Laura Osuri's eyes, bloodshot from lack of sleep, 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," said Osuri, 31, as she collapsed into a chair at the Breastfeeding Center for Greater Washington. Then the baby started to arch his back and cry, she said. 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 lactation consultant Pat Shelly, who explored Isaac's mouth with a rubber-gloved pinkie and quietly studied the baby as he finally began trying to suck.
Sending a message
Nicknamed "the breast whisperer" by some clients, Shelly's work has gained traction as breast-feeding has gradually increased nationwide. She is 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 downtown. Office appointments cost $85 an hour, with two free visits reserved each week for low-income families.
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 synch, workplaces with no place or time for working mothers to pump, and an American society squeamish about a woman's breasts providing a child's food.
The support network
Shelly is like a detective with her clients, ferreting out problems: a baby with a small tongue or high palate, a mother with 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, an amount that 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, 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."
Many clients say they found Shelly a cheerleader who withheld judgment.
"Breast-feeding is the most natural thing in the world, but it's not natural for everybody," said Erica Pressman, 37, who turned to Shelly when daughter Tali, now 4 months, was losing weight at a few days old and developed reflux at 3 months.
"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 (giving birth), so I think it takes a lot of us by surprise."
Naomi Barry-Perez's baby, Emilio, now 4 months, had problems nursing from the start. She was battling postpartum depression and felt that "if I couldn't breast-feed competently, I was a bad mother," she said.
Shelly found that the ligament beneath Emilio's tongue was too tight, something a physician confirmed and fixed with a simple procedure, said Barry-Perez, 34, who works for the Department of Labor.
"I went in hanging my head and saying, 'I'm using formula,' '' Barry-Perez said. "She said, 'You're doing the best you can do for your baby, and you should be congratulated for that.' That was huge."
Shelly urges women with newborns to make breast-feeding a priority, putting off thank-you notes and other chores if necessary. "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."
Shelly tells a class of pregnant women that their breasts will have different "personalities" and warns 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."
She realizes 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."
That's why pediatrician Amy Pullman said she refers mothers to Shelly: Unlike some hard-core "purists," 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."
Shelly 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.