Dear Nurse Julie- a letter to my labor and delivery nurse

Dear Nurse Julie,

You were in my life for about two and a half days 13 years ago, I’d never met you before nor have I seen you since.  It may have been brief but you made a huge difference in my life and I owe you a deep debt of gratitude.

I had prepared so much for the birth, read everything I could get my hands on including an OB text book, took a childbirth education class, and practiced Bradley method relaxation for weeks at home with The Piano Man.  We knew what we wanted for our birth and after a complicated pregnancy, we were prepared to fight for it.  When I went into labor at 41 weeks and 4 days we were ready.  The Piano Man was an amazing advocate for me, actively intercepting anyone that entered the room and questioning every procedure (no enema!) while helping me relax and focus on the work of birthing our daughter.  Together, he and I made a great labor and birthing team.  I’m pleased to say that 5 babies later and one on the way, we still do.

Our bags were packed, there was film in the camera (remember that?  Cameras that used film?), we were so ready to have a baby.  Except for one thing: we had done nothing to prepare for breastfeeding.  The thought hadn’t even occurred to us.  We knew that was how we were going to feed out baby once we had her in our arms but we read nothing, took no classes, and never even thought to see if there was anything we needed to know before breastfeeding.  Both of our mothers had breastfed, we knew a few friends that had so really, how hard could it be?

All our nurses were nice enough and the birth was mostly amazing with some traumatic experiences.  Earth Baby was born at 6.39am and we met you shortly after with the shift change.  Instantly I felt connected to you, your smile, your warmth, and your genuine congratulations on our baby as if you hadn’t seen hundreds of births and newborns every week.  After I was all stitched up, hydrated, and my blood loss dealt with you asked me an incredibly important question: “are you ready to breastfeed your baby?”

Nobody had mentioned it.  I knew it was in my chart because something I had read about birth plans suggested to ask for it to be put in my chart.  Still, you were the first to say anything about it.  Having just lost a lot of blood with a partially retained placenta and manual D&C, I was feeling weak and more tired than I had ever felt in my life.  Holding my baby, let alone breastfeeding her, completely wore me out.  Like a dear in headlights I told you yes, but only because I remembered that it was the plan.  Your response: “good, because she’s hungry and I think she’s ready to eat well for you” jarred me out of feeling my exhaustion and into the reality that my baby needed me to meet her needs.  I really was ready to feed my baby.

I don’t remember how long you stayed in my room but somehow, you made me feel like I was the only mom that needed your attention.  Perched on the side of my bed, you helped me get into a position I found comfortable, plumped plenty of pillows to support Earth Baby and I, encouraged me to drop the shoulder of the hospital gown, and talked me through latching Earth Baby for the first time.  Your encouragement for how well we were doing, what a healthy strong latch Earth Baby had, and suggestions for positions made me feel like not only could I breastfeed my baby, I already was and doing great!  You answered every one of my questions, no matter how basic or obvious the answer may have been, as though it was a pleasure to answer my important concerns with patience and care.  Even when Earth Baby was latched and I was comfortable, you stayed and chatted, telling me about your 2 boys, that you had breastfed your second one but not the first, and telling me about how you were drawn to OB nursing and how you loved helping moms.

It showed.

Once I was moved to the postpartum wing, you continued to visit me.  You’re ongoing support regarding everything I was experiencing from peeing for the first time after giving birth to changing my baby’s diaper to breastfeeding helped grow my confidence that I could, in fact, take this baby home and not kill either of us.  When I told you my nipples were hurting you showed me how to position my baby’s chin lower on my breast so she took a big mouthful of nipple.  When I was still drained from the birth, you explained different positions and helped me practice using them.  Constantly considerate, you never touched me without asking and receiving my permission first and even then you rarely handled my breast choosing instead to carefully and patiently explain how I could do it myself.  I can’t even begin to tell you how far that went in helping me not be afraid or feel strange about my own body.  From the bottom of my heart I thank you for that gift, it has remained with me to today, growing stronger over the years.

When the grumpy nurse, who’s name I can’t recall because for the last 13 years I’ve referred to her as “grumpy nurse,” told me I was starving my baby because my breasts were empty and not meeting my baby’s needs, I cried.  A lot.  Earth Baby had lost over a pound in just a matter of 2 days and the grumpy nursery nurse that made me cry told me I’d never be sent home with my baby if I didn’t agree to give her formula.  Oh the things I know now!  All those fluids we had in labor… but back then I had now idea.  I caved.  Still weak from the blood loss, recovering from a 4th degree tear, and afraid my baby was hurting I agreed to a bottle of formula.  My heart ached, I never meant to starve my baby and my fears were confirmed, I was already failing as a mother.  She whisked my baby away, a satisfied smile on her face as she told me I was making a good choice for the good of my baby, and ran off with my daughter to feed her the bottle of formula.  I sobbed.  You came in shortly after and was surprised Earth Baby wasn’t with me.  When I told you why I saw the storm clouds gather in your normally incredibly friendly eyes and you told me you’d be back.  What I didn’t know is that you must have marched out to that nurses station, called our pediatrician, asked him about the situation, advocated for our breastfeeding relationship, asked him to call the nursery, and headed down there to get my baby back for me.  When you walked in about 15 minutes later with grumpy nursery nurse and my daughter, I had already spoken with our pediatrician who called me to assure me our baby was going to be fine breastfeeding and at this point did not need any formula.  He told me that he had spoken with you and trusted you that Earth Baby and I were doing great breastfeeding, that my milk was coming in, and that I was already a pro.  I cried again.  Someone believed in me.

Somewhere I still have the picture of you and I and Earth Baby just before we were discharged.  My face is red from crying having just gotten Earth Baby back.  You had told me that we were going to be fine, that I was a natural, that Earth Baby was lucky to have me as her mom, and that you enjoyed working with me.  That’s what you told me.  Some many had dismissed me as a young mom and at 20 I was, but you stuck with me respectfully teaching me as though my age was of no consequence.  What you taught me without directly saying so was that I could feed my baby, my body was amazing, I didn’t need to be afraid of my breasts, and I could advocate for myself and my baby.  My husband believed in me but I knew he was just as clueless as I was.  But you?  You were not only an experienced mother, you were a nurse that saw mother after mother with new babies and you believed in me.  If you said I could do it, I probably really could.

Today, 13 years later, I owe a lot to you.  For starters, my breastfeeding relationship with Earth Baby which lasted a year and then extending on to 4 (now almost 5!) babies.  Thanks to you, today I now help support other mothers with their birthing and breastfeeding journeys.  Thank you for supporting me even when I wasn’t sure how to support myself.  Thank you for giving me the courage to be the kind of mother I naturally was but was insecure about stepping into.  Thank you for being kind and encouraging when I was most vulnerable.  Thank you for making a difference in my life and the lives of my children.  You have touched more than you know.  I want to be like you and just love helping moms.

I hope it shows.

 

Sincerely,

 

Jessica Martin-Weber

The Leaky Boob

 

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Baby Explains- Normal Newborn Behavior

By Diana Cassar-Uhl, IBCLC 

 

Dear Mommy,

Thank you so much for breastfeeding me!  You probably already know that your milk is designed especially for me, and is better than anything else you could feed me.

I know that right now, you feel like your friends who aren’t breastfeeding their babies seem to have an easier time of things.  Those other babies sleep soundly and longer between feedings, they drink so much, and they don’t fuss to eat all the time like I do!  I can tell you’re getting a little bit frustrated, and I hear all the advice you’re getting … my grandma says you weren’t breastfed and you turned out just fine, my daddy says he feels like he can’t do anything to soothe me, and that lady with the cold hands that you call “doctor” gave you a can of something that she says will help me grow faster.  You’re tired and frustrated because taking care of me just seems too hard, but please mommy, before you give up this yummy breastfeeding thing, let me explain some of my behavior to you.  It might help you feel better.

First, if you and I were separated after I was born, for any reason (maybe it was hospital protocol that I be left under a warmer, maybe you were recovering from surgery), I’ve got some catching up to do, because I probably lost more weight than my friends who got to stay close to their mommies.  It’s OK … I’m really good at letting you know when I need some more calories, but it’s important that you let me breastfeed lots and lots, even if my grandma says “he just ate!!”  In my first few days, the nurses at the hospital might tell you I’m hungry and your body can’t make enough milk for me … but mommy, that colostrum from your breasts is some awesome stuff!  It’s packed with protein, which binds to any bilirubin in my body (elevated bilirubin causes jaundice in more than half of newborns) so I can poop it on out.  It’s also a great laxative, which makes it easy for me to get all that black, tarry meconium out of me and we can move on to the seedy, yellow-brown poops that are much easier to clean off my sweet tushie.  Now, the colostrum is really thick and sticky, and I’m so small and still figuring out how to move my tongue, and we’re both still trying to get comfortable together, so it might take me 20 minutes or longer to suck out just ONE TEASPOON (5-7 mL) of that liquid gold.

But it’s OK, mommy!  You know, there is really nowhere I’d rather be than in your arms, hearing your sweet voice and smelling you  — even though you haven’t had a shower since before I was born, you’re just delicious to me.  And something else you should know about me … even though I have a really cute “Buddha belly” that looks all chubby, the capacity of my stomach on the day I’m born is just 5-7 milliliters – that’s the size of a small marble!  You’re the smartest woman in my whole world, so I know you see the connection here!  The amount of colostrum in your breast is exactly the capacity of my tummy!  My stomach walls on my first day of life are very rigid and won’t stretch; this is why, if anyone tries to feed me with a bottle, I’m going to spit most of it back up again, even though I eagerly suck at it.  See, mommy, I only have two ways to send and receive information from my brand-new world – I can cry, and I can suck.  I can’t see much, and all these sounds are so much louder than when I was inside you, and I can use my hands to help me orient myself on your breast, but crying and sucking are pretty much how I make sense of everything.

From the Heart Photography – Tiffany Hileman

I know it seems really confusing, mommy, that I would want to suck and suck and suck even though my tummy is full.  When I suck, lots of great things happen for both of us.  I keep my own digestion moving by triggering the involuntary digestive muscles in peristalsis – moving the contents of my stomach along because I’m still moving my mouth and tongue, which are the beginning of my digestive tract.  When you let me do all this suckling at your breast, I can very easily regulate how I suck, depending on why I’m sucking at any given moment.  You can probably feel when I’m suckling nutritively and swallowing lots of milk, and when I’m kind of relaxed about it, feeding sort of like I’m savoring a bowl of ice cream … you know how sometimes, you scrape just a tiny bit onto your spoon, because you want it to last a long time?  To me, you’re better than ice cream!  But on a bottle, it’s impossible for me to suck and not get whatever’s in there, and that’s confusing to me, so I might keep sucking because that’s what my instinct is telling me to do, or I might realize my tummy hurts (because even on day 10, my stomach capacity is only a ping pong ball) and I’ll cry and cry because all I really know is crying and sucking!

A word about these instincts I feel … I really can’t help it, mommy, that I want to suckle so much.  It’s just how I came out, and there doesn’t seem to be much that I can do about it.  Please believe me, I’m not trying to trick you!  In a few weeks, this need lets up a tiny bit, but for now, suckling is my M.O.  But, do you want to know something really cool?  I’m not the only one who benefits!  When I suckle at your breast in these early days, your body actually activates prolactin receptors!  Isn’t that amazing?  In my first two weeks, the higher I make your prolactin levels go (my suckling triggers a prolactin surge in your body), the more of these receptors get activated in your breasts, and the higher your potential milk production will be for as long as you choose to breastfeed me.  That’s one reason your lactation consultant tells you to wait on introducing that bottle or that binky– this prolactin receptor thing only happens for the first 10-14 days.  After that, the prolatcin surges when I breastfeed are much smaller, so the more receptors there are to gobble up what prolactin is there, the more easily you’ll make all the milk I need.

Besides prolactin, there’s oxytocin, another hormone I activate when I am at your breast.  Oxytocin is part of what makes you so addicted to me!  It’s “the love hormone” and it helps you feel relaxed and content when we’re breastfeeding.  Go ahead, mommy, exhale and relax!  It’s OK!  Oxytocin release is triggered by nipple stimulation, not necessarily milk removal (though when things are going well, my stimulation of your nipples usually means I’m removing milk!).  Now, I know this might sound a little awkward coming from your baby, but I need you to know something about oxytocin.  There are only three events in your life that trigger oxytocin release: nipple stimulation (like when I’m breastfeeding), labor (the oxytocin released during childbirth stimulates uterine contractions, which is why nipple stimulation might be suggested when labor stalls, and also explains why sometimes, after you breastfeed me, you feel an increased expulsion of lochia and maybe some cramping), and … orgasm!!  Isn’t neat that the same hormone plays a part in making me, birthing me, and feeding me, and it’s a hormone that makes you feel GOOD to do all three?

Mommy, I know you are trying your very best for me and you’ve been worried about whether your body can satisfy my appetite.  I know you’re used to being able to measure everything, and your breasts don’t have markers on them to tell you how much milk I got.  Maybe you used a breast pump, and that confirmed your worries that there isn’t much milk there – but mommy, please understand that a good pump can mimic me, but your body wasn’t designed to have all these wonderful hormone surges for a cold piece of plastic with a noisy vacuum motor.  You know that feeling you get when you hold my warmth and weight, smell how delicious I am, and nom nom nom on my fat cheeks?  That feeling helps you make milk!  That feeling is part of the whole system that was designed to make you need to be close to me, just as much as I need to be close to you.  And mommy, I know you’re very busy, and important, and there’s so much you used to do before I came, and I know right now, it feels like you’ll never do those things again, and our house is getting messy, and maybe that scares you.  But please know, every moment you spend holding me, every time you gaze lovingly at me, and every hour you spend breastfeeding me in these early days is so important to me, because you’re all I know.  I love daddy and grandma and all of our friends, but I’m designed to be happiest and least stressed when I’m with you.  Can you wear me in a sling or soft carrier after I’m milk-drunk?  I really like listening to your heart beating while I sleep, and you are warm and soft and smell so good.  That space between your breasts is perfectly sized for my head, and there’s nothing I like better than the feel of your skin against mine.  Well, maybe there is something I like better … I love it when you sleep next to me after we’ve been breastfeeding.  Oh, mommy, when you nurse me while lying down, you relax and your milk flows so nicely, and I feel like you’re so happy to be with me, and I’m very special to you because you don’t have to run off and do something else as soon as I’ve let your breast go.

And mommy, I have a promise to make to you.  I can’t say for sure when it will happen, but there will come a day when I need you a little bit less intensely.  My feedings will get more organized, my weight gain will stabilize, and sometimes, I’ll even like when my daddy or grandma or other loving person holds me.  But today, I need you.  You’ll always be my number one, even after we’re done breastfeeding, but I will learn, like you did, to defer my needs and to trust others to meet them once you and I get a good thing going.  Thank you so much for all you’ve done for me so far. Until you start giving me an allowance, I hope my good health, sweet smiles, coos, and giggles will sustain you!

Love,

Baby


 

Many thanks to the hundreds of readers that shared so many beautiful photos of their newborn babies.  There is just a small sampling here but you all have incredible photographs of your beautiful babies.  Thank you for being willing to share and to all the photographers of these precious images!

 

Diana Cassar-Uhl, IBCLC and La Leche League Leader, has written articles for the La Leche League publications Leaven and Breastfeeding Today, and is the author of the La Leche League tear-off sheet Vitamin D, Your Baby, and You. She is a frequent presenter at breastfeeding education events. Excited about her work toward a Master of Public Health, Diana hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition. Diana, mother to three breastfed children, has served as a clarinetist on active Army duty in the West Point Band since 1995. Diana enjoys running, writing, skiing, and cross-stitching when she finds herself with spare time.  She also writes at Normal, like breathing

 

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