Moment of Clarity

A client left me a message at the office while I was out in the field. She told the administrative tech she was having problems breastfeeding and she needed to speak with me right away. I remembered talking to this client a while she was pregnant and she was very interested in breastfeeding. She had two other children but she stated she had them young and she had no desire to breastfeed with them. She was adamant about trying with her third child. She was concerned she wouldn’t be able to because she had a breast reduction. I told her that most of the time women who had breast reduction surgery would be able to breastfeed. It just depends when the surgery took place and what the surgeon had removed. The only way to really know for sure is to see once the baby was born and then see how much the breast would produce.

So I went out to see the client the next day and completed my assessment. The infant had lost a few ounces, the baby would latch only to one breast, and he didn’t have enough voids or poops. These were all signs that her baby wasn’t getting enough to eat. I witnessed a feed and my client’s infant was very fussy at one breast vs the other. I immediately recognized that one breast probably wasn’t producing milk or the infant wasn’t able to get enough from one breast. Even though my client was having all these difficulties she was still serious about continuing to breastfeed. My client didn’t have a pump but she did qualify for one through WIC. The rule with WIC is that the mother has to wait 6 weeks after she delivered to get a pump. My client had just had her baby a week ago. They MIGHT issue the pump if the baby has a medical issue. My thoughts were well it is a medical issue because a) the baby had lost weight and although this is common; he had lost weight because my client b) had a breast reduction which is further proves the medical issue. That should be enough, right?

So I called an IBCLC while was on the visit at a local hospital because proving the breast reduction could be part of the issue was out of my scope of practice. (Read further about that here :  if you are so inclined). She agreed to see my client the next day. Then I called her local WIC office to see if they would be able to give her a pump early. No answer. #sigh Meanwhile, I encouraged my client to do hand expression and told her she is going to have to supplement with formula in the interim. I also told her that I would continue to call WIC to see if they could set her up with an appointment and see if they could give her a pump based on specific medical conditions. I would follow up with her the next day.

The next day I talked to the local IBCLC and she confirmed everything I saw in my visit. She couldn’t tell specifically what had happened because she didn’t have the doctors notes about the breast reduction but she did notice that one breast was producing a significant amount of milk than the other one. She recommended that my client needed to pump and she would have given her a pump but she didn’t have to give at the time. I then called my client also took her baby back to the pediatrician and he had lost more weight (which was a full pound at this point) and they recommended that she supplement with formula immediately. Of course my client felt defeated and riddled with guilt. I assured her that everything would be okay and this was just a bump in the road. I told her that now that we know what is wrong, we can do things to fix it. Still encouraged her to give hand expression a try and tell her to try to stay encouraged. By this point I had I finally got in contact with someone at another WIC office (my client’s local one still hadn’t called my back) and told them about my client. She had an appointment to see them on Monday morning at 9am.

So fast forward to Monday morning and FINALLY get a call from my client’s local WIC office……a whole 2 business days later. The nutritionist proceeds to tell me about their policy about giving away breast pumps and how my client hadn’t been in the clinic for several months and pick up her vouchers and etc and so forth. (._.) So I told her as politely as I could that I was familiar with WIC’s policy of giving away pumps and the reason why I asked for the pump was because of medical reasons. I told her that my client went to see an IBCLC because of her breast reduction and her having difficulty with latch, and the baby had lost a pound. Once again the nutritionist had to try to trump me with her expertise. She told me that mom needed to try skin to skin to help get the milk flowing and mom was so stressed that this could be the reason why mom couldn’t produce milk. Nevermind, I told her that my client was producing milk significantly from one breast than the other. Nevermind the IBCLC had confirmed my thoughts. Nevermind the baby had lost a FULL pound in a week. More importantly, nevermind the client had did everything in her power to try to continue to breastfeed her son. The nutritionist was more concerned about being RIGHT than helpful. Needless to say, she wasn’t able to get a pump because breast reduction is not medical concern according to WIC. So I got frustrated with her call and ended it quickly.

I was pissed for the entire day. I don’t want to trash WIC as an entire organization because they have done so many things to further the cause of breastfeeding. But how many mothers had that nutritionist spoken to that way? How many mothers had they discouraged by their tone? How can you support a mother if you are more concerned with being right with the information you give them instead of actually LISTENING to them? The nutritionist claim she was an CLC but one of the first things you learn as a counselor is to put your biases aside and “counsel” the client. Then if a client has an issue with breastfeeding  does it take 2 whole business days to return the call? That’s eternity to a breastfeeding mother.

I think it was at that moment I realized that I have to get out of public health. There is too much red tape you have to go through to help people the way I really want. Secondly, it is so black and white. There are NO shades of grey. My client couldn’t get the pump because ‘on paper’ the medical reason wasn’t listed on WIC list of reasons. Thirdly, most of the employees in public health (well in my area) are so jaded about the clients we serve and the work we do. My nutritionist friend didn’t feel like going an extra step to serve my client even though I did. I felt like she could have and maybe I’m wrong for expecting the best out of people. i know one thing I’m tired of…being around people who lack passion about what they do. I need people around who drive me and vice versa.

My client was able to get a pump. Two actually. One of her church members bought one for her and her son’s pediatrician was able to get her one through the Affordable Care Act. Thank God for small miracles.



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