The best way to protect babies from lactation consultants who lie

11714559 - never - word written in colorful chalk on a blackboard

For the past two days I’ve been engaged in a discussion in a private Facebook group about the injuries and deaths caused by lactation consultants who lie. As anticipated, I was met with a wall of denial from lactation professionals. During the course of the discussion I presented more than a dozen scientific citations and those disagreeing with me presented zero, yet that didn’t move the lactation professionals even a tiny bit. Neither did the reports of infant injuries and deaths including the heartbreaking and entirely preventable death of Baby Landon Johnson.

Making breastfeeding readmissions never events will reduce the epidemic of babies injured by relentless promotion of exclusive breastfeeding. It will save babies and it will save money — the ultimate win-win.

As I noted earlier this week — lactivists lie first and foremost to themselves and each other — claiming that insufficient breastmilk is rare when it is common. The purported justification is that women are “designed” to breastfeed. It’s like insisting that nearsightedness is rare because eyes are designed to see.

The wall of denial illustrates the primary problem with lactation consultants; they aren’t real medical professionals. When a patient dies from a hospital error — and, make no mistake, infant injuries and deaths from exclusive breastfeeding are hospital errors — real medical professionals ask, “how can we avoid this happening to anyone else?” Lactation consultants, in contrast, ask, “how can we avoid blame?”

Therefore, the best way to protect babies from lactation consultants who lie is to force hospitals to monitor them. The best way to do that is to designate breastfeeding readmissions as “never events.”

What are “never events”?

According to the Agency for Healthcare Research and Quality (AHRQ):

The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to particularly shocking medical errors (such as wrong-site surgery) that should never occur. Over time, the list has been expanded to signify adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable…

For example, the “death or serious injury of a neonate associated with labor or delivery in a low-risk pregnancy” is a never event.

Hospitals should do everything in their power to prevent never events, since the whole point is that they should never happen. As a result:

Because Never Events are devastating and preventable, health care organizations are under increasing pressure to eliminate them completely. The Centers for Medicare and Medicaid Services (CMS) announced in August 2007 that Medicare would no longer pay for additional costs associated with many preventable errors, including those considered Never Events. Since then, many states and private insurers have adopted similar policies…

In other words, when a hospital presides over a never event, they will not be reimbursed for the treatment required as a result. That’s a tremendous impetus for hospitals to do everything in their power to prevent never events. Most importantly, it an unbiased, independent method of holding hospital employees to account even when hospitals themselves would prefer not to do so.

There are currently 29 designated never events. We should add a thirtieth: death or serious injury of a neonate associated with exclusive breastfeeding in a low-risk pregnancy that occurs within the first two weeks after birth.

If hospitals had to bear the cost of readmissions for dehydration, hypoglycemia and starvation, it wouldn’t merely break a hole the lactation consultants wall of denial about the high incidence of insufficient breastmilk; it would obliterate it.

How common are such readmissions?

According to this 2013 paper in the journal Pediatric Emergency Care:

In the neonatal period, dehydration … is one of the most common causes of re- hospitalization. According to the serum osmolality, dehydration is classified into 3 forms as hypernatremic, normonatremic, and hyponatremic dehydration. Hypernatremic type is a potentially lethal form because it adversely affects central nervous system, leading to devastating consequences such as intracranial hemor- rhage, thrombosis, and even death. Recently, along with many other etiologies, early discharge and failure of breast-feeding are increasingly documented as major causes of hypernatremic dehydration.

High serum sodium (Na) concentration, which is associated with diminished fluid or excessive Na intake, or excessive fluid loss, is usually caused by inadequate breast-milk feeding in otherwise healthy newborns…

How common is readmission for neonatal dehydration?

During the study period, 4280 neonates were admitted to NICU. Among them, 97 had HD. Sixteen patients were ex- cluded from the study. Prevalence of HD was 1.8% (81/4280). All the patients were fed with breast milk. Fifty-nine patients were born in our hospital; 51 patients were discharged from the hospital within the first 48 hours of life.

And that’s just readmissions for dehydration. When you add hypoglycemia and injuries that result from infants falling from or smothering in mothers’ hospital beds the numbers would be considerably higher.

The cost to the hospital if insurance companies refused to pay for these readmissions would be enormous. As a result, we could expect to see hospitals’ risk management departments undertake thorough education on monitoring of its lactation consultants.

At the moment, lactation consultants have no accountability when babies are injured or die as a result of their lies and their relentless promotion of exclusive breastfeeding and near pathological resistance to the benefits of formula supplementation. That would change quite dramatically and it would no longer be possible for them to continue lying to themselves, each other and vulnerable new mothers.

If we take lactation consultants at their word, they should be delighted to accept accountability. According to them, neonatal injuries and deaths as a result of exclusive breastfeeding are vanishingly rare and are prevented when lactation consultants assiduously weigh and monitor newborns and offer timely formula supplementation.

If they’re wrong, it’s going to cost hospitals a fortune. As a result lactation consultants will no longer be free to ignore scientific evidence in favor of ideology. Moreover, they will start telling mothers the truth about the fact that insufficient breastmilk is common, particularly during the first few days after birth. They will teach mothers to look for and respond to the signs of dehydration instead of falsely reassuring them that these warning signs are no reason to be concerned.

Most importantly, making breastfeeding readmissions never events will reduce the epidemic of babies injured and even killed by overzealous encouragement of breastfeeding.

It will save babies and it will save money — the ultimate win-win.

  • momofone

    OT: I saw an article about the Australian member of Parliament who breastfed her baby at work this week, and the intro said something along the lines of “the baby who was breastfed will have something to brag about on the playground in ten or eleven years.” I have a ten-year-old and am absolutely certain that no one “on the playground” is talking about how they were fed. In fact, I’d just about bet that talking about that would be a sure path to spending recess alone.

    • Empress of the Iguana People

      *snort* good lord, I’ve seen a couple headlines but neither said anything that silly!

  • D/

    Unfortunately, the push for breastmilk exclusivity is no longer restricted to the domain of lactation consultants or of BFHI-designated facilities.

    Physicians and nurses are influenced by administrative expectations of increased exclusive breastmilk feeding rates, and EBF has been so effectively “marketed” for public consumption at this point– that in my own practice– it is regularly becoming an adamant parental directive … even when supplementation is beyond obviously necessary.

    Now I don’t believe for one minute that mothers (and medical professionals) are spontaneously developing some new innate unwillingness to feed babies. Breastfeeding advocates have just done their job “well”, too well actually.

    The virgin gut is common knowledge or a simple google search away. Now we’re not saying that formula is bad or that YOUR baby doesn’t need formula. We’re just saying that anything else but breastmilk in a baby’s gut, and well there goes his virginity for chrissakes! … And we’re not saying YOUR baby doesn’t need formula or that YOU using formula would be a bad thing. We’re just saying that breasts won’t make more milk unless more milk is moved out of them, and feeding formula moves less out, not more … And we’re not saying YOU will definitely make enough milk for YOUR baby to grow and thrive or that YOU will not need to use formula. We’re just saying mothers who feel they aren’t making enough milk are wrong often enough that they should always question themselves … /s

    As for doctors and nurses, *every* JCAHO-accredited hospital in the US delivering >300 babies per year is expected to report on the Perinatal Care bundle (which includes EBF) and are expected to “increase” their EBF rate as a quality metric for continued JCAHO certification regardless of BFHI designation. In my non-BFHI hospital practice, this expectation is being driven by non-clinical, administrative directive with an ultimate **100% EBF** rate target … because “without that hard target the importance of EBF is minimized”. Our efforts are deemed successful by conditionally formatted cells in a spreadsheet that make pretty colors with a 10% annual increase in EBF.

    Despite BFHI guidelines **clearly** stating that the focus must never be on withholding formula as the first and only step to influence EBF rates, that is in fact the “easiest” way to influence them. Since most babies can manage being underfed for those early days without something disastrous happening, our ability to reassure parents’ concerns with tiny belly-tiny feedings talk and prescribing the normalcy of almost all mothers making enough milk works as a go-to feeding plan enough of the time that it is tempting to fall back on, again and again. After all, exclusivity is important– whatever the reasons– sometimes for everyone.

    The EBF cow’s been let out of the barn, so to speak. I’m ashamed to say that I wished for this, for some outside expectation of quality breastfeeding support as a means to assure adequate resources for doing my job. Yet another example of being careful what you wish for, I suppose 🙁

  • BeatriceC

    Totally OT: Today is OK’s 18th birthday. It hardly seems possible that this much time has passed. It seems like only yesterday he was just a baby. Where does the time go?

    • Chant de la Mer

      Congratulations! It’s an enormous amount of work to not murder your teenager and you got him all the way to 18! Seriously though congratulations on raising an infant to adulthood, it’s really hard and the job isn’t even quite over yet. I’ve got one nearly there and it’s rather bittersweet.

      • BeatriceC

        One down, two to go!

        • Empress of the Iguana People

          Did you get him his very own penguin?

          • Empress of the Iguana People
          • BeatriceC

            I don’t have a picture handy, but he has an entire flock of stuffed penguins. I think he’s got over 50 of the stuffed critters.

          • Empress of the Iguana People

            Penguiny here is BoyBard’s 2nd best friend (after Snoopy). He picked Penguiny out himself last year. Penguiny is a he, not a she.

          • BeatriceC

            Alas, he did not get his own penguin. Due to my health crisis last week and my ongoing political activities, today snuck up on me without me realizing it, so I took the easy way out. I shoved all the cash I had on hand into a card and called it good. He didn’t complain.

  • Empress of the Iguana People

    Hear here!

  • BeatriceC

    I replied to a comment on FB, but it brought up a question. How do you track readmission rates when the infants is admitted to a different hospital than where he or she was born? Regional hospitals may not have adequate pediatric units so ER’s would transfer to larger hospitals, or parents might take the infant to a Children’s hospital ER instead of the hospital where the mother delivered, or any other of the dozens of reasons I can think of why the infant would be admitted for care to a different hospital than the hospital of delivery. Is this sort of mobility affecting our ability to show trends even now?

    • Young CC Prof

      My son was readmitted to a different hospital because it offered a higher level of care. Yes, this happens a lot, and it allows small community hospitals to ignore the problem because they aren’t seeing the babies come back.

      Still, insurance records would allow proper tracking anyway.

    • Mattie

      Do the hospitals not communicate? Like, what about child abuse cases where parents go to multiple different hospitals? Here if you go to A&E or are in hospital they tell your GP who will follow up with you once you’re out of hospital.

      • BeatriceC

        If they’re within the same system, yes. Otherwise, not always. For example, I mentioned I recently presented to the ER with a sudden and severe headache. It was so bad that we went to the closest ER, not the ER affiliated with my doctor’s office. In order for my doctor to get my hospital records I had to sign a release. There are four main systems in San Diego: Kaiser, Sharp, Scripps, and UCSD. My doctors are a part of UCSD. The hospital I went to was a part of Sharp. They don’t talk to each other. If I could have managed the additional 10-15 minute drive to the UCSD ER, my doctors could have just pulled up my records from their office computers.

        • Mattie

          Oh man :/ we had some pretty high profile child abuse cases where children presented at different hospitals, then they changed the system so that admissions were tracked better. You’d think that the hospitals could work something out to better communicate 🙁

          • BeatriceC

            It would perhaps be nice if patient records followed them around a little bit better. It might have prevented a full stroke code from being run on me if the hospital where I presented knew that I have normal-for-me right side weakness (possibly not, as the sheer amount of pain and other symptoms might have warranted the code, but from what I recall, it was the neuro exam that was the final trigger for the code to be called). At any rate, this is another example of why the US healthcare system is a complete mess.

          • Azuran

            Although it would be nice to have universal records, it would be something VERY huge to implant.
            We are basically talking having every health care provider of any kind (both private/public and both in and out of hospital) to all use the same computer system.

            Putting aside the basically impossible task of having a computer program that would fit every kind of medical provider. It would all need to be linked together to allow any health care provider to have access to it. It would centre the health info of the entire country in one place. Making a successful hacking devastating.

            And then, more information is not always better. A medical file can be very long. The info you might be looking for could be hidden very deep into it. Asking the patient for any pertinent medical history is faster and easier. And if they can’t answer you, you probably don’t have the time to read their entire medical file.

          • Mattie

            I mean, they don’t need to be national…even just ‘state’ based would be better surely?

          • Azuran

            I’m not familiar with how the USA health practitioners deal with different states. But considering the size of some states, it wouldn’t really make a big difference. A program that can deal with an entire state would probably not be much smaller than one for the entire country at that point.
            And that’s if those living on the border of states always stay in their own state for their treatments.

          • Empress of the Iguana People

            I think it would really depend. I was born in Rhode Island. Apparently there are ranches the size of Rhode Island out west. The local hospital where my nephew was born sends more complicated cases across state lines because Boston is closer than Hartford. Many of the nation’s children go to St Jude’s in Memphis, Tennessee.

          • Charybdis

            I think what is considered the “Metro Area” in my city is larger than Rhode Island…

          • Empress of the Iguana People

            Probably, lol

          • Mattie

            But surely a start is better than nothing? Like…even if you can’t immediately create a perfect situation, surely as good as you can manage right now is better? Unless people think the current system IS the best thing they got (it doesn’t seem like it to me, but total outsider lol)

          • Dr Kitty

            My ECR is a portal through the intranet.
            The only way I can access it is online through a computer connected to the Trust intranet and as far as I understand it, it is as secure as it is possible to make these things.
            The system has some built in safeguards, and it records who looks at each set of notes, and queries if you look at notes of people you don’t appear to have direct clinical responsibility for.

            Azuran- I don’t always find patients give great histories, and would query whether asking them is always easier!

            Patients who can’t remember why they have the massive surgical scar on their abdomen, patients who forget to tell you they have an implantable defibrillator, or their double hip replacements, or history of renal disease…

          • Azuran

            Oh I don’t trust patients either.
            I’m just saying that having a single medical file that follows you everywhere is a lot harder than is sounds like.

          • guest

            As a patient, I can tell you that I routinely forget parts of my medical history when asked (and my medical history is not that involved!) I’ve started keeping a printout with all pertinent history that I add to and then take to each appointment. I always pull all my meds out of the cupboard and write them down before each appointment or I will forget at least one.

          • Dr Kitty

            Up to a point, this works in the NHS.
            I have access to something called the Northern Ireland Electronic Care Record.
            It shows me a list of all the patients of my practice who have attended an ED anywhere in NI within the last 8 days, any of my patients who are currently in hospital in Northern Ireland and I can look up all blood results, imaging results, outpatient letters, and upcoming outpatient appointments on the system.
            It is updated in real time.

            Which means that if I send a patient to the ED in the morning, I can check they have attended, see what investigations were done and whether they were admitted by the next morning.

            I can see if any of my vulnerable patients took overdoses over the weekend and need a welfare check phone call on Monday morning. I can see if it looks like an elderly person who has been in hospital for weeks has been discharged that day.

            It’s very helpful.
            It doesn’t extend to the rest of the UK or the Republic of Ireland, but I know I’ll get the paper letters from those ED or hospital attendances eventually.

            As GP it is part of my role to be aware of what is going on with my patients. The ECR is essential to that.

            The atomisation of the US system, where you may see multiple doctors who might not talk to each other, scares me.

          • evidencebasedbreastfeeding

            I did a previous comment but it’s been lost, so not sure, will try and retype again. You could use hospital episode statistics. Also, there was a report in the guardian recently on a doubling of jaundice readmissions over a decade, worrying, not sure why this is.

            Also Dr Kitty: given that NHS is under such ££ pressure – wondering if you have any insight into the decision making around Baby Friendly accreditation. Why units make the decision to spend ££ on going through the process – with the changing evidence on BFI effects, who can we go to to point this out and ask whether they have taken all that evidence into account in their decision making about whether to sign up (or re-accreditate) for BFI. That type of thing. Who do you talk to in “the system”? Can they (?commissioners, clinical directors etc) talk to BFI and say, well, we would accredit but we are concerned about evidence base for XYZ, have you considered re-evaluating the standards and making changes to reflect the changing evidence? Etc.

          • Dr Kitty

            BFHI saves the NHS money.
            Early discharge home 6hrs after normal delivery saves money.
            Rooming-in with no well baby nursery saves staffing costs.
            Not stocking formula (except prescription formula for preemies etc) saves money.

          • evidencebasedbreastfeeding

            are you sure… even if you factor in ££ of readmissions for dehydration & jaundice..? and the costs of the accreditation and the training and the BFI materials?
            The rooming in, I had thought that nurseries in NHS mat units went out of the window before BFI so these are not likely to come back (and non Baby Friendly units in the UK don’t have nurseries do they? – or am I mistaken). – My first was born in a unit that wasn’t BFI then, but is now, and they had no nursery. This was just 3 years ago. There will be units out there that aren’t BFI (but might be thinking of going BFI), but don’t have the nurseries and already do early discharge.
            I’m not challenging you, I’m just trying to find out if a case can be made for discarding the stuff that doesn’t work, or that we don’t have evidence for, independently from any other background stuff that isn’t necessarily linked to it.

        • Young CC Prof

          Really? That’s astonishing. Around here, if you go to the emergency room, they can’t get records from an inpatient stay at the same hospital, much less another hospital in the system. And by records I mean such basic things as drug allergies.

          • That is a great benefit of having a national identity card. My medical records are always accessible from other hospitals, as my ID number is the number on my patient chart, no matter where I’m being treated.

          • Roadstergal

            Any attempt at national identity cards are derailed by a small but vocal faction of rapture-types here who think identity cards are the Number of the Beast. I wish I were kidding.

          • Charybdis

            The whole Electronic Medical Records thing is a shambles. It was supposed to be the Best Thing Ever; all the patient’s medical records corralled and contained in one file on some sort of master server, perhaps in the cloud. Easily accessible by doctors, nurses, PA’s, NP’s, etc, so continuity of care would be So Damn Easy.
            Not so much in practice. There were numerous companies who started to peddle the Electronic Health Records software and then surprise! The different softwares could not/would not talk to each other, so there was no easy way to integrate them. One hospital system may use XXX software for Windows based computers and another might use YYY software for Apple based computers. Or if they were using the same type of computers, one doctor might prefer software A because it has reminders, coordinates with the doctor’s calendar and has a patient portal for test results, questions, etc. Another doctor just wants the “bare bones”: a place to save and store patient records digitally and that’s all.
            Small systems may use different EPR than large-to-gigantic systems, or they might be older and then newer ones are not backwards compatible. Or the ones used in my state might not talk to the ones in your state; my PPO might use different software than your HMO. Some might have had some tweaking by in house IT folks so that it no longer really resembles the original software.
            Then there are the prescription records. It is all insanity.

          • MaineJen

            Exactly. Our health care system has changed computer systems multiple times since I started here. Computers within the same health care cooperative can talk to each other, because they’re all using the same system. In theory. But the hospital uses a slightly different version of the software from the lab, from the blood draw station, from the pharmacy, from the blood bank, from the micro lab…etc. Nothing but problems. And that’s just within one system.

            If everyone in the country used the same system, it would be great. But that would also be considered a monopoly. Competition = multiple competing systems, and companies have zero incentive to make those systems talk to each other.

    • Wasnomofear

      I think you look at it from the insurance claim records, not from the hospital side.

  • Sheven

    This is great, but relies on the hospital doing something. Could a homemade solution work? Could parents demand that lactation consultants sign a piece of paper stating, “I, ______, certify that enough breastmilk is being produced to adequately feed this baby and I will take full responsibility if this is not the case”?

    • JDM

      A parent who is ready and willing to do that would almost certainly be ready and willing to gainsay the lactation consultant anyway. There needs to be a system in place that protects those who have fallen for lies and therefore wouldn’t be ready to buck those they’ve been told (and believed) are there to help and protect their newborn.

      • Charybdis

        I think that a lot of women are going into the whole ordeal planning on at least trying to breastfeed. It is expected, after all. What they are NOT planning on is the fact that once they have indicated that they intend to breastfeed, that they will be held hostage to that decision. “Sure, I’ll try breastfeeding, but if I have issues, I can always switch to formula. I’ll just ask the nurse to bring some formula if my baby seems hungry after nursing, to top them off until my milk comes in.”
        This seems reasonable, right? “I’ll try, but there is always a backup if there are issues”. They aren’t ready for the rabid zeal with which that one little decision will be defended by the “support staff”: “You said you were breastfeeding, so we are here to “help” (make, insist, demand, browbeat, gaslight, whatever) you breastfeed. And you can’t breastfeed if you are using formula or even entertaining the thought of using it. WE ARE HERE TO SUPPORT YOU IN YOUR BREASTFEEDING JOURNEY, NOT YOUR FORMULA FEEDING JOURNEY.”
        They aren’t prepared for that level of “dedication”.

        • maidmarian555

          This!!! I had read plenty before I had my son, I’d spoken to friends and my partner and I had a really casual ‘well I will try breastfeeding but I’m totally fine with using formula if it’s not working out’ attitude. I had not bought into any woo at all.

          I was completely unprepared for the way breastfeeding pressure was applied in hospital. I wasn’t physically or mentally capable after my birth ordeal of dealing with how overzealous a number of the midwives were about it. It didn’t occur to me that I should have pre-researched every possible eventuality and what failure might actually look like (for example the amount of weight loss that might be dangerous) as I ‘stupidly’ believed that medical staff would prioritise medical need over their EBF discharge rates. I didn’t expect to be told when I asked for extra formula that I was ‘supposed’ to be breastfeeding – why would I expect to be questioned about ensuring my baby had enough to eat?!

          I felt afterwards, and still do, that most of them didn’t give two shits about me or my son. Just the EBF rates. When I complained to the community midwife and HV that I couldn’t cope with clusterfeeding, they just laughed at me (oh haha that’s just clusterfeeding, you’ll have to haha get used to it haha you *wanted* to breastfeed, remember haha) I had to work out how to deal with everything entirely by myself.

          It’s all very well having an attitude that means you are totally prepared to listen to medical advice. You have to be given that advice in the first place. You have to have your concerns actually listened to and addressed, not just fobbed off at a time when you are constantly questioning yourself and in no way confident that you have a clue what you’re doing. Looking back I was hopelessly naive. I just had no idea how insane the whole breastfeeding issue is.

          • crazy grad mama

            Yes! I too started with an attitude of “I’d like to breastfeed but only as long as it’s working for me and the baby.” I wasn’t prepared for how many breastfeeding “facts,” coming from apparently legitimate sources like the hospital breastfeeding class, are just crap. Like the stuff about tiny newborn stomachs, or the emphasis on never ever ever supplementing because it will ruin your supply.

          • maidmarian555

            I think the one that still makes me most angry when I think about it was that using a dummy would cause nipple confusion and that I absolutely positively should NOT offer one before the baby was 1 month old. I mean, looking back it makes no logical sense at all but I believed it at the time because my Health Visitor said it. It took my MIL after over two weeks of clusterfeeding to very gently suggest that it really wasn’t normal to have a baby attached to my boob all day and that it was totally fine to offer him a dummy and she’d never heard of it causing a problem with a baby eating before. I’m so glad she intervened, I felt like I was going insane! Turned out he just liked to suck on something and really didn’t mind what it was. Funnily enough, he never forgot to let me know he was hungry if I accidentally tried to offer him a dummy instead. I have no idea why I was told that lie. If anything, it nearly stopped me breastfeeding altogether!

          • crazy grad mama

            One of my baby care books admitted that there wasn’t any evidence of pacifiers causing nipple confusion (even though they still advised waiting to use them), so we gave in and gave my son one at about four days old. I was so defensive about this and felt like I had to preemptively explain it to everyone who saw him! In retrospect, I can tell that our families were thinking “of course you gave him a pacifier, why wouldn’t you.”

          • Empress of the Iguana People

            I was planning on bf’ing my first. My husband says they brought him to me several times that first night to eat. I was so loopy from the magnesium that I don’t remember it at all. Pretty sure I shouldn’t have been holding a baby. But at least my l&d didn’t expect me to fetch him myself with the pulsing boots and the cathetic

        • Young CC Prof

          They also expect providers to tell them in a timely fashion if there are any signs breastfeeding is not going well. Unfortunately, many hospitals now have a policy of waiting until an actual medical problem appears as a result, and parents do not know this going in.

    • Melaniexxxx

      this would be AMAZING! Turn their ridiculous shaming ‘formula contracts’ back on them

  • crazy grad mama

    OT: Anyone have experience with pregnancy after C-section and their scar feeling weird? I’m 23 weeks along with my second kid and occasionally get pinching or pulling or what feels like rubbing on the inside of one end of my CS scar. Is it just that the nerves are wonky there?

    All I get on Google is a bunch of people all a-flutter that they might not “get” their VBAC, which does not reassure me about the accuracy of their information.

    • Charybdis

      I would surmise it is a combination of things: slightly wonky nerves in that area and the stretching/growing of the uterus and skin in that area.
      No actual experience with pregnancy after CS; I’ve only had the one. But I could see how things could feel a bit odd.

    • Roadstergal

      I’ve had non-CS scars feel ‘weird’ like that, like they were adhering randomly to stuff underneath. I had a physical therapist teach me some ‘scar work’ to loosen up the scar, and doing that regularly for a few weeks made it feel normal again going forward. She said she does a lot of C/S scar work. Something to consider?

    • maidmarian555

      I’m almost 20wks and have noticed the numbness that had almost gone after I healed up after #1 appears to be creeping back. I haven’t noticed any pulls or twinges but it does feel a bit weird.

    • somethingobscure

      Yes that happened to me throughout my second pregnancy post c section. My doctor assured me it was fine and that nothing was wrong. That said I recommend you ask your doctor, not the Internet!!

      • crazy grad mama

        Hahaha yeah, I know. But my next OB appointment’s not for another 3 weeks, and I have a passionate hatred of making phone calls.

    • Dr Kitty

      I had that.
      It’s just weird feed-back signals from severed nerves being pulled.

      Check with your provider that your placenta isn’t lying over the scar.
      Other than that, it should be fine.

      My son seemed to take much joy in kicking my scar, a habit he did not let go of on the outside either. No harm was done.
      We have many scan photos of his feet, because they always seemed to be just beside my scar whenever they were checking it.

    • Helen

      My laparoscopic adhesions felt like that. Probably you have a scar adhesion that is no being stretched as the second baby grows.

  • Young CC Prof

    Never-ever designation would be fantastic. But any sort of tracking and monitoring is really key to solving the problem.

    When an adult patient covered by Medicare is discharged from the hospital and then requires unplanned readmission for the same problem in a short period of time, Medicare considers it a sign of bad care, records the incident and may refuse to pay for the second stay.

    Just over half of births in the USA are covered by Medicaid. If Medicaid started tracking and penalizing neonatal readmission associated with dehydration, hospitals would respond rapidly by working to prevent such readmissions. (And if Medicaid did it, major private insurers would probably follow suit.)

    Other options for accountability include making neonatal readmission rate a quality metric by the Joint Commission or the Leapfrog Group, although you’d definitely want to separate out the preventable ones, otherwise you’d wind up penalizing any hospital with a high-level NICU. (Say, readmissions of babies whose initial hospitalization was 4 days or less?)

    Ultimately, it just requires SOMEone in authority to decide that a medical problem that apparently leads to tens of thousands of preventable hospitalizations every year matters. What you measure, that’s what changes.

    • The Bofa on the Sofa

      When an adult patient covered by Medicare is discharged from the hospital and then requires unplanned readmission for the same problem in a short period of time, Medicare considers it a sign of bad care, records the incident and may refuse to pay for the second stay.

      Was that just started as part of the ACA, or was it being done before?

      • Young CC Prof

        I thought they’d been doing it for a while, but apparently it’s ACA: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html

        I do not believe any potential repeal bills include changes to the readmission penalty program.

        • The Bofa on the Sofa

          I thought I remembered it being talked about with the ACA; that was going to be one of the ways to control costs. Obama spent a lot of time talking about holding care providers responsible for reducing costs.

      • StephanieA

        When I worked med/surg we tracked readmissions for certain illnesses, and that was before the ACA. But that may just have been our facility.

        • The Bofa on the Sofa

          Likely. I was thinking more about the issue of Medicare and their coverage of these things.

        • Heidi

          Yes, I’m pretty sure when I worked on med-surg before the ACA fully kicked in, certain things got no reimbursement – bed sores, CAUTIs, etc.

  • Karen in SC

    Who or where can we write in support of this proposed Never Event?

    • Emilie Bishop

      Yes! When I wrote my story to my hospital, I was basically blown off by idiots who said they were sorry but were quick to point to lines in my chart that said my goal was exclusive breastfeeding and they were trying to help me achieve that. (I was never told I have every physical marker for IGT and that exclusive nursing was medically impossible, but funny how they didn’t own up to that.) I can’t imagine the hospital would care if I brought this up. Do we start by writing to our insurance companies? A professional organization? I will write, but I need to know where!

      • Young CC Prof

        You can file a formal complaint with the Joint Commission. I did it, it wasn’t hard. I would also complain to your insurance company if their bad care cost the insurance company additional money, such as extended hospital stay or readmission.

  • Azuran

    I wonder, when they talk about ‘readmission’ for dehydratation, I guess that excludes any baby that never leaved the hospital.
    They should probably also look at extended hospitalizations due to jaundice, dehydratation or excessive weight loss.

    • The Bofa on the Sofa

      Yep. Our first guy had to stay an extra day (even after the c-section, an extra extra day) due to jaundice. And no, breastfeeding was not going well at the time (he was suckling great with colostrum, but when my wife’s milk came in, I think it was such a gush that he retreated; we ended up feeding him expressed milk through a syringe)

    • Young CC Prof

      NICU or special care admissions after 24 hours of life are one place to look for that.

      It’s hard to track this stuff, because in addition to discharge and readmission, you have extended stays. And if the diagnosis is only jaundice, was it related to insufficient intake, or not? Insufficient milk intake is the most fixable risk factor for severe jaundice, but babies can develop jaundice bad enough to need treatment even if they have ample milk intake. Blood type mismatch is one risk factor, but not the only one.

      • MI Dawn

        (waves hand) Yeah, ABO incompatibility for both kids. It’s lovely to watch them turn yellow even with plenty of fluids (I was a great cow from day 1 onwards). Bili testing and levels of 18/19/20. But they let me take them home as long as I promised (which I faithfully did) to stick them naked in front of a window for several time periods during the day.

        Worst mistake I ever did, though, was taking Child 1 home in a very lovely knitted outfit made by my grandmother. It was yellow…and Child 1 matched the yarn color!

        • Dr Kitty

          I find it very hard to look at pics from my daughter’s first few days at home now.
          It is obvious to me now that she is deeply jaundiced and looks scrawny, and I think her weight loss was probably more than they told me. I had great supply, but in retrospect she was probably too sleepy to feed well for the first week.
          They tried to give her top ups of my colostrum with a cup in hospital. More ended up on the baby than in the baby, so we were supppsed to use a syringe. I’d get about 2mLs in before she fell asleep.
          No one suggested giving It in a bottle, never mind formula, which makes me angry now.
          I’d have happily topped up with EBM in a bottle, and I’m sure she’d have thrived.

          As we didn’t find out the sex of our babies, my daughter was in a lot of yellow for the first few weeks. It was, as you say, not a good look.

          • MI Dawn

            Yeah..yellow kid in yellow clothing. But I was lucky I gave birth long before the BFHI stuff. Yes, I wanted to breastfeed but no, even then I didn’t believe in nipple confusion, which they were touting (I’d seen WAY too many premies learn to nurse after weeks to bottle to believer).

            I also didn’t trust LLL after they gave a good friend (and fellow nurse) a hard time with her baby and nursing. Her baby cried constantly but was gaining weight and thriving otherwise. Turns out, baby was so very lactose intolerent that even if she ate any foods containing lactose OR any beef, baby would react. 2 feeds on special formula and happy baby. Who’d a thunk it?

          • Empress of the Iguana People

            Hugs.
            The number of doctors in this group who made this mistake makes me very worried for the percents among the rest of us. 🙁

        • momofone

          ABO incompatibility here too. Levels in the low 20s and I remember being worried that the fluids and formula would keep him from breastfeeding. Because clearly that was the most important thing! (Thank goodness for an excellent pediatrician, whose patience and willing to call bullshit when she heard it.)

  • Anj Fabian

    Questions parents should be asked when their baby is admitted.
    Who is your pediatrician?
    Who provided your breast feeding support?

    That way the hospital can track which LCs have the most readmits.
    Peds should be interested in which LCs are the riskiest. Not to infringe on patient choice, but to schedule more frequent weight checks for those babies.

  • Charybdis

    This just makes me *almost* want to get pregnant again, just so I can say I’m exclusively formula feeding and ban LC’s from my room and utilize the nursery at night. All after my repeat CS, because, by the way, I refuse to entertain the idea of a VBAC.
    I wonder how many head I’d get to explode.

    • Ariana Ramos

      I’m pretty sure I’m gonna lost a couple of friends if/when I get pregnant because of things like that.

      One of them had her second child by VBAC at home (and ended up at the hospital because of her placenta. Still thinks it was a wonderful idea.) and exclusively breastfeed even though at 5 months the baby was out of charts as he was so small. Now he started eating (6 months old) and, alas, is finally gaining weight. Even worst, all friends in common support her decisions as if she couldn’t do no wrong. Now, I undestand that mothers need to be supported but this “no questions” support for things that clearly weren’t good ideas, ugh. Pretty sure they will all talk about me by my back when I announce I want a CS.

      • Charybdis

        Don’t let it bother you one iota. The best way to deal with that stuff, I’ve found, is to embrace it and not be the slightest bit apologetic about your decisions. That tends to take the wind out of their sails pretty quickly, because they don’t sense any weakness/hesitation that they can exploit.
        Something along the lines of: “Oh, Dear God, no. I don’t want to be in labor for hours. Scheduled CS is the BEST option-I assume all the risk of the surgery and we don’t have to put any undue stress on the baby that way. Epidural/Spinal all the way…I can be conscious and still somewhat participate in the birth, plus, NO PAIN! Planning on feeding formula from the get-go. That way, Dad, grandparents, aunts, uncles, best friends, older siblings, etc can all help with feeding. Pacifiers? Absolutely! Didn’t you know that they help prevent SIDS?!? No, that’s actually true and I’m all for reducing the risk of SIDS: pacifiers, baby in his own sleeping space (no bedsharing), back to sleep, etc.”
        State this in a pleasant, cheerful but firm tone and let them tsk-tsk all they want.

        • Roadstergal

          So much this. No apologies. You’re doing what’s best for you and yours and have damn good reasons for doing it – be proud!

          • Charybdis

            “Mutant and proud”. Mystique, X-Men First Class.
            Not hiding the formula, bottles, pacifiers or CS scar/support anymore.

        • Ariana Ramos

          Loved the ideas, thanks. The thing that makes me most angry is that I know they will treat me as if I just didn’t have enough information to do an educated decision. I see this already when they talk about people outside our group that decided for a scheduled CS for example. As if, if only we had the right information, everyone would choose VB

          • Charybdis

            You could ask them if they can guarantee that you won’t have any pelvic floor or other damage from a vaginal delivery. You know, things like urinary and fecal incontinence, nerve damage, tears, cervical lacerations, broken coccyx (tailbone), muscle tearing, retained placenta, PPH, sexual dysfunction, etc. Because they are ALL a risk of vaginal birth and no one, not even the doctor, can GUARANTEE that you will not suffer any of those things, not to mention things like cord prolapse, nuchal cords, shoulder dystocia, knotted cords, OP presentation, failure to descend, placental abruption, any of the things that can affect the baby direcrtlly in addition to making things difficult for the mother.
            A pre-labor/early labor CS is the only way to completely avoid all of the above potential issues. You take on all the risk of surgery so your baby won’t have to gamble on tolerating labor well and going through a vaginal delivery that might require forceps or vacuum assistance. Not to mention if the baby is transverse or breech..
            You could tell them that you have been reliably toilet trained since toddlerhood and you see no reason to risk that accomplishment just so you can say “I had a vaginal birth!”. You can’t look at a crowd of people and pick out the CS babies from the vaginally delivered ones.

          • BeatriceC

            “You could tell them that you have been reliably toilet trained since toddlerhood and you see no reason to risk that accomplishment just so you can say “I had a vaginal birth!”. ”

            And if they tell you that doesn’t happen you can tell them you know this 41 year old woman in California who would beg to differ.

          • Ariana Ramos

            I sure will! My grandmother had problems for the rest of her life too after her 4th delivery.

          • Empress of the Iguana People

            This 40 year old from Connecticut has the same problem, and I have since I had my first.

          • Dr Kitty

            Ah no.
            I’m a doctor.
            I’ve been at maybe 50 vaginal deliveries and another 50 CS. Which is more than most CPMs.

            I knew *exactly* what I was doing when I opted for a prelabour CS. Twice.

            *For me* the risk/benefit analysis of CS/ VB shook out in favour of CS.

            Now, I am happy for other women who say that they would make different choices to me.

            But I get really annoyed with people who think I made my decision because I “didn’t have the right information”.

            I had that information, I just decided that it wasn’t important to me when weighed against other things that mattered more to me.

            I didn’t care about shorter recovery and natural experience, I cared about my baby’s brain function and preserving my continence and sexual function.

          • Ariana Ramos

            Exactly! I looked the information, weighted the risks and am pretty sure of my choice. I don’t care about recovery time either if the baby has a lower chance of having problems. I’m not in the medical field but i’ve “done my research” and, above all, I searched for people that have the necessary expertise to guide me (so, thats why im here =p). I’m sure i’m not the only one.

            But then just this week my friends were talking about her VBAC again (gosh, its been 6 months but everyone loves to talk about it) and I was startled to hear that all of them want a VB at home since it worked so well for his one friend (no, it didn’t, she ended up at the hospital). Like, no reading anything, no looking in at the risks, etc. This made me so mad I ended up saying some things against home birth…then the mother apeared, said I couldn’t understand and everyone sided with her. It’s a lost cause i guess.

          • Empress of the Iguana People

            This kind of blindness reminds me of the time when a woman I was talking to told me that her body knew how to give birth. Five minutes earlier she was telling me that all her 5 or 6 kids were preemies.

          • Wasnomofear

            Speaking from having been there… It’s confirmation bias. They can’t admit that they were wrong, that they made bad decisions​, that they failed at the basic principle of parenting – protect the baby – because that’s admitting that they’re bad people. For my case, finding this site was a godsend, because I was able to see that I had been lied to and fooled by midwifery/the out of hospital birth industry, which still stings, but it’s quite different than being given all the information (you know, that thing called informed consent the NCB crowd is always yammering on about, but not actually giving to mothers themselves) and still choosing the most dangerous option.

          • swbarnes2

            Do you know if there any studies on the choices that female OBs make about their own childbirths, as compared to the general population?

          • Poogles

            I remember reading something that said female OBs were more likely to choose CS for themselves, but I don’t remember if it was a study or survey or what and I’m not able to look for it right now.

          • Sue

            It’s not unusual for doctors to weigh up risk-benefit of labor and opt for pre-labor CS when having their (our) own babies.

        • Kelly

          I have done this and they don’t have much to say because you didn’t give them an edge.

      • Young CC Prof

        There are a lot of parental decisions I can support even if I personally don’t agree with. Failing to feed your kid? Nope, that’s not supportable.

      • Empress of the Iguana People

        A friend was recommendng a local PPD group to me. I noticed it was run by the local homebirth association (didn’t even know we had one.) She said they’re inclusive, but, well, i don’t think I can be polite well enough right now. My filter is a bit loose these days.

    • Young CC Prof

      I’m delivering #2 in the hospital that saved #1 after he developed hypernatremic dehydration (because some genius at a different hospital discharged a baby who’d already lost 11% of his body weight, without telling his parents.)

      I do want to try to breastfeed, but she’s getting a top-up after every feeding until milk comes in adequately. If anyone gives me trouble about it, they’re getting a faceful of my son with blue light and tubes and wires all over him.

      • Dr Kitty

        Good for you!
        When is #2 expected to arrive?
        Time flies, and it seems like yesterday #1 was on his way.

        • Young CC Prof

          Last week in July, I hope.

          • Dr Kitty

            Good to know.
            Will keep you in my thoughts.

      • Karen in SC

        Idea – I should become a Feeding Doula and make sure baby is fed and mother is not annoyed by lactivists.

        • yentavegan

          You know, you might have a real good idea there.

        • yes please

          I would hire a Feeding Doula, especially if she’d take care of the baby for several hours so I could sleep.

        • Sue

          LOVE this idea, Karen.

          A science-based Doula to protect the family from woo, and facilitate evidence-based care. Perfect!

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    • StephanieA

      Right now my hospital is being ‘watched’ by BFHI because our rooming in rates suck. So we are being chastised more and more for taking babies out of rooms, and are not supposed to offer at all. So I can imagine what my colleagues would say if you wanted to send baby out for the entire night.

      • Young CC Prof

        Precisely. Currently, we are actively tracking and incentivizing care practices that CAUSE neonatal starvation, including continuous rooming-in and exclusive breastfeeding rate at discharge. Other than potential lawsuits for babies who suffer actual kernicterus or other permanent brain injury, there are no penalties for neonatal starvation.

        Which means the hospital is being encouraged to shove 2-day-old babies crying with hunger into the arms of mothers who aren’t producing milk yet, say everything is fine, stuff them out the door and let the cards fall where they will. Just make sure they have a pediatrician appointment the next day, the ped can handle it if there’s any problems. Never mind that it could easily be a full-blown emergency by then…