I would like to introduce you to Kathleen Stahl, an RN and IBCLC from the Annapolis/Baltimore area. I first met Kathleen at a local educational meeting and have since had several conversations with her about her unique perspective on breastfeeding support. As a NICU IBCLC in a hospital that primarily sees an underserved population and with a private practice in a particularly wealthy area, she sees a wide range of perspectives on breastfeeding support.
Can you describe a typical day in your current hospital job?
I work as a lactation consultant in the NICU of a large, Baltimore hospital. Most of the babies that I see in the NICU are very premature and may not feed by mouth for several weeks or more so, in working with them, I support moms in pumping. I touch base with any moms who are coming in for feedings but many aren’t able due to transportation issues. I will follow up with moms who are still admitted to the hospital, making sure everything is going well and that they have a breast pump for discharge home. I will also see anyone who is on bed rest prenatally that is high risk to talk about the value of breastfeeding. I also do consults in the NICU during the day for the babies that are starting to go to breast.
In addition, I do follow up phone calls to track our breastfeeding in the NICU at 1 week, 2 weeks, 6 weeks, 3 months, and 6 months and provide outpatient support as we frequently have preemies going home that are not consistently feeding well at breast and will need to have supplemental expressed milk. The outpatient consult also gives the mother the confidence and reassurance she needs to wean off of breast milk supplementation to exclusive breastfeeding. I have found that in this particular NICU setting, private outpatient consultation has been more successful than breastfeeding support group once the babies are discharged. Mothers can schedule the time to come in when it works for them. While all the mothers have phones, many do not have cars or computers, so finding the best mode of communication for each mom is vital.
The majority of the time I spend educating mothers on the value of breastfeeding. It is a very scary and stressful time for these mothers with babies in an intensive care unit. They are afraid to touch and hold their babies and they are fearful of the monitors. I spend alot of time just building relationships of trust with them so they feel comfortable talking with me about their breastfeeding concerns. Since the parents watch the nurses with wide eyes as they measure everything that goes in and out of their babies, it is difficult to get the parents to have the confidence while breastfeeding when they cannot measure exactly how much is going in to the baby.
In the NICU, the challenge is mother and infant separation. Ideally, I would like to see both parents be able to stay comfortably with their babies. I feel that there is room for more parent education that would make them more comfortable to help in the care of their babies. The NICU is very intimidating with all of the wires that are attached to the babies and the monitor alarms going off. It makes parents and family members/visitors very nervous. NICU is a very scary time for families. It is important in my role to educate and try to help the parents be at ease with their baby.
How does your hospital work contrast with your role in private practitioner?
Many of the mothers who have premature babies where I work have not even considered breastfeeding. Many of the pregnancies are not planned. Formula feeding/bottlefeeding is the cultural norm. They are shell shocked to have just given birth to a baby that weighs a little over a pound. They may not have even planned to breastfeed but just spoke with a neonatologist that told them that breast milk can help save their baby’s life. Often times there is a cultural barrier…all they know is bottle feeding. They are afraid of people seeing their breasts and most have had very little prenatal care or none at all. Due to economic barriers, they come at most once a day and stay for about an hour or two and leave. Some are just stressed from the dire circumstances of their baby’s health and the stress can impede their milk supply. I spend most of my time talking parents into breastfeeding and how wonderful it is not just for the baby but for them. Many of these patients have economic stressors like one mother I supported who was back to work 2 weeks after giving birth at a local fast food chain. Many mothers are single parents and many have poor family support.
Contrast that with the mothers I see in my private practice who want to breastfeed. They have already been educated about the value of breastfeeding not only for the baby but for themselves. They know they will have a healthier baby and many do not want formula to ever touch their baby’s lips. Many of these parents were breastfed as infants and see formula feeding as a failure. These parents would gladly pump or stand on their heads to breastfeed. These parents are usually higher-income, higher-educated people who have taken the classes and had the prenatal care. They are usually committed couples who do not have many economic stressors. Most also don’t have the stressor of an extremely ill child. These parents have invited me in to assist with their breastfeeding relationship of a healthy child.
These groups are as different as night and day. Most mothers in the NICU will pump once they are informed of the benefits of human milk for their sick babies. But they have many social and economic barriers that cause additional stressors to the mother and infant dyad. Where as in my private practice, there are many fewer barriers to breastfeeding. These mothers have plenty of support and they see breastfeeding as the cultural/desired norm.
What are the unique challenges of each of these kinds of work?
I wish I could do more for these mothers. A single mother who has 5 children at home giving birth to a 28 weeker, and her car breaks down…I wish I could find a way to fix her car! Talk about stress and socio-economic factors! Also, the father of the baby is not involved. How do I meet her needs? Need I say more? My heart breaks for the disadvantaged families here.
The rewards of seeing healthy babies going out the door. That is a huge reward! The biggest reward is the great big smile on a mother’s face when she can tell that the baby is nursing well. Often times, NICU mothers have a hard time exclusive breastfeeding when they go home because they still have to supplement and because they don’t trust that the baby will get enough. I do test weights so the parents can see what baby is getting. I have had a mom of twins that is now exclusively breastfeeding because she was coming in for outpatient consults after her babies were in the NICU. That has been a very rewarding experience for her and me.
I have to say that my private practice support group recharges my soul when I get discouraged working in the NICU. Those mothers and babies in the NICU have so much working against them, separation, sick baby, having to pump, stress, stress stress. Nurses that are used to measuring everything going in and going out that are unsure of breastfeeding and inadvertently say the wrong things…parents that stop pumping or don’t want to put baby to breast and I feel like I have failed them…like I have let them down. Then I go to my mother’s support group and look at the 2 year old that is still nursing whose mommy told me he was a failure to thrive 20 months before. I am encouraged how we worked together and he is a beautiful happy breastfeeding boy! Or the mom that says she is thinking of weaning and at the end of group says, “Nope, we’re not ready yet”. I have moms of newborns that are having melt downs and another mother puts her arm around her and tells her not to give up. I have hope for the next day.
Annapolis Breastfeeding Care,LLC, was formed in January of 2008 by Kathleen Stahl, recognizing the needs of women and infants with the desire to receive services in the privacy and comfort of their own home. Kathleen provides private home consultations, breastfeeding classes, pump rentals, sales and breastfeeding accessories. Kathleen has been a registered nurse since 1994 and an International Board Certified Lactation Consultant since 1999.
After years of working in Labor and Delivery, Kathleen decided to dedicate her nursing skills to helping mothers breastfeed. Kathleen is a strong believer in the many benefits which breastfeeding provides for both mother and baby, and after almost 10 years of working in Lactation departments, helping mothers and listening to their struggles and concerns (and having had two kids of her own!), Kathleen realized that having to travel back and forth to the hospital with a newborn added unnecessary stress to new mothers. So, in January of 2008 Kathleen started Annapolis Breastfeeding Care, LLC, which offers a wide array of lactation consulting services, geared towards bringing quality lactation services and products to the comfort of one’s home.
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