“Asha doesn't like my milk!" the young mother declares. "It must not be strong enough for her. I guess it's time for formula."
Her words are a surprise to me. Four-week-old Asha had regained her birth weight in just ten days and was now growing at a great, one ounce-per-day clip. I see her cheeks beginning to fill out, and she is "filling" her diapers with gusto. Why is this mother thinking that her breastfeeding is going poorly?
"She just doesn't seem satisfied," Asha's mother explains. After a deep sigh, this young mother adds, “and she seems to be fussier this week.”
At the baby’s two-week-old weight check I had shared with Mom evidence that breastfeeding was going well. I commented on the baby’s effective, painless latch and the sound of milk being swallowed. I applauded Mom’s careful recording of wet and stooled diapers, and I pointed to the baby’s achievements on the growth chart. Though today I am tempted to begin by reviewing these signs again, I hesitate. I am suspicious that Asha's mom is concerned about the baby’s non-feeding behavior and projecting those concerns onto her breastfeeding experience.
I am prepared for this moment. In recent months I have studied the medical literature on breastfeeding duration and have learned that many women give up nursing their baby after misinterpreting a baby’s normal behavior. Writings by Donna Karl, RN, PNP, explain that a mother will see her baby as "satisfied" when she observes particular newborn behaviors, many of which are not related to feeding. A mother wants to see her baby become alert and gaze deeply into her eyes. She wants to calm her baby effectively and doesn't want her baby to appear irritable or difficult to console. Mothers want the hard work of parenting acknowledged by seeing her baby respond to HER.
Instead of focusing on the milestones of effective breastfeeding, I recognize the need to broaden my breastfeeding support by reflecting on the baby’s behavior.
When Asha’s mother moves her from the baby carrier to her lap, I avoid general statements like, “She looks happy with you.” Instead, I describe Asha’s specific behavior. “Her skin is pink, and her breathing is relaxed and regular.” As the mother talks quietly to her baby, I remark, “When you talk to your baby her forehead relaxes, her eyes widen, and her eyebrows go up.” A moment later I go on, “When you speak, she lifts her face toward yours and moves her arms in smooth circles over her head—almost like she’s dancing with you.”
I ask if Mom might want to see Asha play some baby “games.” Mom smiles and hands me the baby. Because Asha is now beginning to look a little drowsy, I sway her gently to bring her to the more fully alert, “Ready Zone.” The baby’s eyes brighten and she looks intently at my red rattle, held just ten inches from her face. Slowly I shake the rattle and watch as the baby’s eyes follow the toy intently from one side to the other. Asha's mom giggles and remarks, "She's really smart, I guess!"
Holding Asha near her mother’s face, I encourage the young mother to call her baby's name. Asha initially gets still when she hears her mother’s voice, and then her eyes seem to shift toward her mother. Mom is delighted to see her daughter actually turn her head slowly in her mom's direction and then notices how their eyes “lock” in an endearing gaze. With a big grin the mother lifts the baby from my hands and snuggles her face into the crease of the baby's soft neck. One of Mom's hands go to her breast to suppress the unexpected let down of milk.
Having received this broader appreciation of her baby’s behavior, Mom now seems able to “hear” feedback about normal infant behavior and reassurance about breastfeeding. I discuss the change in crying patterns of babies this age, and I help mom practice some comforting techniques. I describe the developing sleep patterns and also point out that “active sleep” can be confused with a baby waking up. I review a baby’s growing ability to interact and mention how at times she might demonstrate some “SOSs” – Signs of Over-Stimulation. Before Asha and her mom leave I remind the mother of all the evidence (pees, poops, weight gain) that her nursing is going great.
Three months later, Asha's mom is a breastfeeding star and an advocate for other new moms. One afternoon she comes to my breastfeeding class to discuss the challenges and joys of breastfeeding. Cuddling with her busy baby, she remarks "Don't just count those pees and poops. Learn about the amazing abilities of your newborn and you'll know for sure that your breastmilk is perfect!"
© HUG Your Baby 2011