Fresh

Most of us will only rarely, if ever, have the opportunity of being around a truly newborn baby. /Fresh from their mother’s body their skin is a pinkish purple color, still plump from being in a water world for the past 9 months of their life. They are, perhaps surprisingly, very warm. If kept with their mothers, they rarely cry and are quite alert; gazing curiously and seriously into the eyes of those who have the privilege of holding them. I happen to think the first few minutes or hours of life are perhaps the closest thing to magic here on this Earth. At only a few hours of age a newborn is already noticeably different; their skin becomes more easily chilled and mottled. They seem to almost deflate a bit. A few hours old baby is often quite sleepy and you will not see much, if any, of their eyes open until they are more than 24 hours old. The first few moments of life are fleetingly beautiful and unique time in life.

Afew days ago I was called to assist with a brand new baby; only minutes old. I usually see mothers a few hours to a couple of days postpartum; my skills are generally more valuable after mothers have had a chance to recover a bit. We were crazy busy that day; full to the point of transferring patients to other hospitals. One of the nurse managers had been called to assist with a difficult birth and asked me to come down and help afterwards as the mother was very upset during the birth and really needed, from an emotional perspective, for breastfeeding to go well. I walked in the room to find the mother raised up high in the bed, flat on her back, legs spread eagled, blood smears everywhere. Her (completely healthy) baby was off in another corner of the room being weighed. A nurse, the baby’s father, and the baby’s grandmother were cooing over the baby. The mother lay alone, shaking, trying to lift her head to catch a glimpse of her new baby. The labor nurse was cleaning up the room. I had a visceral and immediate reaction to the scene. I remember how after a challenging 44 hour labor with Older I longed only to hold him. Being apart from him, even just to have him checked over after a difficult birth made me feel an utterly empty despair. At least my midwife stayed by my side, holding my hand, advocating for my baby to be brought back to me (which, after a few long minutes, he was). I also remember how I shook after Baby’s homebirth. I could not get warm for hours, but rather than being left alone I was helped to my own bed where Baby lay on my chest, Husband sat next to me, and I was covered with warm blankets.  I’m still new at this job – fresh here – and finding my place. I realize that someday my tendency speak my mind and take charge is probably going to get me in trouble (again – it already has in the past) but within thirty seconds of walking into the room I began to work – and it wasn’t to deal with breastfeeding. “Why is baby not with the mother?” I asked. I moved some equipment so that mom could see the baby better. The mother had been planning a homebirth and after the birth had not gone well she had transferred to the hospital to eventually require a forceps assisted birth from an obstetrician. The mother’s midwife had come with her from home but within a minute of my entering the room, she left, stammering that “she thought she was coming down with something and didn’t want to pass it on the baby.” I was flabbergasted that the midwife would leave the mother at probably THE most vulnerable moment of her life. I was also perplexed; the midwife didn’t feel well enough to handle the baby, but she didn’t seem to have an issue with being potentially contagious and being in very close contact with the mother. I doubt she was sick at all, but instead wanted to leave the hospital to avoid questions. Midwives like this woman give the homebirth and the field of midwifery a bad name. I stepped to the mother’s side and in between asking the baby’s nurse to get baby back to mom I asked the labor nurse for warm blankets for the mother. I held the mother hand until the baby’s nurse gave me a curt nod and I told the father (who seemed oblivious to his wife) “Pick him [the baby] up and bring him to mom. I tucked the baby in under his mother’s gown. The baby was crying and both he and his new mother looked lost. I told that her that baby knew her voice and to speak to him softly while patting or rubbing his back. I turned the lights down low and the baby opened his eyes. The warm blankets arrived and were tossed on the foot of the bed. I covered the mother up and she gave any audible happy sigh.

The obstetrician then walked in the room. He spoke to the mother “congratulating” her on “letting him” use forceps. “If you hadn’t said yes to the forceps, I would have had to section [Cesarean Section] you,” he said with a little chuckle. He then went to on expound upon his skills with forceps and difficult births, how long and illustrious his career had been, and how lucky she was to have had him as her OB; anyone else “would have just sectioned you” he said. I looked on aghast . Here was this new family meeting their baby for the first time; moments they will NEVER get back and the OB is taking precious minutes blowing into the balloon that is his ego. He then turned his attention to me. Although we had met before he didn’t remember who I was and mistook me for a pediatrician. He was surprised when I told him I was a lactation consultant. He said I sure acted like a doctor. I think he meant it as a compliment. He then said “Well I’m done with this one!” and scurried off (presumably to “save” some other mother), muttering under his breast that “this sure was a tricky one”. Obstetricians like this one give the field of obstetrics a bad name. 
While the mother was distracted by the OB, the baby had begun to root and the mother instinctively guided him into a better position. “See you don’t need me,” I said. “You both know what to do.” The mother was still shaking and unsure so I explained how the baby’s behavior would lead to successful breastfeeding. I told her why she was shaking, how long it might last, and what her husband could do to make her feel better. I congratulated her on a fantastic job giving birth. We enjoyed a few quiet minutes together, me reassuring her, and occasionally helping reposition baby. With her more comfortable and distractions minimized she and her beautiful new son really did know what to do and the baby began to suckle. And although I could have happily stayed in that room for a while longer soaking up all that marvelous new baby energy I left them alone; things were going well now and it was not my place to intrude upon their nascent family.  
I’m happy here at my new job. I’m helping mothers and babies every day and I am being included in management decisions. I’ve even got my own office and coworkers that bring me chocolate. I’m definitely needed. But everyday I am fighting an uphill battle. There are so many things to change. Breastfeeding doesn’t exist in the absence of birth and birth sure is rough on mothers in this country. I started keeping track of everything I want to do – just directly related to breastfeeding – by writing it down on a post-it note and sticking it to my wall. There are 15 yellow squares on the wall so far. I am fighting against decades of ingrained cultural and medical practice and I feel like they’ve got nuclear weapons and I’m fighting back with a squirt gun (full of breast milk, of course). I didn’t get to dealing with any of the yellow sticky notes last week. But I hope I hope that mother can look back on her birth experience and remember the warm blanket and the baby content on her chest. 

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