The Perfect Mother

Thanks to Brooke Shields (and unfortunately Tom Cruise), there has been much discussion in the last few years about Postpartum Depression. I’m glad the issue has attracted a lot of attention! Not only are people talking about it, more and more mothers are becoming aware of the symptoms, addressing it promptly and seeking help. It isn’t such a taboo subject anymore. Brooke’s book, Down Came the Rain, is a terrific book for mothers experiencing postpartum depression, those who want to prevent it, and people who are supporting a loved one suffering from it. I highly recommend it as a resource that gives hope and shows the light at the end of the tunnel!

Fortunately, I don’t see too many patients with postpartum depression in my practice. What I am seeing with increasing frequency, is mothers who are completely overcome by anxiety. These are women from all walks of life, who are crippled by their fears and doubt their ability to care for their baby. They are exhausted and spend the majority of their time questioning every aspect when it comes to the care of their baby. They read anything they can get their hands on regarding childcare and inevitably find something that reinforces their insecurity that they are doing everything wrong. They are tormented by all the different opinions out there and feel completely incapable of deciding what is best for their family. Their minds are racing with all the things they should be doing and how they can do them better. The expectation that they be perfect mothers is an all-consuming goal that none of them will ever achieve.

My experience in this regard has also been that the more educated and successful a woman is before she has her baby, the more significant the anxiety after the baby is born. It is almost as if these women have life under control and are confident before the baby. But once the baby comes, they are no longer in control of their situation (who is with a new baby?). In an attempt to regain some semblance of control, they go overboard, hoping to do an even better job at motherhood than they did in their career. They throw themselves into the new job, but make themselves anxious in their pursuit of doing it right.

I realize that I am making a lot of generalizations with nothing but my experience to support it. But I do find this to be the most heartbreaking aspect of my job: trying to help an obviously smart, capable, loving and devoted mother see that she is doing a wonderful job! No matter how hard I try to point out all the things they are doing right, they can find me a contrary opinion that says they are doing it wrong-breast or bottle, family bed or Ferber, to vaccinate or not, Gerber baby food or homemade, cloth diapers or Pampers? It is nearly impossible for me to provide the reassurance they need and I frequently find myself at a loss when trying to make them feel better.

The other difficulty is that these women are usually able to function rather well, compared to a woman who is truly depressed. It is usually several months after giving birth that anyone notices these mothers struggling, as they are relentless in their pursuit of the appearance of perfection. Because they are running on overdrive, only the people who are closest to them realize they are having difficulty and often don’t know what to do to help them. And I am not sure what the best answer is.

I do know though that there are people far more qualified than I am to deal with these sort of mental health issues, and that should be the first place to start. Counseling and medication do help, and it is not forever. We have to remember that many phases of motherhood are just that, a phase that will pass. Sleep also makes a big difference, and that should be a priority of every new mother and those who can help her. And I am not talking about an 8 hour night. But a good nap each afternoon or in the early evening works wonders to help your body and mind rejuvenate. In addition, socialization with other mothers is strongly encouraged. Isolation makes anxiety much more intense. Having other mothers to share your experiences with and who can offer insight into how they have handled similar challenges can make all the difference!

When visiting the lactation offices at Women and Infants Hospital one day, I saw quotes on their wall that I wish every mother could remember:

You’re the only mother your baby has, and she thinks you’re wonderful!

The good news is that you don’t have to be perfect!

How I wish every new mother knew that and took it to heart!

Nipple Shields – To Use or Not To Use?

I used to hate nipple shields and never used them. My bias was based on literature that came out many years ago that indicated they caused nipple damage, usually because they were used incorrectly. They also contributed to lazy latches with ineffective drainage of the breast leading to a subsequent decreased milk production and infant weight loss. So I basically just steered clear of them, thinking that no good could come from using them.

Then in the fall of 2007, I attended a conference hosted by the Rhode Island Breastfeeding Coalition (RIBC) on “The Challenges of Breastfeeding the Near Term Infant.” The speaker was Molly Pessl, RN BSN IBCLC, and she changed my mind about nipple shields. She taught us all how they really get the baby who isn’t quite term in their development nursing at the breast. These babies look like they should be able to nurse without difficulty, but developmentally, they are not quite there and the shield makes all the difference. Many of them were bottle fed and were used to plastic. The plastic shield tricks them into getting on the breast and its firmness makes it easier for them to drain the breast when used correctly. I started using them in these circumstances and found that she was absolutely right! Christina Smillie MD, FAAP FABM, who spoke at the 2009 RIBC conference on “Baby Led Breastfeeding” agreed with this use of the nipple shield, and supported anything that gets the baby nursing directly from the breast.

Now I sometimes feel as if I am passing nipple shields out like candy. I don’t leave home without them. They are always the last resort, after first assessing the situation and trying to get the baby to nurse without it. I make sure the family is aware of all the contradictions and side effects of improper use, and agrees to frequent weight checks and follow up with me. I explain that use of the shield is a temporary thing. I find that usually after about 2-3 weeks of good nursing and weight gain, the baby doesn’t need it any more. They wean easily and all those difficulties in the beginning are a distant memory. Once they understand all that, we give it a try….

I have had many moms burst into tears when I help them latch their baby on the breast with the shield. They are thrilled to see milk in the shield and so proud of the intake we are able to measure on my scale. The swallowing they witness is much stronger than what had been happening without the shield, if they were ever even able to get the baby on the breast! The family is happy, and then so am I.

There are two other situations in which I use nipple shields. One is for the mother with flat or inverted nipples. That is probably not a surprise to anyone. It provides the baby with something to latch onto without causing the mother any pain. I also use them for babies who latch without incident, look absolutely perfect on the outside, and despite numerous suggestions on positioning and support , still cause their mother pain. I never am really sure why this happens and nothing fixes it. But the shield does. Mom nurses pain free, and like the other situations, the baby eventually weans off it.

So this is all good, right? When used in these situations and while working with someone knowledgeable about breastfeeding and infant growth and development, it really does fix problems and get the baby nursing. However, now I am running into a much bigger problem.

You can get a nipple shield anywhere. Target, Babies-R -Us, and Walmart all sell them. As a result, I am seeing moms at 3 weeks post partum, who brought a shield to the hospital after buying it in the store and started nursing with it immediately after birth. They never even tried to latch on their own. They assumed that since it was in the store, it was just one more thing they had to have to breastfeed. I am called in because the baby isn’t gaining weight, mom reports she has no milk and had to start supplementation. And at this point, there is not a lot I can do. The hormonal response that establishes and maintains a woman’s milk supply has come and gone. The window of opportunity to get things off to a good start has been missed. It is heartbreaking to have to tell a mom this and have her realize she probably never needed to use the shield in the first place.

What has typically been happening in situations like this is that the baby has spent a tremendous amount of time at the breast, using the nipple shield as a pacifier. The shield slides in and out of the baby’s mouth, and the breast is not drained. I see this immediately when I ask the mom to show me what she has been doing. The only milk the baby gets is from the mom’s letdown. Mom interprets the length of time at the breast as a good thing, not realizing that the baby is wasting calories with all the ineffective sucking, and not gaining weight. The ineffective draining of the breast then causes her milk to dry up, as you have to remove the milk in order for it to be replaced.

The key to all this is that these feeding devices are intended to be used under medical supervision. While it clearly states that on the packaging, it is on the back and the last thing mentioned, after stating all the things a nipple shield is good for. I have complained to the manufacturer about this, and have been told that they are working to make that statement more noticeable, but will continue selling them in retail stores.

At HBHM Inc., we have a very specific protocol that we follow when using shields with a family that involves frequent follow up and weight checks. I am planning to revise that protocol with our new website launch to include not selling these shields to moms unless they are working with us or I can confirm they are working with another healthcare provider. I am sure many mothers will not appreciate that extra requirement. But I don’t want to be responsible for providing someone with something, that when used incorrectly and without guidance, can have such grave consequences. I will let the manufacturers and retailers get the credit for that!