By Katherine Shaver
Washington Post Staff Writer
Sunday, April 27, 2008
Laura Osuri's eyes, bloodshot from lack of sleep, were rimmed with tears as 2-week-old Isaac slept in his car seat carrier, oblivious to his mother's worry and frustration.
"The first week, he was nursing fine, no problem," Osuri, 31, said as she collapsed into a chair at the Breastfeeding Center for Greater Washington. Then, she said, the baby started to arch his back and cry. He had become so uncooperative and she so sore that she had stopped nursing four days earlier.
"It just wasn't worth it," Osuri said, almost apologetically.
It was another mystery for Pat Shelly, one of the Washington area's best-known lactation consultants, who set about exploring Isaac's mouth with a rubber-gloved pinkie and quietly studied the baby as he finally began trying to suck.
Nicknamed "the breast whisperer" by some clients, Shelly, a registered nurse, has gained traction as breast-feeding has increased across the country. She is also part of a booming breast-feeding industry that in the past 15 years has given rise to specially designed pillows such as "My Brest Friend," hands-free pumping bras and charm bracelets that keep track of a baby's feedings.
In the Washington area, where parenting consultants specialize in everything from infant sleep problems to college applications, Shelly is in high demand. House calls, billed at $150 an hour, begin at 7 a.m. and end about 11 p.m. In between, she is booked solid, seeing about 80 women a week for classes and private consultations at her center on K Street.
Office appointments cost $85 an hour, with two free visits reserved each week for low-income families.
"I think every woman I know in this city has seen Pat," said Margaret Lidstone, 37, of the District, who has had two consultations with Shelly about her 4-month-old daughter, Maisie.
For Shelly, breast-feeding is less a business than a 25-year cause. Her center is nonprofit, and many of its classes are free. Her message: Breast-feeding may not always be easy, but it's the healthiest option for babies' development and immune systems, as well as for their mothers' stress levels and improved protection against some cancers.
Getting that message out, she said, means battling the influence of well-financed formula companies, brief maternity leaves that allow little time for mother and baby to get in sync, workplaces with no place -- or no time -- for working mothers to pump and an American society squeamish about a woman's breasts providing a child's food.
When working with clients, Shelly is like a detective, ferreting out whether a problem hinges more on a baby who might have issues such as a small tongue or high palate or a mother with challenges such as a low milk supply.
"I look at mother and baby as dance partners, both physically and emotionally," Shelly said.
Clients have included breast cancer survivors, women who have undergone breast surgery and those who want to nurse their adopted babies (yes, it's possible).
She also helps women with breast-feeding long-term, particularly after returning to work. Government studies show that almost 75 percent of newborns are breast-fed, but that figure falls to 42 percent by six months and 21 percent at a year. The American Academy of Pediatrics recommends breast-feeding exclusively for six months and then continuing, along with iron-rich solid foods, until the baby is at least 1.
"Women need a village, and we're in a big city," said Shelly, 52, of Annandale, a self-described "earth mother" to two adult sons whom she breast-fed for two years. "Some women don't want to listen to their mothers when it comes to breast-feeding. They want a professional."
More than that, many clients say, they found in Shelly a cheerleader who withholds judgment.
"Breast-feeding is the most natural thing in the world, but it's not natural for everybody," said District resident Erica Pressman, 37. She saw Shelly when her daughter, Tali, now 4 months old, was losing weight at a few days old and again at 3 months, when she developed reflux.
"I have yet to find a friend who didn't have some problem with breast-feeding," said Pressman, director of a philanthropic foundation. "No one tells you that before [having a baby], so I think it takes a lot of us by surprise."
Naomi Barry-Perez, 34, said Shelly boosted her confidence when she needed it most. Her baby, Emilio, now 4 months, had problems nursing from the start. At the time, she said, she was battling postpartum depression and felt that "if I couldn't breast-feed competently, I was a bad mother."
When she sought Shelly's help at the six-week point, she said, she was feeding her son pumped breast milk from a bottle and supplementing with formula because the pediatrician had concerns about the baby's weight. Barry-Perez said Shelly found that the ligament beneath her son's tongue was too tight, something a physician confirmed and fixed with a simple procedure. She credits Shelly with helping her to breast-feed full-time.
"I went in hanging my head and saying, 'I'm using formula,' " said Barry-Perez, a lawyer by training who works for the U.S. Department of Labor. "She said, 'You're doing the best you can do for your baby, and you should be congratulated for that.' That was huge."
Shelly is down-to-earth and practical. She tells a class of pregnant women that their breasts will have different "personalities" and says that their first time using a breast pump may feel "kind of bovine." She encourages those having problems to hold the baby naked against their bare chests as much as possible to keep the infant "loving the breast."
Thinking of buying those freezable ice packs to treat a blocked milk duct? "Just use a bag of frozen peas," she says.
She urges women to let go after the baby arrives, to put off the thank-you notes and other chores so they can focus on breast-feeding.
"The minute the baby is born, all eyes are off the mom and on the baby," Shelly said. "But the mothers are going through a huge life change."
She is careful with her words, often prefacing her opinion with, "How do I say this?" She notes that she must navigate the often emotionally charged waters between her belief that breast is best and the reality that some women physically can't nurse while many others will choose not to at some point.
"If a mom says, 'I'm only going three months,' I try to make the most out of her three months," Shelly said. "I'll be there to help her wean. Once they know that, I think they can relax a bit and enjoy their baby."
Amy Pullman, a District pediatrician, said she refers mothers to Shelly because she's not a "purist." Unlike some hard-core lactation consultants, Pullman said, Shelly will work with a doctor's wishes if a baby needs formula supplements to treat jaundice or significant weight loss, for instance.
"We like to be flexible with mothers in terms of breast-feeding so they don't feel like failures if they can't or don't want to," Pullman said. "Pat doesn't tell them that they're poisoning their baby if their kid needs formula."
Lidstone first saw Shelly when Maisie was a week old because, she said, "I didn't know what I was doing." A couple weeks ago, she returned with a new problem: Her milk supply seemed to be dropping just as she was headed back to work. Meanwhile, Maisie seemed to be allergic to formula.
"I'm slightly panicked about, come Monday, what she's going to eat," Lidstone said.
Shelly noted that the stress of returning to work might be limiting Lidstone's milk production or that Maisie, suddenly distracted by a growing interest in the world beyond her mother's breast, might not be nursing as well. Then, noticing that Maisie became fussy when lying on her back, Shelly spotted another possible culprit: reflux, perhaps aggravated by dairy coming through her mother's milk. As a precaution, Shelly recommended that Lidstone cut dairy from her own diet.
"But I'm from Wisconsin!" Lidstone protested with a laugh.
After suggesting that Lidstone boost her milk supply with more pumping and buy hypo-allergenic formula as a backup, Shelly ended with her working-mother pep talk: "When you go back to work, remember you built her from scratch."
Shelly has building dreams of her own. She hopes someday to open a small hotel on Capitol Hill, a place where breast-feeding mothers could stay overnight to get help or support. She plans to call it a breast and breakfast.