slip under my pelvic bone; since I'd gotten into the pool, I'd contracted leaning forward on the side of the tub.

I was skeptical that I'd be able to move, but I did, and was able to balance on the edge of the stair/seat so that there was no pressure on anything sensitive. This is, I believe the second to last contraction.

I could tell (but not see; I had to close my eyes against the pain) when his head came out. I begged James and Stephanie to "take him out, please! Get him the rest of the way out!" but it was already better. His shoulders were intense, but not as bad as the head. The rest of him was no big deal. James got to grab him, pull him out of the water, and hand him to me. Enter Malcolm Khrystopher Gatannah at 1:19 PM on September 24. 2014... after 4 hours at the birthing center and probably just under an hour of what felt like work, but only 10 minutes or so of "I can't control my own actions and sounds and words" labor.

My James was an awesome birthing partner. He was right there if I needed him, but didn't do more than I wanted him to. He asked about everything and listened if I said, "I like that, but not this right now." I couldn't look at his face between my really heavy contractions because he was so concerned. I could see it in his face, and I could hear him sniffing. My sister said she gave him a little reassurance that she knew it was hard to watch, but that what I was doing was exactly right. 

Of note: Mal was blue when he was born, and was wrapped up in the cord (which stands to reason; his heart rate reading was usually somewhere behind the cord pulse), both things that might have gotten him whisked off to NICU in a hospital. But he was fine. His APGAR score at 1 minute after birth was 8, and at 5 minutes after birth was 9. His cord was clamped 13 minutes after he was born, and James got to cut it... but not easily. I guess he really REALLY didn't want to leave his mommy, and we might have gotten him out, but he was still kind of holding on.

We stayed in the water until I'd finished the complete delivery, and then when it was time to get out, James took the baby and I hosed off and was treated like an Egyptian princess. Nikki, a midwife intern and a doula, dried me off while my sister prepared my gown and put it over my head. This morning's after-shower routine by myself was a real letdown after all of that.

We got to sit and hold Malcolm for about an hour before Stephanie did the newborn exam.

Grandma Patsy and Aunt Pat were in and out, so they missed a lot of the more colorful and nudity-filled moments. (Although I suppose they were in the entry of the building and actually probably heard more than they're bugging me about.)

8 pounds, 2 ounces! 21 1/4 inches long. Everything checked out great, the only note on his physical was that he was still blue at the extremities when we left.

First diaper. Much less disturbing than changing him, 'cause, you know, meconium. 

My sister took all of the pictures, and she finally got into one! I'm glad she was there, and not just to document everything.

The birth ended up being everything I'd wanted, and we got to go home three hours after Mal was born. We walked home; James carried the baby and Hannah carried my stuff. It was so nice to start and finish the day at home, and to get to hang out with Daphne for the afternoon and evening instead of being tied up at the hospital for 24-48 hours.

I know that there were hundreds of people praying for me to go into labor so I wouldn't have to be transported to the hospital for any emergency intervention. Thank you, people! I am SO grateful! Also, Stephanie said he only looked 41ish weeks, which surprised me not at all. It was a great experience all around. I highly recommend Birthwise Birth Center and Family Services. Such great midwives and laid-back but thorough care.

Today when I looked at my delivery progress notes, they were recording everything I ate, the stuff I was saying to indicate my tolerance of labor, etc. But they also did not insert themselves into the delivery in a way that said, "I'm the boss; you're going to do what I say, and don't ask questions." They will tell you as much or as little as you want about progress, they will conduct as many tests as you want, and not pressure you if you decline.

So happy to be home with our family and looking forward to whatever is to come! Mal had a peaceful (except for my yelling, then his) entry into the world, which hopefully bodes very well for his future.