The lessons here:

            1) Bring in a full milk supply with a hospital grade pump
            2) Do as much s2s and infant massage and holding as the baby will tolerate.
            3) Offer the breast regularly.
            4) Be patient and persistent.
            5) Never push the baby to breast.
            6) Safe bedsharing.
            7) Give the baby every opportunity to make the best choice.

    This woman's story is sad because it is too common. Even in 2005, some hospital staff are still ignorant about breastfeeding.

     I worked today with a mother that had been battling at breast with her new baby for 2 weeks. She was doing everything that she had been taught to do in the hospital. This included feeding on a 2-3 hour schedule, shoving her breast into the baby's mouth, using the back of the baby's head as a handle to ram baby onto the breast and holding it there tightly, and waking the baby from a deep sleep at night so as not to go "too long" between nursings.

     Both of them were having a miserable time. The mother was pumping and bottle-feeding her milk when breastfeeding wasn't working. She was dreading feeding.

     Thank goodness she called for help.

     She had an idea in her mind that the baby would nurse for 10-15 minutes on the first side, get burped, and then nurse 10-15 minutes on the other. She thought the baby would do this every 2-3 hours. The mother felt like a failure when her breastfeeding did not look like this idea.

     What helped this dyad was letting them discover each other, using skin-to-skin to have pleasure and help the baby feel safe at breast. The mother learned to read her baby's feeding cues, to expect clusters of snack feeds, and to let the baby latch while she positioned herself comfortably.

    At the end of our visit, the mother described what she had learned:

              1)  For breastfeeding to work, the baby has to like it.

              2)  I have to be comfortable myself.

              3)  Feeding takes longer than I thought it would.

              4)  My baby has her own rhythm

INTEGRITY  and  COURAGE

Integrity and courage take many forms. I think of the mother, whose nipples were like hamburger, saying fiercely, "I have to breastfeed! I'm a pediatrician!"  She  gathered herself, and put her baby to her damaged nipple, hoping and trusting that the new technique of latch would be comfortable.

She wept with joy and relief when it was.

No Time Like the Present

Sometimes, when breastfeeding doesn't go well, someone may say to the mother, "Well, next time you can try again." Some women can't try again. Here is a story about that:

A woman and her husband got pregnant. They were very happy about this,  and she looked forward to breastfeeding. She was surprised and excited to learn that she was carrying twins. At 24 weeks gestation, she went into premature labor and was hospitalized; she was kept on strict bedrest, and had to take medication around the clock. At 31 weeks, she went into labor despite all this medical support, and delivered her babies. Both twins went to the intensive care unit, because they were too little to go home. One twin died. The other twin survived and went home. Unfortunately, the mother didn't get any help or encouragement or teaching about ways to make a full milk supply or to breastfeed. She is still sad about the loss of breastfeeding, because as a side effect of all that she went through, she can never have another baby.

She has chosen to become a breastfeeding helper, so that no woman has to suffer the way that she did.
                               

THE SLOW GAINING YOUNGER SIBLING

By Maureen Koestler RN, Mother of 6 sons, Foster-mother of 3 sons, BS, IBCLC, LLL

My first challenging experience with a mother whose baby was not gaining was the fifth or sixth child of a mother who had nursed before. At the home visit, I left a baby scale and a schedule for feeding times and length of time for each nursing.  Mrs. B was to weigh the baby daily.

This was enough to increase the baby's intake and weight, because Mrs. B was committed to breastfeeding.  Baby B was pleasant, easy-going, and "happy to starve".  Whenever mother was breastfeeding, but was interrupted by an older child for a shoe-tie or a nose-wipe, she would put the baby down and he would stay contentedly until she remembered him.  Several days of a schedule got Baby B to recognize what a full belly felt like, and he then began to demand on his own.  Scheduling was no longer necessary.

Since little B, I've been in contact with women who were successful nursing their first babies, but had problems with subsequent babies.  A home visit may reveal that the baby can latch on and, nurse well but the mother is so distracted by the demands of the treasured first child, her partner's current neediness, or her career, that she does not focus sufficiently on the new baby.

These women perceive that they are responding to the baby, sometimes commenting that this one is much more "difficult" or "demanding" than the first. Observing the mother and baby together tells a different tale.  Requesting that the mother keep a 24-48 hour log of all nursing and other activities can illustrate how little time is spent caring for and nursing the infant.  When this is identified, the mother then has to decide on priorities.  A key factor in these cases is the mother's motivation to breastfeed.  If she decides on the baby, she will adjust her routine, and make the time.

If her priority is some other area of her life, she may still insist on nursing.  This is when I try to inject some reality into her plan.  I have suggested that she nurse at those times when breastfeeding is manageable for her, and use artificial feeding at those times when it is not.  She has to decide if pumping will work for her or if manufactured baby milk is more realistic.  These women need structure and flexible alternatives, while making sure that the baby is adequately nourished.

There have been a few women who, when practicing an altered plan, decide that they really want to get back to what they had initially resisted, i.e. exclusive breastfeeding.  These mothers will then work out a plan that fulfills that desire.  In my experience, most have stayed with a blend of feeding methods and have gradually weaned from the breast.  Remember, even a little breastfeeding for a limited time is better than none at all.

(Note: This is the story of one woman who found a way to manage 5 babies under the age of 6!  Breastfeeding is different for every mother and baby.  Each mother of multiples has a unique story. Nikki suggests that everyone working with breastfeeding to go and visit a mother with triplets or more to gain an appreciation of the immensity of the situation. Please remember that this woman's ways of figuring out what to do are her own. and are not intended as blanket recommendations.)

CASE STUDY: PROFESSIONAL WOMAN, MOTHER OF 5 AND NURSING TRIPLETS

By Peggy DeFelice MD, Mother of 5

      Peggy, apediatrician and a mother of two boys aged 3 ½ and 5 wanted another baby, and conceived in the Fall.  In the first trimester, she learned that she was carrying triplets. Selective reduction was never an option. “You don’t know my God,” she says with a smile. “ These are the Lord’s babies.”

       Peggy’s pregnancy was complicated by uterine entrapment and bleeding. At 29 weeks gestation, she was hospitalized for hypertension and dilatation. Her attitude remained positive, despite many physical discomforts during the last weeks, for “every day that they weren’t born was a gift.” She had gastro-esophageal reflux, and also had to sleep sitting up, as breathing was difficult with a large abdomen. She was in pain because her xyphoid process was dislocated by Baby C’s position in utero. She suffered constant itching and a rash secondary to the hormones of pregnancy and developed HELLP syndrome and pre-eclampsia. There was no time for entries in baby books or writing thank you notes as she was unable, due to physical discomforts, to do much work in advance.

She wanted a vaginal birth but medical concerns about her blood pressure and the possibility of cord entanglement precluded that option. The fraternal female triplets were born at 35-½ weeks gestational age by cesarean section. She was concerned about their ability to breastfeed, as they were early and one was kept in the intensive care nursery for a brief period, but all three girls nursed very well.

       Her postpartum recovery was complicated by a hematoma of the rectus sheath, endometritis, sacroiliaitis, and a urinary tract infection. “I needed physical therapy to be able to stand up straight again. I was determined to get back into shape and to keep up with all my responsibilities.”

Amazing help came from Peggy’s commitment to breastfeeding (reinforced by her eldest son’s allergies and ear infections), from her wonderful husband, from her family, neighbors, friends from her church, and from some hired hands. People brought meals, cleaned, and did several loads of laundry every day. Her life with triplets became the focus of her community.

       Breastfeeding was a positive factor in her recovery because “I was free to sit down with the babies and it helped the girls to bond with one another. Over time they learned to hold hands, or twirl each other’s hair while they nursed and snuggled together.” Fortunately, Peggy was already an experienced nurser so getting the triplets started at the breast was not as daunting as it might have been. Her supply was usually ample. It was also fortunate that the babies had no difficulty going from breast to bottle and back again.   

  Getting started with 3 babies was still a challenge.  “So much is having the right attitude. I was determined to breastfeed. I used some formula in the beginning especially at night. By about 4 months of age, they were all exclusively human milk fed.” Peggy stresses that “people need to realize that it is possible to start out using formula and get to exclusive breastfeeding and also go back and forth between breastfeeding and using formula as needed; it is not all or nothing. What made the beginning so rough was that they never all got hungry at the same time. As quickly as I could, I fed two at a time and the third got pacified with my pinky. It took about a month before I could feed two at once. Before then, I nursed one at a time, which meant that I was nursing continuously. Somebody was always hungry. I figured I was nursing 24-30 times in 24 hours. It was great for bonding, as I had individual time with each baby, but that was all I was doing: nursing, eating, and playing with the boys. Fortunately, this period of intense nursing lasted only a month or two.”

   Peggy’s 4-year-old asked to nurse. “He snuggled on the nursing pillow but quickly realized that all he wanted was the right to do what the babies were doing. At times he would lie in the football position while the 3^rd baby was feeding and just enjoy being part of the action and close to mommy.”

   She drank a lot of fluids and did her best to get sleep at night, as she was not a good napper.  In the beginning, she used bottles at night so that her husband, sisters or friends could share in the feeding and she could sleep. Any extra time was spent with her older children.

  Her goal was to have scheduled feeding sessions, where there would be times for feeding, and times when she wasn’t feeding. By the time the triplets were about two months old, Peggy would watch for cues. If one baby got hungry, she would gather all three together on pillows on the floor and stimulate the other two to eat.  Peggy taught the girls to feed on more of a schedule, as she couldn’t have managed demand feeding with three, while mothering two older children, and working outside the home.

       All babies took their turn at being the dominant one, although Denise tended to be the most patient, and gained the most weight, possibly because she often was the last to nurse and got more fatty milk than the others. Laura, who has reflux, was the most difficult to pacify. Peggy chose to refeed Laura, rather than use medication. Consequently, she often felt like she was nursing quadruplets. Laura would feed, and then throw up and need to be fed again. Sarah, the smallest at birth (4 LB, 4 oz) was the “pokiest eater”. She would be finishing the right side, while Denise and Laura would have both finished the left breast, and Laura would be ready to feed again.

  In the beginning, the girls slept in 3 bassinets next to her bed. When they outgrew the bassinets, they were moved to separate cribs in their own room. Sometimes Peggy would put two in one crib. Laura wasn’t able to be in bed with the others because of her reflux. There are 3 portacribs downstairs to provide another sleeping space if one baby naps and Peggy needs to be downstairs with her sons. It also makes it easier for her helpers.

       When Peggy noticed that the babies were sleeping through the night for more than 1 week, nursing well by day, and gaining weight, she stopped nighttime breastfeeding.  From then on, nighttime management meant that if the babies woke at night, her husband went to them first.  He would pat them on the back and soothe them to sleep. If he couldn’t comfort them, he would go and get Peggy, who would nurse.

They have no live-in help because they prefer their privacy. When her husband works at home, he can help out during the day as well as at night. His commitment to breastfeeding was a major source of strength for Peggy whenever she considered weaning. He would remind her that this time was such a short one in their lives, and that she was doing something very important for their health. He would ask her “how can we make this work as he remembered the value breastfeeding had in suppressing the pain she had suffered with endometriosis.

When the babies were 2 ½ months old, Peggy went back to the office for 3 hours a day, 4 days a week. This was a short enough interval that she didn’t need to pump. After about two weeks, she increased her workday to 4 hours, gradually increasing to 6 hours by the time they were about 5 months old. When the triplets were around 9 months old, she resumed her on-call schedule 12 hours, 1-2 times per month. As her workdays became longer, she needed to pump at work.

There have been some low points. It is an emotional adjustment to surrender to three babies; “with 3, they are not always ready to work together as a group. All it takes is for one to be out of synch.”  Because the 2 older children are in school, the babies have all had many colds and ear infections. During a one-month period, Peggy had mastitis 3 times because the babies were congested and weren’t nursing well. At the time, she was too busy to figure out the cause until after the 3^rd bout. The solution was to make more time to pump, because a nursing that would ordinarily take 35 minutes would take 1-½ hours when the babies were sick.  Another low point was when her supply went down at 5-6 months. By the end of the day, the girls were unhappy. Peggy was working more hours and thought she would have to wean. Around the same time, her husband brought home a nutritional supplement (another one of his business interests) which she began to take. After a few weeks, she noticed an increase in her supply and was delighted. She says, “If I hadn’t found a way to increase my supply besides rest and more fluids, I probably would have quit.”

       Around the time that she noticed her supply going down Peggy noticed that they all had started kneading the breast while feeding. And they have continued to do this, particularly the 3^rd one on, who is most likely stimulating let-downs and flow because the first two to nurse have reduced the milk supply. Peggy notices that they also massage their bottles, as they would the breast. The bottles they use are self-feeding and use a system of tubes that allow all babies to be satisfied at once without any bottle propping. They are used to manage the rare time when there are three hungry babies crying at once. Her childcare provider has made more use of this technique than she has.

 She feels letdowns enough that “it is annoying.”  She describes it as a “pulling feeling, as if the breast was being pulled out using the nipple as the handle.” Sometimes she thinks,  “Honestly, I can’t believe that I have to nurse again.” Sometimes she feels that “I just can’t do it.” She noticed a lot of blistering in the beginning, and feels it was from  “nipple abuse” or “over-use syndrome”. She also had an recurrent milk blister for the longest time.

Solids were started at 5 ½ months; she tried some at 5 months, but noticed that the babies were still pushing things out with their tongues. She preferred to wait to start solids until the babies were more mature, rather than deal with a big mess and all the time it would take for feeding. “They could not manage finger foods at that time; they would fill up their mouths with food and gag. So it was too risky to have them feed themselves solids. And there was always a 4-year-old to be watched as well.”

 Peggy is happy to share her story, because people doubt that nursing triplets is possible. Many people tried to dissuade her from nursing out of concern for her health and well being. “It is more of a challenge to nurse 8 month old triplets than newborns. Now they roll off the pillow or pull off the breast to see what is going on if something catches their attention.” She is spending more time nursing now as they get older because they want to nurse, then eat, then nurse, then play whereas before they would nurse and be done. There is more to juggle, as she can’t sit on the floor and nurse one while feeding solids to two. She tries to nurse two at once, and holds the other one off with toys or activities. Or the 3^rd baby will find something else to suck on, such as someone else’s sleeve or finger or toe.

  They have their own preferences. Sometimes some want to nurse first, then feed; at other times, some want to feed first and then nurse. There was a period of time when Denise needed to be alone to nurse; so Peggy would have to take her to another room. The constant challenge is to balance their activity and their distractibility with their feeding.

 Peggy strongly recommends working with a lactation consultant, because nursing triplets is such an unusual situation. Her advice is to “stay very organized and make a schedule for the whole family. Put it in writing and revise it as your children grow.”  Another recommendation is to keep a log of feeds, and diaper changes for the first 2-3 months; she has saved some of the records she made and says, “It makes a great baby book.” This helps to avoid situations like the one where she changed three diapers: one baby twice, one baby once, and one baby not at all. After the first few months, Peggy found that the basic chores of baby maintenance became automatic and there was no further need for a log, although she does keep written record of any baby receiving medications. Currently, Peggy uses her computer to generate a daily printed schedule that is invaluable to her.

Another recommendation is to be flexible and look for the positive. “ Be willing to let people share in your joy by helping in any way. You will all be blessed. No matter how busy you are try to live in the moment and enjoy each stage. With 5 children age 6 and under, I will never be caught up, but my priorities have changed. I used to think I could do it all. I now know I can’t do it all, but I can do all that matters. I pray continually for wisdom to know how to use my time.”

References and Resources:

1) M.O.S.T. (Mothers of Super-Twins) P.O. Box 951, Brentwood NY 11717-0627 http://www.mostonline.org

(an organization for mothers of triplets and more)

2) The Triplet Connection P.O. Box 99571, Stockton, CA 95209  

3) ”Breastfeeding Success with Preterm Quadruplets” by Mead, Chuffo, Lawlor-Klean and Meier. May-June 1992, JOGGN Vol. 21 #3 pp. 221-226

4) “Breastfeeding Triplets – It Can Be Done!”  by Julie Duggin Nov 1994 Breastfeeding Review Vol. 2 #10 pp. 469-470

6 months postpartum, and still wanting to breastfeed.

RP got pregnant after the first act of aiming (“Surprise!”) and felt pretty good all along. In the 5^th month of pregnancy, a routine ultrasound revealed that her baby was had several organ defects. Her world changed.

At 28 weeks, she began to have weekly ultrasounds. She always felt that her baby was fine, despite continual worry and monitoring by healthcare workers, and hearing messages like “We’re not looking at a stillbirth this week”, said by a healthcare worker after one of these regular ultrasounds. She described the pregnancy as stressful, and cited being told “You might be an unfavorable environment for your baby” as an example.  RP needed some guidance to re-discover her emotional reaction to these comments as her first reaction was to “understand” why the healthcare professionals might have said those things. Women are quick to understand and see the other side; while this coping mechanism can be helpful, it can also bury a mother’s own reaction and become a defense or a way to diminish the impact of poor treatment. After some probing, she owned that those comments “Hurt my feelings, I was sad. I was mad.”

She did everything she was advised to do, even when it went against her own intuition and wisdom. After going into labor spontaneously, her doula kept her on track to a completely unmedicated labor and delivery. She was ecstatic; she wanted to boast, “See, I told you things were alright” to the healthcare workers. Her baby was gorgeous, pink and latched on quickly after birth. The labor room nurse let the baby stay longer than the usual hour, part of the joyful memory.

The baby stayed in the NICU because of the prenatal diagnosis. She, discharged as a patient after 2 days, spent the next 2 days in the parent’s room of the NICU, pumping and wanting her baby. She was angered and dismayed when staff refused to understand or recognize the reason for her distress with giving her baby formula. She had read about the health risks of formula and said “I didn’t want my baby to get diabetes” and felt unheard and unvalued for having this desire. She wanted to breastfeed, especially because her baby was going to have corrective surgery. She saw breastfeeding as a way to compensate, and make things better by giving her baby the best nourishment.

While in the hospital for 2 days postpartum, the policy of checking on a postpartum mother every hour made it impossible to sleep. She described being wakened many times, and of having her baby forcefully applied to her breast every 2 hours. An extremely modest person, she hates being naked and has trouble with open physicality. She found sharing a postpartum room with another mother uncomfortable and unsafe. She worried that her baby would keep the other mother awake by crying; her roommate’s crying baby kept her awake.

She went home with her sweet new baby, and worked on breastfeeding. A nipple shield helped some, but she felt wrong about using it. She was pumping, and her baby was getting this milk in a bottle, in addition to some formula and some fortifier added to her milk.

At age one week, her baby went from the follow-up pediatric office visit immediately to the largest children’s hospital in the region, as what she had perceived as normal sleepiness was actually organ failure. She berated herself for not knowing this on her own. This feeling reinforced what she had been told in pregnancy, that she “was an unfavorable environment”. She felt wrong, and was scared beyond measure, and also felt angry.

It took 2 months at home for her to be able to let go of constant vigilance, especially at night. She feared missing some sign, some warning that her baby was in distress. She became angry again, after doing research and discovering that the lactation specialists could have done lots more to help her at the beginning. She started using the bottles more after breastfeeding because that was the solution to her baby’s fussiness. No one ever did a complete evaluation of this fussiness. The distress because she couldn’t make enough milk lowered her confidence and impaired her milk flow which led to more distress,  a vicious cycle.

At the office visit, I saw a weakly-attached dyad. At one point, the mother put her finger into her fussy baby’s mouth for comfort. The baby suddenly shrieked. The mother apologized, saying that her fingernail probably cut the baby’s mouth. I was stopped by this admission. She said that her nails had scratched the baby several times before. She hadn’t considered that her baby might be reluctant to get closer physically as a consequence of intermittent injury by her mother’s nails.  Her baby often played with or pulled her mother’s fingers towards her mouth. “That’s what babies do,” I said, “So you should cut your nails.” And I showed her mine, trimmed below finger-tip length.

Her baby was carried akimbo, ventral surface side-by-side to ventral surface with RP’s shoulder twisted up and out; the whole posture looked uncomfortable and distant. The full body embrace didn’t start until the start of the 3^rd hour of the consult, after a lot of somatoemotional release while she was telling her story. She had a tendency to rush past particular important or emotionally charged events; a goal of our work was to slow down to give the story and self-awareness time to emerge. By the end of the visit, she and her baby had become completely physically intertwined and finally looked completely and wonderfully connected.

I choose to be away from my office when she arrived, leaving a note on the floor, inviting her in to wait for my return. I imagined that she had been told to do so many things by different health workers and might have a low level of trust as a result. I wanted her to have the total choice to sit exactly where she wanted, and where she would be most comfortable.…….she chose the davenport and held her baby and talked and came close to weeping at least 6 times. She never did completely breakdown, never let herself go completely though, the way other mothers have; her level of expression was completely genuine and was the most she could do at that time. (I, as the CST practitioner, had to let go of my expectation that the mother would have to cry a lot in the office for healing to occur, as many mothers have done. I give thanks for every mother I see, and am grateful for the lessons they bring to me.)

We discussed her ecstatic feeling after the birth. She missed celebrating this major achievement as a result of the medical response to her baby’s condition. I told her that in 30+ years of working with women, and reading about ecstatic births in Spiritual Midwifery and Mothering Magazine and in books by Sheila Kitzinger, that I had never before met a mother with that experience. She was my first. I encouraged her to claim that feeling and revel in it. She did make a perfect baby. That joy, that glory is hers. What happened a week later, when a well-nourished baby outgrew its organ, is another story. What an inspiration. Her eyes welled with tears as I spoke of my admiration.

She retrieved another good feeling. She spoke of her amazement that her baby is so well-adjusted and certainly this baby is quite a personality, a real extrovert! We spoke of what a good mother she must be to have such a dynamite baby. We spoke of ways that she could remember these good feelings too, along with the other stuff. She mentioned writing notes and taping them to the breast pump.

Her initial complaint was “feeling so emotional when my baby rejects my breast.” I applauded her feeling “emotional”, saying that it is completely real and understandable. She listened intently to a description of the parts of the brain, the side that deals with thoughts and action, and the side that deals with feelings. She came to understand that her feelings hadn’t caught up with her actions; this was part of the reason she was so “emotional” when her baby refused to nurse. The feelings need to be brought to light, examined, honored, and let go. She was invited to ask any question, give any feedback, and to do what made sense to her. I was there to open doors.

During our initial conversation, her baby got fussier and fussier. I suggested skin to skin, and showed her a way to lift her shirt over her head while leaving it on, so her shoulders would be covered while her chest was bare. (Dr. Tina Smillie has mentioned this as a way that mothers can feel safe and comfortable with bare breasts.) and left them alone to get together. Up until that time she’d jiggled and swung her baby, and prodded at its mouth with a pacifier fitted over her index finger.

When I returned to the room, I was surprised to see her completely nude from the waist up as I was expecting her, in view of her self-stated modesty, to have kept her shoulders covered. Her baby initially snuggled, started to root to the faster producing left side, and then became furious and cried and raged for at least 20 minutes. When the crying started, the mother could accept that her baby was telling a story, and that she herself probably carried that same emotional story. During the outburst, I was coaxing and coaching the mother to listen to her baby’s story, ask to understand, and engage in some intimate dialogue…..and keep the baby from falling off her chest. (Her first reaction to the baby’s rooting was to grab her breast and try to bring it to the baby’s mouth.)

After about 20 minutes, I reminded the mother that it was her baby and that she could do whatever she felt to be right. She then sat up, and started to bottle-feed. This was fine, and her technique was adjusted some to make the intake under the baby’s control. I told her that little groove, the philtrum, is actually the place to put the nipple or teat. Let the baby reach up each time. Drop the level of the fluid below the teat hole every 5-7 sucks and let baby catch up breathe, and re-initiate the feed. The mother was able to do this and see her baby’s reaction.

After taking about 2/3 of the contents of the bottle, the baby went to sleep, one arm outstretched, with the little hand open on mother’s chest. The mother spoke of not wanting the baby to cry, of wondering what the difference was between telling a story and crying for some reason. We talked about exploring, of figuring that out, and of  listening to a particular quality  in a cry or feeling some energy change as ways to know that her baby was telling a story. She was reminded that she could decide what to do, from her Inner Wisdom.

She did admit to having a lot of feelings inside and listened to a selection of activities of expression: scream out loud in car when driving and alone, paint, take walks outside, write in a journal. She choose taking a walk outside and writing in a journal. She considered searching the Internet for women whose babies have had major surgery at a very young age. There is sure to be some sort of list or group or chat.

Her main questions, after a lengthy debriefing, were “Why did my baby breastfeed for a while, then stop? What went wrong?” She made some statements about breastfeeding that showed she was following some rules about it, rather than letting the baby lead.

Her baby will show the most rooting in sleep, so they nap together. I referred her to the UNICEF/UK website with a lovely safe-bedsharing pamphlet, and suggested that breastfeeding might be possible in sleep.

I noticed her baby start rooting after s2s while the mother was reclining and the baby was lying alongside her mother. This is another good sign that the basic nervous system reactions are present.

We spoke of her desire to protect her baby, and of how she could understand the reason for the surgery. But her baby couldn’t. All her baby knows is that there was intolerable pain and mamma wasn’t there. She spoke admiringly of the surgeons, “that do one of these (surgeries) a day” that still apologized to her baby for causing pain. She was very impressed with the level of caring she experienced in the hospital.

“Maybe” she’s been overcompensating for the horrible scary time by being a perfect mother every single second. At first she admitted to this, then went on to deny it. That’s fine. She’s spoken the words, the thoughts and feelings will follow. She welcomed a suggestion to wear her baby and start catching up on housework, instead of spending all day trying to make the baby happy.

She feared her baby lying on the incision, by now a scar. She was taught and encouraged to use the craniosacral touch, melting her palm into her baby’s skin and connecting with the different tissues (skin, muscle and bone) below the skin to evaluate her baby’s healing. We spoke of a ritual to make with rubbing some of her milk into the scar, and thanking it for holding her baby together.

She was praised for her dedication and intelligence, her ability to stay home, for a helpful partner, and for loving her baby so much. It’s amazing that she is still seeking the breastfeeding relationship, still making milk and still wanting to do more.

Three hours went by the blink of an eye!

PostScript: 9 days after our office visit. In the words of the mother:

“You showed me a lot to think about.  The most powerful part for me is trying to find my intuition again.  At a neighborhood party my husband noticed the same thing you brought up, which is that I get anxious and start sticking things in Baby’s mouth when Baby starts to get fussy. 

I realized that it's not even that I don't want Baby to bother people, it's that it drives me up a tree when people make suggestions of what Baby needs, because I feel like I'm being revealed to be incompetent.  I thought back to when I actually felt competent and like I was really contributing and expressing myself, which was several years ago (!) and I'm seeing some ways to regain those good feelings.  I am doing that by being positive and noticing what really is happening in the moment, instead of ticking things off my impossible, eternal to-do list. 

I almost hate to tell you this, but I don't want to keep trying to get Baby to nurse.  It overshadows our good times together too much, and I have seen this with all our attempts -- Baby will do it in sleep a little sometimes, but not when awake, and it is causing too much strife for both of us for me to keep harping on it.  I am pumping 4-5 times a day and am still getting enough, and feeling better about the whole process.  We still enjoy our skin to skin naps and all our time together, and I just have to move on from this one thing and do everything else with that I have planned/daydreamed about.  I know it's a very important thing, and I am sad when I hear about moms who don't even try to breastfeed, so I understand everyone's disappointment, and I have to deal with my grief over it too. 

I will work on what we talked about, though, in dealing with what happened and how I keep reliving it too.  Writing helps.”