Feminist IBCLC

Leaky mammaries from a feminist perpective

[feministlc]

Social Justice Doxxing

This is a tough thing for me to write, as I hate being the public vulnerability gal as a general rule. I'm mostly venting and also posing a request to the justice-oriented Tumblr community who may come across this. I'm never on Tumblr but...

Preface: I'm a queer white cisgender female. An article was posted on a feminist blog's Facebook page on Thursday that seemed, I dunno, "out of form" for this particular blog. The blog usually publishes complex content and stays away from click-baity titles and throwing-the-baby-out-with-the-bathwater types of entries. The entry in question set out to discuss white privilege and holiday anxiety. Good premise, poor delivery. I am also a guest contributor for this blog, so I commented to verbalize my critique.

Well.

A self-described "white male ally" took note and started throwing what basically amounted to "Becky memes" at my comment. Apparently I used one or two terms that are occasionally used by oppressive asshats (specifically, "oppression olympics" and "SJW"). Whatever. I slung a bit back, but mostly clarified my intent: the article's presentation was off. Pretty much left it at that.

While getting ready for work, I started getting messages from friends. Yup... he had gone through my FB friends list and picked out several PoC friends and messaged them telling them that I was a racist. WTF??

He didn't stop there. I said on the thread that the individual was doxxing me. He denied it, despite my screen shots which he maintained were "shopped." I mentioned that I was getting ready for work, where I'll actually do some good in the world, and had no time to be photoshopping. Told him to get a life, that his meme slinging was doing no one any good. Especially not the communities he claimed to be an "ally" of (bothering my Black friends.... classy). He slung the term "White Savior Complex" at me because, I guess, I mentioned I help people at work. (I threw back that I work in a NICU so he'd better call me "ageist" or say I had a "Grown-up Savior Complex" and went about my night.)

Fast forward to my dinner break. Checked the messages on our office phone and THERE WAS A MESSAGE FROM A MAN USING MY NAME. Telling my department I guess (I was the only one present at the time) that they were harboring a "White Feminist Becky." What the serious fuck.

So I called him on it on FB, which he vociferously denied and called me "paranoid." I said he should get that I, as a woman, need to be a bit paranoid when a man bullying you on the internet, and as a proclaimed "ally" he should get that. He then accused me of "gaslighting him" and resumed posting "white fragility" memes and Becky memes and used an AAEV phrase to suggest I should get punched in the genitals. He also maintained that he did NOT dox me but if I did then I "deserved it." When I called him on THAT, he told me he was using AAEV and I must not have many Black friends or I’d get that (never mind that he messaged a handful of them).

At that point I realized I was playing into this little boy's SJW masturbation game and reported him to the admin of the blog. The admin - a colleague I've had the pleasure of working with on several pieces - deleted all his comments and finally suggested I delete my original comment. I said "You go ahead" and that was that.

Here's my point in all this: This Social Justice Pissing Contest is out of control. Being threatened by a white male who perceived I was being racist. Having my FUCKING OFFICE called and my WoC friends harassed??

The justice community has a real problem with this and it needs to fucking stop.

[feministlc]

#BlackLivesMatter

Some rooms just have that Weight in them. That heaviness you sense the moment you enter. Most often you expect it, like when the baby is in the NICU or the mother is very ill. Other times it takes you by surprise.

People think Mother-Baby is all joyous, celebratory, healthy babies born to families with the desire and ability to pour their entire lives into the well being of new life. That's a portion of the job. That's, really, a smaller portion than you might think. The reality, though, is that babies are born into less-than-joyous situations all the time. On Mother-Baby, we see it all.

I walked into a room recently and immediately felt That Weight. I wondered what I'd missed. The baby was healthy, term, no substance history in mother, no social work consults placed... what was going on here?

I announced myself and pulled back the curtain. A Black family, eyes glued to the television. Another police shooting. Another Black man dead, this time in a city very close to us. Protests. Riot police. More violence. More Black lives lost.

And on the bed, my patients: a mother clutching a beautiful Black boy tightly to her chest. A beautiful Black boy, six hours old.

The grandmother welcomes me, mutes the television. I go about my assessment, congratulating the family on the new arrival. The grandmother beams, "He's perfect in every way." I concur. "This child is blessed," she tells me, but I can tell she's really speaking to the mother, eyes still glued to the television.

I recall a friend telling me how much dread she’d felt when her own Black boy was born, and folks kept remarking on how big he would become. Long feet, long arms, looks like Daddy, gonna be a big boy. A big Black man. My friend told me that scared her more than the birth herself. So I watch my words.

"He's beautiful," I tell the mother. I look over at the father, also beaming with pride, and realize how much this child looks like his dad. His dad, no less than 6'4, broad shoulders, dark skin. Mother's dread.

By all accounts this room should not have that Weight. This was a healthy baby, born to a healthy mother with a present family who saw his arrival as a reason to celebrate. But there was that weight... this new Black boy, destined to become a big Black man like his father. And on the TV, another Black man dead, guilty of nothing but "fitting the description."

Fuck.

[feministlc]

Just set up the pump

[discssion of postpartum depression/psychoisis]

It's a fairly quiet night, so I don't mind when the call comes in from the ED. Until I answer the phone.

Readmit. Going to Behavioral, elopement risk wing. Baby is 4 weeks old, is at home with a friend. Patient needs a breast pump set up. "Don't talk to her when you get here, just set up the pump. Just set up the pump."

I take a peek at the chart first. I'll be charting on her later anyway. Mother, 20 years old, nearly one month postpartum with her first baby. Husband is involved, but works out of town most of the time. Mother has no family support. She's been struggling with postpartum depression. And today, she called her doctor and said she planned to kill her baby.

Don't talk to her except to give her instructions. "Just set up the pump."

Catty nurses on my floor have gotten wind of it, somehow. Shaking their heads. "What a terrible mother." "How could she want to kill her baby." "Why does she care if she keeps her milk supply up if she's just going to kill her baby? Are you really going to go down there?"

Don't say anything to them. "Just set up the pump."

On Behavioral, I get buzzed in. Sterile white hallway. Doors that lock from the outside. Windows with wire woven in. A TV in each room, protected by a cage and shatter-proof glass.

I report to the nurse. She shows me the mother's room. "Remember, don't talk to her except to give instructions. The psychiatrist was clear about this. Just set up the pump."

I enter the room and try to figure out how to... behave. Do I smile? Introduce myself. Don't say anything else. "I'm here to set up your breast pump." Nothing. "Have you ever used an electric breast pump before?" A firm shake of the head. No eye contact. "That's ok, it's pretty easy. I'm here to help."

The relatively short process seems torturously long when there's no small talk to be had. No windows. No warm curtains. No cheery gifts of congratulations. No family at her side, no older child running around telling me about their new baby sibling.

Curved, corner-less sink with cold water only. The same caged television. The light switch is outside of the room. Now the fun part: There's no electrical outlet. The pump cord reaches to an outlet just outside the door. The bed opposite the door is chained down. Can we get a chair in here for while mother pumps? "Just for when she pumps."

I get the mother pumping and cringe at the lack of privacy. There's a window into the hallway, and I've also noticed a video camera with microphone. I want to hug her. I want to tell her she's a good person. To tell her how she's a good mother for calling her doctor the moment those scary thoughts entered her mind. That she's going to get through this. She and her baby. It's going to be ok.

I don't say anything, though. I just set up the pump.

Try to tell her she needs to pump every 3 hours. Realize there's no clock in the room. Report to nurse. "She can't be in there with that alone. Am I really going to have to sit there with her every 3 hours for 15 minutes?"

I can't get out of there soon enough.

Back on my floor. New parents walking the halls with their newborns. Baby cries emanating from some rooms, peaceful silence from others. It's not all rosy. But it's not all bad either.

I hole myself up back in the office. Deep breath. Chart the encounter.

"Lactation to patient's room to set up breast pump."

[feministlc]

Things quiet down: Alright! I'm gonna go down to the cafeteria and grab some food!

Get food: Alright! A tasty veggie burger and slaw.

Four pages later: Great... a cold veggie pattie on a soggy bun....

[feministlc]

We have a pet mammary gland at work now. :D

[feministlc]

Wings

[TW: pregnancy loss, infant loss, fetal demise] I was checking off discharges at the nurse's station when I got a call from high risk. "We have a patient in [room number] who needs a pump set up. When you get a moment, come on up because I need to speak to you about her situation." I had a bit of charting to do, and the nurse said it was no rush, so I sat down for a minute. I looked in the system at her room number. There was an icon next to her name. Wings. I was confused... did I have the right room number? Let me explain. In our system, we place wings next to a patient's name if their baby has died. We also put a picture of an angel on their door, so everyone coming and going knows not to congratulate them or ask where their baby is. I wondered if, maybe, this family had lost a multiple? The chart indicated it was a singleton, born still at 26 weeks. Unexplained fetal demise. I finished my charting and walked up to high risk. The social worker met me at the nurse's station and explained that this mother had lost her baby and wanted to pump breastmilk for a milk bank. This is unusual, but not unheard of. We would never recommend a grieving parent pump to donate, but when we encounter a patient who volunteers such a thing, it's something to jump on. The couple was in their room, both seated on the couch. I offered my sympathies and took a seat. "So, I understand you're interested in donating your breastmilk?" The mother had clearly been crying, but she seemed completely lucid and calm. "Our first baby was a NICU baby. He received donor milk here, until I got my supply up. I want to return that gift to someone else." I gave her information about the milk bank, how to go about becoming a donor, and set up a hospital pump. Then came the tricky part. She didn't have a pump at home. They'd gotten rid of the old one, expecting to get a new one when this baby arrived. Most insurance companies will send you a breast pump, but it's considered a medical device for the patient: the baby. If there's no patient, they won't send a pump. "Let me see what I can do," I said. We happened to have a spare loaner pump available, just for a few days. I contacted the milk bank; they seemed to have a protocol for this situation and offered to send a voucher for a rental pump from our hospital. Amazing. I printed out the paperwork they would need and returned to the family's room. I explained how she needed to go about maintaining a milk supply for as long as she wanted to donate, and went through the paperwork. But no pressure. She could stop at any time. "This will help me heal," she told me. I offered my sympathies one more time, thanked her for the priceless gift she was giving, and left her alone with her family. I was way behind on my rounds. Worth it.

[feministlc]

Offer unlimited phone/text support, they said...

Things I like about being a private practice LC: My patients have my cell phone number.

Things I don't like about being a private practice LC: My patients have my cell phone number.

[feministlc]

I was in a patient’s room for an initial assessment post-delivery. I asked the new parent, did you breastfeed your first baby? She said, “Yes for one year.”

"That’s great!" I said.

"Well, not breastfeed. I pumped and bottle fed. Couldn’t ever get a good latch."

"You exclusively pumped and bottle fed… for a whole year?"

The mom looked a bit ashamed. “Yes.”

"That’s AMAZING," I said. "No joke, you did all that work for a year??"

"Yes, I’d rather not do it again!"

"I hear you," I said, "That is a lot of work. That’s totally rad though."

The new parent smiled and hugged her new baby closer. “Yeah, it was hard, but I’m really proud of myself.”

"As you should be. Would you like to try to nurse this one at the breast?"

"Oh my goodness, yes!"

Let me tell y’all something about parents who exclusively pump and bottle feed for any amount of time: they are troopers.

Breastfeeders know the time it takes to get a good milk supply going, they know the worry over getting enough to their babies, and they’ve most likely dealt with at least one or two breast pathology issues (sore nipples, mastitis, engorgement, etc). Formula feeders know the time it takes to mix up bottles, especially in the middle of the night, cleaning extra dishes and making sure things are set up for the next feeding.

Exclusive pumpers, they know both sides of this. And not just for a couple weeks, like when I have new parents temporarily pumping a bit to get their supply up or help a baby get enough to eat while we wait for the planets to align. They do this for weeks, sometimes months, and in rare cases, a whole year or more!

So if you’re an exclusive pumper worried over “failing” your baby because you never got them to breast, remember this. You’re pulling double duty so that your baby can have your milk. No matter how long you are able to keep this up, be it a few weeks or a few months, you are giving your baby the gift of breastmilk, and you’re working extra hard to do it. You are rad.

[feministlc]

Happy IBCLC Day!

A blessing for all IBCLCs today: May all parents be empowered to make healthy and unhindered infant choices. May they be supported and sustained by friends, families, and health care providers. May every baby be born healthy, wakeful, and alert. May each child open their mouths like baby birds. May their frenulums be loose, their jaws unclenched, their palates smooth. May every areola be soft and graspable. May every nipple evert readily without pain. May every working parent receive paid family leave. May every baby's genitals be left intact and unmodified. May every well-meaning night nurse know what cluster feeding is. May they all be supportive of their patients' exhaustion. May they have a few minutes to demonstrate hand expression and cup feeding. May you all have a lovely IBCLC Day, today and every day.

[feministlc]

Accessory

Content Warning: genital mutilation

I struggled with whether or not to write this one out or not, but I believe, ultimately, that getting it "out there" will help me process and deal with issues like this in the future. 

Since starting at the hospital, I've learned that being "a part of the team" means negotiation and participation in things that aren't really my job as an LC. This is new for me since I don't come from the nursing background; in private practice, I do my job and call it a day. 

Hospitals aren't great places to learn to breastfeed. Every hour there's someone new at your door: the nurse, the pediatrician, the picture person, hearing screen, nurse again, your obstetrician or midwife, the birth certificate person, the lactation consultant you paged an hour ago, your afternoon meal, some visitors, and oh hey it's time for the nurse to come in again. I always say that, while 8+ feedings on day 2 is ideal, getting six good ones is a win. 

And so I, the lactation consultant, negotiate that space with all these other folks who also have a job to do. Sometimes we have to make compromises. I've learned to just say "yes" to a nurse or CNA's request if that means my patient is going to have a good feeding at the breast, if my time allows. 

So the other day I was helping a new mother and her very sleepy baby. We finally got the baby awake and interested in nursing, put him to breast. She reported "the first pain-free feeding she'd had so far," and boom. The CNA arrives. "I'm here to take [baby] for his circumcision!" 

"Can it wait? We literally just got him on the breast," I said. I learned fast that protecting a new parent's space is part of the job. 

 "That's fine, I'm going to go grab the others for the day. Can you bring him to the treatment nursery when he's done?" 

 "Sure, no problem." The basic negotiation, helping out for the good of our mutual patients. And then I realized what I had agreed to. 

 A thousand conflicting thoughts raced through my head. "I'm okay with this. Am I okay with this?" "You got him a few minutes to eat. You're doing the best you can." "You're an accessory. You're an active part in his circumcision." "At least you're making sure he's eating first. He won't want to the rest of the day." "Say something. Save him." 

 The baby was nursing well, so I stepped out of the room for a minute to chart the visit. When I returned, the parents were wrapping him back up. "Sorry, buddy," his mother was saying, "You're not going to like this, but it has to be done." There it is! There's your opening! But my mouth wouldn't move. 

 More thoughts. Should I speak up? How should I put it? Will they listen or will I be just another judgey LC? They don't know. They think this is no big deal. If they knew we wouldn't be doing this. But nothing came. Just... "I'm glad he ate, he won't want to the rest of the day. He'll be sleepy from the trauma." The trauma! There it is! You planted the seed. 

 Too late. "Okay [baby], we'll see you on the other side!" And he was in the cart ready to go. 

 The walk to the nursery took forever. Sensing the sudden absence of his parents, the baby began to cry the moment we left the room. Nurses, residents, CNAs, and visitors flurried around the halls on this typically busy hospital morning, unaware of me and this poor little soul. I kept my eyes on him almost the whole walk. "I'm sorry, baby, I'm so sorry," I kept whispering, as if it would help anything at all. Tears welled up in my eyes and I became grateful for the hustle and bustle of the floor that rendered me nearly invisible. 

 We arrived at the treatment nursery and I took a breath. "Forgive me," I said finally, and placed my hand on his sweet little head. An offering of strength, I suppose; if I could I'd have given him all I had. I fought back tears as I pushed open the door and wheeled the little guy into the lineup. Five or six others, all sweetly wiggling in their carts, unaware of what was about to happen to them. Perfect little beings about to be mutilated. 

 "Thank you so much!" the CNA acknowledged, and all I could produce was a nod. 

 I barely kept it together as a headed for the bathroom. I don't really remember the walk but I was sure I was going to vomit. Shaking, nauseated, hating myself profusely. Sobbed for about five minutes, then cleaned myself up and headed back out. What else was there to do? 

 I ran into the parents later that day as they were going home and I was headed down for a coffee. "Everything go alright?" I asked, as if they had any clue. They do all the procedures in the parent's room now, except for the circumcision. Surely they had been told, like so many others, "He slept right through it." 

 "He came back and ate really well! Thank you for all your help." I had to smile then. This little one, he's a trouper. A survivor of legal genital mutilation. All in all, he looked good. 

He's ok. Am I?

[feministlc]

Back to Work at 6 Weeks Postpartum

Can we talk about family leave in this country?

About how many times a week I hear “I’m not going to breastfeed because I have to go back to work in 6 weeks?”

How so many follow up with “…but I wish I could,” “I feel like it doesn’t matter,” “I just can’t stay out of work any longer.”

How many people come into my office for outpatient, can’t get their milk supply up because pumping at work just isn’t doing it for them?

At the hospital it’s “You can get a pump from insurance/WIC” and that’s pretty much it.

At the office it’s all fenugreek and weekend pumping.

I can go the rest of my life without saying "Any amount of breastmilk is better than no breastmilk" when the parent very clearly would rather nurse for months and months.

"They have to give you time and space; it’s the law" doesn’t cut it when so many of your patients work in places with exemptions, or in low-paying jobs that make up any old reason to ditch you. Or they’re undocumented and just can’t make a stink.

How the fuck are we supposed to expect breastfeeding rates at 3 and 6 months to go up when the vast majority of working parents are going back to work while they’re still recovering from a birth?

Boggles the damn mind.

[feministlc]

Taking Time

Today at the hospital I was assigned to a room I'd tried to work with yesterday. The mother had delivered overnight and was on magnesium sulfate. She hadn't slept and the mag was taking its toll. Long story short, there was no chance of breastfeeding that morning. When I returned this morning she told me it wasn't a good time. The room was empty and dark. The baby slept swaddled in her crib. I said, "Would you like me to come back later?" "Yes." It was about that time I noticed she was crying and looked like she had been for a while. I stopped at the door. "Are you okay?" "Yes." Walked back in. "You sure?" No response. The unit was busy with discharges, but all of my patients were doing well and I still had an hour before I had to be at my outpatient, so I decided to dig a little. "It doesn't have to be about breastfeeding. Don't even have to chart it. Is there something I can do for you?" I sat down with her and she told me what was going on. "Family troubles," the kind you should really get a case worker on. Not something I'd wish on any new parent, especially one recovering from pre-e and a cesarean birth. "There's a lot of people here that can help you with this. Provide some resources for when you leave, make sure [name] doesn't come back in here. It would need to be charted, but [name] would never know." "I guess. It's just...everyone here seems really busy." Yeah. This is really the nurse's job, but she's busy. The case worker wouldn't come in unless someone had already noticed something was wrong. Given this delivery and subsequent issues, it didn't surprise me no one had. People think "lactation consultant" and they think a lot of things. Breastfeeding help. Baby whisperer. "Breastapo" to those who don't exactly love us. Folks forget that we're a part of the team, and hell, we forget too. We get asked to do these things (grabbing an extra blanket, helping someone order lunch, etc) and we feel like it throws us off our rhythm. But taking a minute every time we can to listen - really listen - is so so important, and in some cases may mean the difference between a new parent going home to a safe place and going home to a dangerous situation. Remember that. Your charting can wait.

[therewerefourinthebed-blog]

[lacigreen]

sosososososssosssosooo important

[feministlc]

<3

[feministlc]

Five Little Words

I went to see a mother day of discharge. She was having some issues latching the baby and I really wanted her to feel confident before we sent her home. When I entered the room, the baby was popping on and off the breast and becoming frustrated. "Can I show you a couple things to help her stay on?" "Oh yes, please do." "Ok. May I touch your breast?" The mother paused. "You're the first person who's asked if they can touch me like that. Yes. Thank you." I cringed inside. This mother was in her early 20s and mostly unsupported. She'd had a vaginal delivery and lots of breastfeeding help. No one had asked if they could touch her. "Well we should all ask," I said simply, as I helped the little one onto the breast for the most textbook latch I'd seen all day. "She looks great. You're doing great. All I did was compress a little closer to the areola." "Thank you." Five words: May I touch your breast. I get a variety of responses when I ask this question. "Of course you can." "Well how else are you going to help?" And so on. It doesn't matter if they expect us to do it, you should always ask, but it's strangely easy not to. Especially if you were just in there the previous day, or if you know that everyone else has had their hands all over them (and inside them) for the past few days. Even if they signed that big fancy consent for treatment form... still, always ask. These bodies we work with belong to people. These people have boundaries. Or they don't. One way to be sure: ASK.