Andrea Altomaro discusses the importance of lending an ear to a patient in times of emotional distress.

Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Spoiler Alert: This post discusses events in Call the Midwife Season 5 Episode 2

Our next episode of Call the Midwife brought along a lot of parallels between 1960s Poplar and our modern-day midwifery practice. We saw Barbara struggle with Mrs. Stella Beckett who was going through a lot of stress and anxiety because her husband was not working; they were struggling financially. Barbara seemed naïve in offering Stella breathing techniques to help her relax, however I felt like I could relate to Barbara in that moment. I have been a midwife for a few years now, but much like all of us, I am continually learning. Sometimes our patients are going through hardships that are so much more difficult than we can understand, let alone help them through. Though we can offer small bits of advice, something I have learned as my practice has evolved is that sometimes listening is much more helpful. Relaxation techniques and deep breathing can work at times, but having a safe place and a caring provider that takes the time with you to make you feel heard is invaluable.

Sadly, our schedules really don’t allow for lengthy conversations; we are usually expected to see each person in around 15 minutes. However, I have found that sometimes it’s worth it to spend the extra five to 10 minutes with someone who may need it. I hope all of the women I serve understand that while I may be running 15 minutes behind, it was because a mother was struggling with postpartum depression and I was spending extra time listening and coordinating follow-up care, or because a young teen had many questions about her body. I have found that when you take your time, make eye contact and listen to your patients, giving them your full attention for the 15 minutes allotted, they understand why you might be running behind. They feel listened to and valued. This relationship is a cornerstone of midwifery and is what keeps women coming back to us for their care.

There are times, however, when our own biases might get in the way of us listening fully to our patients. We saw an example of that this week with Sister Evangelina and Mrs. Connie Manley. As a midwife and a fierce breastfeeding advocate, I could completely understand Sister Evangelina becoming riled up hearing the formula advertiser. Better than breast milk? It will make your baby more intelligent? Sounds like a load of rubbish propaganda to me, too, Sister! I would probably also be up in arms if this woman was in my clinic, feeding this information to the mothers I care for.

I’m going to say right here that I agree that breast milk is amazing. I agree that processed infant formulas pale in comparison to the antibodies and nutrients in breast milk. Breast milk is the best milk for human babies, and it is created by our bodies specifically for our babies. However, I do believe that fed is best. This is much easier for me to say having gone through my own breastfeeding struggles with my son, sobbing at home four days after he was born because I needed to give him a bottle of formula. He had not had any wet diapers that day. He was losing weight. Here I was, a midwife, and I couldn’t even feed my own baby!

I’ve watched many women sometimes spiral into a depression surrounding breastfeeding difficulties. As natural as breastfeeding is, there are many challenges in the beginning. There can be so many reasons why a mother who is dedicated to breastfeeding might struggle. In my case, it had to do with a previous breast surgery. It might take a long time for milk to come in. A baby’s latch might not be correct, which can lead to pain and difficulty getting milk from the breast. Some of these problems can be solved with help from a knowledgeable lactation professional, like an International Board Certified Lactation Consultant (IBCLC).

Of course, it takes a lot of work from the mother and the baby. Sometimes even with the best help and the most motivation, breastfeeding isn’t exactly perfect. As midwives, we can offer nonjudgmental support and resources to help women based on what their desires are. Some women want to keep working with breastfeeding, some want to formula feed. Some might want or need to do a combination of both.

My heart broke for Connie when she felt like she was letting her baby down by not being able to breastfeed. I understood Sister Evangelina’s distress when she realized how much she had pressured Connie into continuing breastfeeding, along with inadvertently making her feel like a bad mother if she chose to use formula. This ultimately led to her baby becoming very dehydrated, and I was so very thankful that Mr. Manley called for help when he knew that something was wrong.

We must remember, a mother is not just a vessel for her baby, then a milk-producer. She is a human being with experiences, feelings and her own mental health. Women need to be given evidence-based information and then be allowed to make their own decisions. We use this philosophy throughout our midwifery practice, and here it is no different. A woman might simply not want to breastfeed. Did you know that one in five women have been sexually assaulted? This can be a huge contributor to not even wanting to try breastfeeding. Some women aren’t comfortable with the idea. They have never seen a woman breastfeeding, they have never known anyone to breastfeed or they might want help from their partner with feeding the baby. The bottom line is this: Offer the information, then allow women to make their own decisions. All women deserve to have their choices respected.

Andrea Altomaro (MS, RN, CNM) has been nurse-midwife for the past three years and is currently working for the Henry Ford Health System. Before becoming a midwife, she worked as a nurse in the emergency department and also in labor and delivery.
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