Cross-Cultural Lactation Consultation

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7 Sept 2013

Acholi babies breastfeed well right after birth. Even first-time mothers have no doubt about their ability to breastfeed. They were breastfed as babies, and they see mothers breastfeeding all the time, for Acholi women with young children breastfeed openly whenever their babies cry. It is natural, normal and totally accepted in Acholi culture – which is quite different from American culture.

In the U.S., I was trained as a certified lactation specialist by IBCLC (International Board-Certified Lactation Consultants) educators, but I haven’t needed to apply any of that training here – until recently.

A baby girl was born here who required resuscitation after birth. She was slow to transition to a healthy, alert state, and she did not seem to be breastfeeding well. Other midwives were for caring for her for a few days before midwife Stephanie asked me to look at the baby, too.

The baby seemed listless when I was examining her with Eugenia. I was concerned about her energy level. She was a small baby, but did not seem to be preterm based on a gestational age assessment (which included peeling skin), and I wondered if this were another IUGR baby – or if the difficulty of her birth and the last few days postpartum had simply exhausted her.

Since other midwives had asked the mother to express milk into a bottle, and it was sitting there waiting for the baby, I went ahead a did a finger-feeding with a syringe full of breastmilk. The baby sucked on my finger, and as she did that, I would release some of the milk into her mouth from the syringe. As she drank, her eyes brightened and focused, and her energy level went up. She also bit down hard on my finger with her gums, which babies do when they really want their mother’s breast to release more milk when it isn’t coming fast enough. So I knew she was hungry, she had a good sucking and swallowing reflex, and she wanted to live. Then, full, she went to sleep like any normal newborn would.

After I did my assessment, I could tell the mother that the baby had three good things going for her: she had a fine sucking reflex, she was swallowing, and she was peeing. But there were two problems: the baby’s tongue was not extending past her lips, which is usually needed for a baby to get a good latch (yet there was no tongue tie!), and she showed absolutely no rooting reflex at all, even with attempts to stimulate it, which is unusual.

The mother affirmed that she was breastfeeding multiple times throughout the day and night, and that she was expressing milk into the baby’s mouth, but she asked me if we would need to transfer the baby to LaCho Hospital based on the two problems I had identified. I suggested she feed the baby normally, at the breast, throughout the night. I would come again in the morning to assess breastfeeding.

In the morning, I observed the baby at the breast, and I could see why my fellow midwives were concerned. The baby did not latch, attach, and suckle vigorously like most four-day old babies do. So I wondered if she were actually transferring enough milk at the breast or not.

Later in the day, however, we weighed her, and found she had gained four grams beyond her birth weight! This was extraordinarily good to see. She was released to go home with her mother – because, after all, weight gain is the bottom line in determining whether babies are getting enough milk at the breast. Two days later, Eugenia made a home visit to check on her, and she found the baby was nursing very well and had gained even more weight. Pure happiness!

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Makeda in her father’s arms

What did I learn from this? Even without a visible rooting reflex, and despite a short tongue, breastfeeding can work just fine. Thank God!

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