Full Belly Sisters: Opening a Closed Door: An Unexpected Relationship Between a New Mom & a Lactation Consultant

Friday, April 19, 2013

Opening a Closed Door: An Unexpected Relationship Between a New Mom & a Lactation Consultant


Image from Birth Without Fear


It was a Saturday, and I was the per diem Lactation Consultant (LC) at my baby-friendly hospital. I had just finished the breastfeeding class and was sitting at the nurses’ station. One of my colleagues was on the phone speaking with a physician about a patient, when the husband of one of her other patients came up and requested help with bottle-feeding.  She smiled and nodded, giving a sort of “one minute” gesture because she was on the phone. Since I wasn’t busy at the moment, I offered to assist. She mouthed thanks, and as I was walking away from the front desk towards the room, I heard her voice urgently say “She’s formula only, Flannery!”
I had assumed as much since they were asking for bottle-feeding help and at this early postpartum stage, breastfeeding moms usually aren’t using bottles. For a moment I wondered what she would think when I walked into the room with the official-looking white coat that the LCs wear. I was there to help with formula and bottle, the opposite of what my uniform indicated. I wondered if this would be a confusing message. But the thought was fleeting, and I pushed open the door to her room, knowing virtually nothing about this family.
The patient was in bed, lots of medical lines and fluids dripping. She had just had a caesarean-section and was trying to feed the baby: a big, saucy baby with pale fuzz on his head. He was sitting on her gowned chest while she attempted to cradle him. His head was bobbing around, and his mouth was trying to find the nipple on the bottle. Mom and baby both were looking for the right position.
I hated to do it, but I suggested that since mom was just out of surgery and having such a difficult time getting a sturdy hold, that I would set the baby up with her husband for this feeding. She quietly said, “Ok,” and the father followed instructions well.
I briefly explained that for some babies it’s easier to feed while they are swaddled so that their arms don’t flail and that it makes it easier to give the baby’s head the support it needs for bottle-feeding at this early stage in the baby’s life. I glanced at the mom, who had a soft, faint smile on her face as she watched her husband feed their baby. I was at the foot of her bed and put my hand on her foot through the hospital blanket. “Hey…you ok?” She held her gaze on the baby. “I just feel sad that I can’t feed him.”

I reminded her that this was temporary and, before the end of the day, she would be more agile. Her face was flushed and her eyes misty as she watched her husband feed the baby.
“Was there a reason” I asked, “that you chose not to breastfeed?” I didn’t know her and really was just curious, no agenda. She responded, “I had a double mastectomy.” Then the tears came… I’m not usually at a loss for words, but this was a morning of firsts for me. I just listened, nodding…then I found some words. 
I agreed that she had a very good reason for feeling sad.  I touched her leg, indicating that I wanted to sit at the edge of her bed (because standing over someone who is crying seems brutally distant).  I did some more listening while she cried and eventually I was able to offer an idea: “You know, I have a friend who adopted a baby; she did what she called 'brottle' feeding.” My patient’s gaze turned to me with eyes full of tears but wide open.
Brottle…what’s that?” I explained that it was my friend’s version of breast-feeding. She would remove her own top, then undress her adopted baby to do skin-to-skin. She’d then feed the baby a bottle that way: brottle.
“What’s skin-to-skin?” mom asked.
I explained that after delivery, skin-to-skin is the best place for a baby to be, undressed and against its mother’s chest for physical—as well as bonding—reasons. I joked that it also just feels nice to have a squishy baby against you. Her eyes darted back and forth between me and the baby and her husband. She wasn’t crying. Her expression had changed from grief to eagerness.
“Does that sound like something you’d like to try?” I asked softly. More tears came, followed by a low breathy “yes” from the mom.
I looked at the baby who by now had downed about ½ ounce of formula and said “ok…let’s do this.” I took the swaddled baby and placed him at the foot of her bed. I unswaddled him and then unsnapped and removed his infant shirt, revealing a chubby belly, a still new and gelatinous umbilical cord with clamp; he had peach-colored shoulders with pale swirls of blonde hair. Mom was now crying softly. I picked him up and said to her, “Are you ok with unsnapping your top so we can put him against your chest?” She sobbed, “Oh, yes.”
She slowly removed the hospital gown to reveal two perfectly round, reconstructed breasts with light pink areola. The baby was fussing in my hands, but I knew what was about to happen. When I placed him on his mom’s chest, he was instantly quiet. His face was relaxed. His arms didn’t flail. He was home. Reconstruction doesn’t mean much to a baby. His face did a little shake as if saying “no.” I told her, “He’s rooting. He’s looking to feed because you’re holding him.” Mom continued to cry and smile. Her husband, teary-eyed, quiet, came to her side and tenderly touched her shoulder.
I then said, “You know, some women who have difficulty nursing, either they're not able to produce milk or they have issues with their nipples, choose to use something called a Supplementary Feeding System (SNS). Is that something you would like to try?"
Again, she said, “Oh, yes.”

Medela SNS

I went to find an SNS: a tube that has one end attached to a bottle of formula or breast milk (and, yes, donor milk is an option!) with the other end under the nipple shield. When the baby sucks, it pulls the formula through the tube and into the baby’s mouth, so mom and baby have the experience of breastfeeding. I found an SNS. Then I found a nipple shield, which is like a mini latex sombrero that serves as a nipple, making a latch possible. I went back into the room where the mom told me she was euphoric, having a major cuddle fest with her baby inside her gown on her chest. I showed her what I had and how they were used. I was completely awkward.  I have not been a Lactation Consultant for long. This was my first experience with the SNS system, but I felt determined.

We got set up, got the baby into position. On our first attempt the baby latched, but no sucking. It didn’t seem to matter to mom; she sobbed tears of joy and love for having the baby on her body in a way that she had assumed was off-limits to her because of her surgical history.
I said, “He’s not ready, but keep him skin-to-skin, and I’ll be back in a bit, and we’ll do this again." She smiled and cried.
About an hour later I went back into the room. Mom and baby were just as I left them earlier: skin-to-skin and perfectly content. Mom, beaming, began to cry as soon as I walked in. I smiled and started getting the gear ready. Nipple shield: on. SNS: hooked up. Baby: adorable and in position at the breast. 
We were still. We waited for the baby’s cues: lip smacking…a little face-shake…then it happened. With his eyes softly open, he tilted his head back and opened his mouth wide. With my hand between his shoulder blades and his mom’s hand over mine, we guided him on to the nipple shield and her breast. He paused. Then we saw his jaw start to work. I looked at the SNS: after a few moments of his lower jaw working, the drips started to flow. I pointed this out to the parents. I whispered to her “He’s breastfeeding. You’re breastfeeding your baby!”


Eureka!

Other staff members came in to see this rather unusual event.  Everyone felt enthusiastic and teary. The mom who, prior to admission, had requested that nobody ask her about breastfeeding, who admitted to me that she was prepared to tell anyone who “judged” her to “go f*** themselves;" who thought she was physically prevented from being able to choose to breastfeed. This woman was breastfeeding. The baby gulped and the mom cried, smiled and thanked me repeatedly.

The fact is: I made a mess. There was formula all over mom, baby and me, but I didn’t care. I felt giddy. Before I said goodbye to her that day, I said I’d have another LC follow up with her on each of the following shifts. That made her cry too. I’m guessing she never thought she’d have a need for an LC to visit. I hugged her goodbye and said, “If you never do this again, you now know you can and that you did. He’s your baby; being nestled on your chest, whether you're lactating or not, is exactly where he needs to be.”


***
I am left with many questions.  Is it a lesson for patients that they should ask questions rather than having (understandable) guards up when it comes to their healthcare? What about the dynamic between Lactation Consultants and women who choose to breastfeed or not? Should that dynamic somehow be more gentle, with patients feeling less apprehensive of being judged? Is it a lesson for nurses and doctors to push themselves to have the difficult conversations, offering options that may be uncomfortable for the provider to discuss or painful for the patient? Is it that our agenda with patients should be to never have an agenda?
I always try to think of what is possible: to look for a silver lining and if it isn’t there, create one, to step out of my comfort zone, and (most importantly) to hope the people I take care of are willing to go there with me.
While walking in and out of her room that day, I was humming in my head some lyrics by Johnny Mercer:  “…accentuate the positive, eliminate the negative, LATCH on to the affirmative…” That Saturday I think we found a silver lining in the place between what was actual and what was perceived. It might not have been breast milk, but it was at the breast, so it was breastfeeding, right? Or perhaps what happened with this family was a man-made silver lining that had positive physiological and psychological benefits for everyone involved. Either way, I think Johnny Mercer would be proud.

I want to dedicate my post to this amazing mom. Thank you for your enthusiasm regarding my writing this story; thank you for sending me that delicious picture of your baby nursing, so that others could know that it is possible; thank you for being brave enough to let down both your emotional guard and your hospital gown; and—most of all—thank you for not telling me to go f*** myself.

by Flannery Fontinell, R.N., B.S.N., IBCLC, LCCE



69 comments:

  1. You are a saint! What a blessing you are to all of the moms whose paths you have crossed!

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  2. Thank you, mama, for your kind words!

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  3. The thing I remember most about trying to BF Alice after my c-section is how exasperated the nurse seemed to be at my frustration with struggling to get Alice to latch on. There was no LC on duty because it was July 4th weekend but all nurses should be as sensitive as Flan was with this new mother.

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  4. Absolutely! those first few hours and days can make such a huge difference and if you don't have supportive, sensitive, educated people around you, breastfeeding can be so much harder! I am very grateful to have had my sister to help me out (b/c the staff at my hospital certainly didn't!).
    ~Justine

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  5. Becky at The Two Bite ClubApril 19, 2013 at 3:13 PM

    Beautiful. As a pro-breastfeeding Mom, I have never contemplated the idea of physically not being ABLE to breastfeed. This story is so inspiring. Brought me to tears! <3

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  6. That's a great story Flannery. So proud of you.

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  7. Replies
    1. Mrs Fontinell - I am expecting my first child, and am in the exact same position as this mother - I had a bilateral mastectomy at 23y old, and have always been told and expected that breastfeeding was off the table for me. And now with our first baby on the way, I expected to have to be like this mom (Defensive - i didnt want to discuss breast feeding, cause what was the point, it was too painful to think about what i could not do for my child). I attended a local le leche meeting in an attempt to get information such as this, and although they were all very kind, I was an anomaly for them. They really didn't know how to help me. Can you help put me in touch with this Lactation consultant or anyone else that has helped a mother with a bilateral mastectomy before? I would be so grateful. This story gives me so much hope!!!!
      DC
      brochtrupjd@prodigy.net

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    2. Hey there. I'm so glad you read this and feel you have options now. This is really not my speciality. However there are people at the store "The Upper Breast Side" on the upper west side of Manhattan that may be able to help you if you give them a call. Good luck and keep us posted!!

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  8. Too amazing and too wonderful! Thanks so much for this I really am now getting exactly what happened and how you bore witness to something amazing by having no agenda!You really have come up with such wonderful questions that EVERY health care worker should bear in mind with EVERY encounter we have with EVERY patient who no matter what we know about them is vulnerable and what we say and do can affect them for the rest of their lives!You were just being you and look what happened! I will use the lessons from this story forever I promise. Thanks again!

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  9. Wow, what a beautiful and inspiring story. I am sitting here crying for joy for that mother and baby that they were able to find their own version of breastfeeding and most importantly a version of what worked best for that family at that time <3

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  10. Yes, that's really what it's about, right? Figuring out what works for you and your baby and your family...

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  11. Wonderful story, great job Flannery! Warm feelings and tears filled my heart. We've come a long way from the day when breastfeeding was discouraged to a place where women can breastfeed with the help and encouragement of professional as your self.

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  12. Beautiful! It is hard to beat the joy of this family together, after all they have been through!

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  13. Your article is absolutely beautiful Flannery. You are a gem and what you did for this Mom and her baby is pure beauty and genuine love. You are a model of nursing and a most compassionate human being.

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  14. This brought me to tears and further deepens my love for you!

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  15. It shows anything is possible,I have breastfeed both my kids.She a wonderful mum and the worker a wonderful woman.xo

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  16. Thank you so much for sharing this story. I have felt so pulled lately, toward looking into becoming a Lactation Consultant. This story just tugs me even harder. Thank you!

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  17. Oh wow! I wish you had been there when I had my daughter in 2007 as I couldn't physically breastfeed her and nobody in the hospital seemed to care, they just thought I wasn't trying hard enough. I never saw a lactation consultant, so it wasn't their fault.

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  18. Tears running down my face. Beautiful story.

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  19. This is so amazing, sat here crying as I read. Thank you for sharing.

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  20. This really made me cry. Thanks to the SNS I managed to bf my son up until he was nearly 3, despite a breast reduction and drastically reduced supply. When he was on solids we managed to move to no SNS at all and "free" breastfeeding. With my first child, my daughter I wasn't able to access the support I needed, and never really got started with her. I wish there had been someone like you at the hospital when she was born

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  21. Jamie Cottrell ThomasJune 17, 2013 at 4:54 PM

    If I may add, i wish LCs and anyone else coming into a room would take one minute to find out about the patient first. I had a baby in October...while I was undergoing chemo for breast cancer. I was pre mastectomy but couldn't nurse because I was full of chemicals. Having the lc burst into my room, look at my bald head with a question and start to instruct me how to nurse was heartwrenching, and i may have been a bit stern when I cut her off with "I have cancer, I cant nurse". Also, would have been a great teachable moment about donor milk. 22weeksandcancer.blogspot.com

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  22. Crying.... And smiling with pride.
    I can't breast feed in the traditional sense. I failed my first born, but am still feeding my 20 month old daughter....formula at one breast. I did manage to lactate... Against the advice of so many ... I truly wish every mummy with boob problems could be given all the options...

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  23. That's a great story. I am teary-eyed. More questions, more openness and less judgement for all will make a better world.

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  24. What a beautiful, heartwarming story! Thank you for sharing it:) I'm still crying, though. Best wishes to the mother and her baby - dad too! I loved breastfeeding my kids and have tried to encourage friends to - without being preachy or judgmental. Never thought about what it would be like to encourage someone to breastfeed who had a situation like that. I guess sometimes we have to take a chance.

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  25. Ashley Benz, IBCLCJune 17, 2013 at 9:19 PM

    Lovely. Just absolutely lovely.

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  26. <3 Loved the story. Breastfeeding isn't all or nothing! There are so many ways to have a successful breastfeeding relationship.
    By the way, if you'd like to have a more appropriate credit for the SNS breastfeeding symbol, my blog's url is http://diaryofalactationfailure.blogspot.com/
    Birth Without Fear had the old link to my blog, and I didn't realize it until I saw this post.

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  27. This is an incredible story, with so many lessons for both birth workers and mothers. And you sound like an amazing LC! Thanks to you and this inspiring mama for sharing her story.

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  28. Gorgeous blog on so many levels -- for you as the IBCLC, using mother-centered care; for mom and dad both realizing the joys of parenting as they had dreamed, for the baby who is snuggled and loved and (heck yes!) breastfed.

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  29. This is very inspiriring story. I would like to ask for a permition to translate it into slovak language and publish it on our webiste www.zenskekruhy.sk - we are an non-government organization and working on human rights in childbirt. This story is so much about respect and support to new-mother, that I would like to share it. Of course we will put there a link to your original article. If you will agree please contact me on zenskekruhy.oz(at)gmail.com. All the best! Zuzka Kriskova

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  30. I wish I had you! The LC at Hospital grabbed a spoon and started squeezing my nipples to give him some off the spoon then grabbed baby and basically slammed his head into my breast :( Poor guy. I hadn't even asked for help!!

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  31. I nursed a newborn foster baby this way, thanks to a wonderful army doctor who cared enough to help me through it.

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  32. Jamie Cottrell ThomasJune 18, 2013 at 5:42 PM

    I commented yesterday but my comment seems not to appear. As a mother who gave birth while in the middle of cancer treatment, I have some critiques on this story. I wish the LV has taken one moment to read my chart before entering my room because, as you assert, i did have my guard up. Until you have cancer while pregnant you know nothing about the pain and disappointment of not being able to nurse (I couldn't have used a SNS, I was pre surgery but full of chemo) so I really have a problem with you sayingshould patients ask more questions instead of having their guard up. I knew all the questions and the answers. And I did have my guard up. Just taking 30 seconds to find out about patients would solve many problems.

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  33. Jamie Cottrell ThomasJune 18, 2013 at 6:03 PM

    As a mother who gave birth while in the middle of cancer treatments, I have a few issues with this article. Until you know the pain and disappointment of not being able to nurse because you have cancer, please don't ask the question, should patients ask more questions instead of having their guard up....maybe in other cases but this is something you can't even imagine. I wish my LC had taken one minute to read my chart instead of me having to relay my story to her for what seemed like the 800th time. No, I couldn't have used a SNS, i was presurgery but full of chemo. I knew all the questions and the answers. And yes, I did have my guard up I will fully admit. Take 30 seconds to read a patients chart beforehand.
    22weeksandcancer.blogspot.com

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  34. Fantastic. Thank you so much for sharing and for being willing to do what you did for that family! And kudos to them for being open to it. Success all around!!!

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  35. I love this story. As a Physician Assistant myself, I was very hard on myself when I wasn't able to breastfeed my firstborn. I had pneumonia and was too sick, which from an objective standpoint seems like I should have gotten a pass, right? It just wasn't possible, but my expectation was that it would come "naturally" for me because I so strongly believed breastfeeding is best. When my second child was born, I was doggedly determined to breastfeed him, but it was excruciatingly painful for the first 8 weeks. I almost gave up, but somehow my son and I figured it out together, and I am still breastfeeding him at 11 months. I am sad to say that before I had children of my own I was very judgmental of women who choose not to breastfeed. My experiences have taught me that every woman has a different perspective and different experience. I love the way Flannery used her own intuition to read the needs of this patient, and was able to offer such healing advice. "No agenda" will be my new mantra when dealing with my own patients.

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  36. This is beautiful! Feeding method aside, what I LOVE about this story was the compassion and the kindness to the new mother. Even the strongest women are incredibly vulnerable at this stage in life. The approach taking with this (understandably guarded) new mother is what made the difference. The understanding, the compassion and listening to her (verbal and body language).
    I am entering the medical field and will take this as a lesson in fantastic bedside manner!

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  37. This nearly made me cry! A friend of mine recently went through all the treatments for breast cancer. She's still grieving for what could potentially be a loss of her fertility and even after that, the opportunity to try breastfeeding. This was beautiful and so full of gentle compassion. <3

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  38. Thank you Flannery, I wish there had been someone as caring as you around when I struggled with BF'ing my son. As a preemie, he had a hard time and still as a 4 year old has muscle weaknesses that has plagued his diet and speech. If only I had someone to suggest a SNS system when it mattered then things would have been better for us.

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  39. NippleHuggers(R)July 2, 2013 at 10:02 AM

    Tears of joy for this mother and for the compassion you obviously felt and showed her.

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  40. Love love love all the love in this story. Happy smeary smile on my face. Thank you.

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  41. So wonderful.Breastfeeding was one of the greatest experiences of my life.I nursed both of my daughters until they were almost two.I am so happy tht this woman had the experience of holding her baby boy on her chest.Babies benifit in so many ways from being nursed.Not as easy as just lifting your shirt and letting him latch on but this mom may have been able to do this for a while to give her son a good start.Blessings to the parents and to the LC that made this possible.

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  42. Oh God! What a beautiful story... I am teary eyed, goose-bumped, and deeply moved!

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  43. This story describes the details of one instance of Flannery's tender yet forceful search for a fitting solution. Having recently seen her in motion, by helping our daughter return to her true self after her emergency C-section, I can attest to the fact that this is one very special person! Along with her documented and certified abilities she has a heart as big as all of NYC. Thank you Flannery for all that you did for Tiffany, Eric and of course Baby Charlie, even though you never got to meet him, you affected all of us so positively. Lots of love being sent your way!

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  44. I've done nothing but cry, so happy and emotional. The love and bond between a mummy and baby is unexplainable and unbreakable once formed. How awful she had to go through the heartache of thinking she couldn't do it as no one told her before. Fantastic nurse thank you for sharing x

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  45. As a mom, nurse and recent double mastectomy patient myself, my heart melted reading this.

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  46. Bravo.

    I'm currently recovering from a radical double mastectomy, and while I am done having children, many of my friends - who are also dealing with the same surgery - aren't sure their families are complete. And one thing we grieve, over and over again, is that our body has so radically changed, we can't do things we used to take for granted.

    The compassion you showed this new mother speaks volumes about you, sweet pea. We are often judged, by ourselves, by others, by society to be freaks, to be weird, and often, as less than women. It's a heart-breaking, soul-shattering thing, having to look in the mirror and know that some people think that we're less than women.

    You showed her compassion and kindness, and you didn't judge. Please keep on doing what you're doing... and if you have the time, and are willing to, go meet the local breast surgeons and plastic surgeons, and introduce yourself. Tell them that you're helping post-mastectomy new mothers learn how to breast feed using a supplemental system, and that you're available, should they have patients who might be interested. You might be surprised at just how many of us there are who would be.

    Keep up the good work, and know that I deeply appreciate the compassion you've shown this new mom.

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  47. Violianka BlogujeAugust 5, 2013 at 6:10 PM

    Great invention!

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  48. Just like this mother I have had a double mastectomy and "breast fed" my baby with a SNS in hospital. It was an amazing experience and something I never thought would happen for me. Thank you for bring awareness to this issue!! My baby girl is ten weeks old and with the help of a breast milk donor is on both breast milk and formula.

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  49. Wow... I've never heard of such a thing.

    I'd love to invite you to come link up some of your favorite breastfeeding/pumping posts: http://thirty-one10.com/motherhood/milking-it-you-want-me-to-do-what-to-my-boobs/ We are compiling posts as a resource for our readers. :)

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  50. sobbing like a baby...I so hope that mama knows how wonderful her story is - and the LC for tactfully helping her. LOVE this

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  51. Flannery FontinellAugust 8, 2013 at 9:25 PM

    Thanks so much. Great suggestion. I absolutely will reach out to the breast specialists I can find!!

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  52. Flannery FontinellAugust 8, 2013 at 9:32 PM

    Taking care if your girl was a pleasure. Thanks for the love!!!

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  53. Thank you for this. :)

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  54. очень трогательная история. рада за эту семью. хорошо, что понимающие и сочувствующие врачи еще существуют

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  55. Amazing story. Your questions are potent ones that care providers -- whoever they might be -- should seriously consider. Thank you to you and to the courageous mama for letting us share this delicious slice of your lives.

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  56. Absolutely loved that story. As an R.N. I am so inspired by your dedication to help your pt.rather than going with the flow. It really gives T.E.E.N'S like myself the incentive to go above and beyond in with all of our pts. Thank you.Truly inspirational 😊xoxo

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  57. Joy Grady-HiltonJune 21, 2014 at 9:06 AM

    Just totally amazing. A true inspiration to young women who have endured BMX and want to proceed with breast feeding when they give birth.

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  58. This story made me tear up with happiness. I am so glad that this mom had the chance to breastfeed when she felt like she couldn't! That is a moment I don't want to miss when I have my baby later this year. This was truly inspiring and I thank you for sharing! The more I hear about lactation consultants, the more I love them and the work they do. http://www.njrainbowpediatrics.com/rainbow-pediatrics-services/lactation-consulting/

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  59. Thank you for sharing this. I recently had a double mascetomy and am pregnant. The thought of not being able to breast feed is hard. your article really touched me. I would love to speak with the mother who experienced this if she is intersted. I never knew a LC could provide this so would love to hear more about her experience, if she did it at home, and any tips to make the who skin to skin experience work better. My iimplants are pretty round and they are cold to the touch so not sure how the baby will feel laying on them but the thought of it makes me feel like it is a way I can bond with the baby :-) I tried to find your personal contact information but can not so if there is a way I can reach you privately that would be great. I am really eager to learn more! Thank you!

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    Replies
    1. I am in your same boat (Bilateral mastectomy) and expecting our first child. I would love to learn more information as well - if you have any leads/ideas/etc you are willing to share - please feel free to contact me.
      brochtrupjd@prodigy.net

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  60. Breastfeeding Aid and Support Supplement-Best Milk Boosting Lactation Formula Capsules for Nursing-Herbal Mother's Select Vitamins to Increase Milk Supply and Production-With Fenugreek seed, blessed thistle, and nursing supplement Breastfeeding Support!: Health & Personal Care.

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  61. PLEASE!!!!Can anyone put me in touch with this lactation consultant or another that has dealt with this situation?
    I had a bilateral mastectomy at 23y, and i don't regret it in that I am alive 16ys later, and expecting my first child. But I am in the same position as this mother. This story gives me great hope. I tried my local Le Leche League, and although they were very nice, they really didn't know how to help me. They had never dealt with anyone in my position. I would love more guidance on my options!!!! Please if anyone knows anyone that can help me, i would be so grateful.
    brochtrupjd@prodigy.net

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