Since 1976, Chris Auer has assisted mother-baby pairs at the Cincinnati Medical Center. Here she relates a tale of two mothers, miles apart, in very different circumstances, to illustrate how breastfeeding is a great leveler.
Breastfeeding is a natural ‘safety net’ against poverty. If the child survives the first month of life (the most dangerous period of childhood), then for the next four months or so, exclusive breastfeeding goes a long way toward canceling out the health differences between being born into affluence … It’s almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born. James Grant, Past President UNICEF.
When seeing babies at the outpatient breastfeeding center, my first impression had never been startled, but when Monica came in with her four-month-old, my mind began to race with worry. The baby was alarmingly failing to thrive. With prominent eyes and sunken cheeks, her features were not unlike starving babies in ads for developing-world relief efforts. Monica had been to the pediatrician the day prior, and he had recommended she set an appointment at the center. Now I was glad we’d gone ahead and squeezed her into the schedule. There was nothing from the phone call that warned me it was an emergency. She simply said her pediatrician recommended that she come in because the baby wasn’t gaining well. That was an understatement!
As Monica told her story in person, we knew that she, indeed, understood the gravity of the situation. The baby had gained well at every check up through the two-month visit. At that point, the next visit was scheduled another two months out, coinciding with the baby’s next immunization. Monica, a single mom, had returned to work just after this two-month visit to the pediatrician.
She was employed driving a city bus during the night shift. The baby stayed with a woman in the same downtown apartment building. Monica would pick her baby up, nurse, fix herself a bite to eat, and then go to bed for the next seven or eight hours. For those two months, the baby slept in her bed and nursed intermittently as mother dozed. Our best deduction of what transpired was that the baby had begun to latch by just barely grasping onto the nipple, eking out only small amounts of milk. Meanwhile, Monica’s body reacted by making less milk each day.
Monica was heartsick; feeling mortified that she’d not noticed what was now apparent. She was so proud of how initially successful breastfeeding had been but now tears streamed down her face as she recounted their story. We both felt for this mother, as Dr. Ballard gave her a box of tissues and embraced her while quietly reassuring her that her baby would soon be better. While Monica worked to rebuild her milk supply, she provided the baby with plenty of formula nutrition to boost her gradually back to the growth curve she’d fallen off. Rebuilding Monica’s self-confidence as a mother would take longer than rebuilding her supply.
I firmly believe that breastfeeding acts as a safety net for infants born to low-income mothers. Monica’s story reveals the wider implications of her poverty that include not having a breastfeeding support network among her bottle-feeding peers and not having a network of well-connected friends that could help her tap into lactation resources sooner. I saw another infant shortly after Monica’s baby. It prompted me to reflect on the different lives of the mothers of these four-month-olds, from drastically different environments.
Cindy was not a patient at the lactation center. She was the sister of a neighbor, and was in town with spouse and child, visiting from a suburb of Detroit. Her firstborn, Emily, was four months old. Susie, her sister, called asking if I had time to come over and examine Cindy’s breasts, as she was experiencing nipple pain that radiated into her chest wall. She’d had no nipple pain prior. While it’s beyond my scope of practice to diagnose, I agreed to go over and provide a little guidance. I’d met Cindy before when she was in town. She was a pleasant, healthy woman in her late 20s, with a supportive husband who is a successful businessman.
Arriving at the house, I learn that Cindy is on an indefinite leave-of-absence from the firm where she practices law. She has a group of friends who are also breastfeeding moms. She’d begun having breastfeeding problems less than 24 hours earlier. The baby is still sleeping, and we chat before I take a look at her breasts. Her red nipples, shiny skin, and description of pain are symptoms strongly suggesting infection, likely requiring medicine before she starts feeling better. She agrees to call her doctor on Monday. I am confident that Cindy will follow through, be treated, and continue breastfeeding Emily without missing a beat.
As the baby awakened, she begins to root, smacking her lips until she finds her fist to suck. Great, I’m thinking, I can watch her latch. I express my delight that I’ll get to observe a feeding. But instead of Cindy picking up her baby, she picks up her Day-Timer (pre-smart phone) and begins to scan her elaborately detailed notes on dates, times, and minutes of each feeding.
“Cindy!” I address her, even as I snatch her little black book and close it without perusing. “Tell me you have not been keeping a daily record of Emily’s feedings for four solid months? Look at your baby—what’s she telling you?”
With that, Cindy ekes out a chuckle that explodes into a belly laugh. She realizes the obvious, and picks up her baby.
Chris Auer is a registered nurse and lactation consultant who has worked at the University of Cincinnati Medical Center for 42 years caring for mother-baby pairs from all walks of life and from as many as 77 countries, particularly those within a high risk demographic and in a Level III NICU setting. For over 20 years, Chris has provided pediatric resident lactation education and internship training and has published articles in seven peer-reviewed journals. See, too, A Breastfeeding Mother and her Newborn’s Drug Withdrawal.