Читать книгу Better Births - Anna Brown - Страница 36

Whilst working on labour ward, I cared for a woman who had her first baby. Our shifts are 12.5 hours long, so we spent a good amount of time with Lois and Jake, her birth partner. I got to know them well and at the end of the shift I left and wished them well.

Three weeks later I came onto shift and Lois's name was on the board as having just arrived in triage. I offered to go and see her as I already knew her. Upon greeting the couple, Jake was holding the baby, who was well and settled. However, Lois had been suffering with her mental health since birth, despite good family and community midwife support. Jake stated that overnight Lois had been having psychotic episodes and had come to triage.

Lois remembered me and embraced me when I entered the room, so very happy to see someone she knew. She was very lucid, and I was able to take her observations and talk to her about her baby. She had struggled with breastfeeding over the last few weeks but was now feeling like it was going much better. I helped her get comfortable and she breastfed her baby beautifully and calmly.

I stayed with her the whole day and was present when all the relevant medics and psychiatrists reviewed her. She was veering between being lucid and experiencing psychotic episodes all day. The first line decision was for Lois to be medicated initially; however, this would mean stopping breastfeeding as the drug would pass through the breastmilk to her baby. She was adamant that she would not stop breastfeeding as it was the only thing she was doing well for her baby.

Lois's capacity was limited, and as her midwife I needed to advocate for her. I knew how much breastfeeding meant to her, and there is very good evidence that links breastfeeding and emotional wellbeing of a new mother. The psychiatrists were adamant that Lois would need to stop immediately and take the medications. I stayed until she was lucid enough to ensure that she had an understanding that for her benefit and of her baby, the medication was the best option for now. However, this wouldn't mean stopping breastfeeding altogether. I got a breast pump for her, with a view to keeping up her milk supply whilst on the medication.

Jake was bereft and felt unable to help, so I arranged for a nursery nurse to show the couple how to correctly make up a formula feed and to sterilise the feeding equipment.

As a midwife I would always support breastfeeding continuation for the benefits of both mother and baby, but ethically at this time, stopping breastfeeding was the only option to try and help with Lois's psychosis. But keeping her milk supply established, using a pump, would give her the option to return to breastfeeding once the medication was stopped.