We're excited to introduce our new Medical Director, Dr. Jessica Madden. Dr. Madden is a board-certified pediatrician and neonatologist who has been taking care of newborn babies for over 15 years. She is currently on staff in the neonatal intensive care unit (NICU) at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. She also provides in-home newborn medicine and lactation support to new mamas and is currently working to become an IBCLC. Dr. Madden will be helping us to provide the best possible educational resources and content on women's health before, during and after pregnancy!
1. What is a typical day in the life of a neonatologist?
I work in the neonatal intensive care unit (NICU) at a large academic children’s hospital. After I get my kids to school and arrive at my office, my work day begins by prioritizing tasks on my to-do list, responding to emails, and review my patient list plus any pertinent radiology and lab test results. I then head to meet my team of medical students, pediatric residents, and fellows to “round” on our NICU patients. During rounds we review any overnight events, vital signs and test results, examine our patients, and get input from bedside nurses. This helps us to create a daily list of tasks for each baby.
Later, I attend conferences, call to update parents, consult subspecialists, review test results, read/sign medical records, look up information in medical journals, and meet with trainees. Often work flow is interrupted to attend high-risk deliveries and admit newborns to the NICU. We can have 24 week triplets, or a newborn with major heart defects admitted to us at any time and these critically ill babies are often born at a moment’s notice. So there’s really not a “typical” day in the life of a neonatologist!
My day doesn’t end after leaving the NICU, I have four school-aged children so my weekday evenings are a flurry of getting dinner on the table, carpooling to and from sports’ practices, helping with homework, and getting them into bed.
Since I work part-time, I have many weeks that I am “off service” and life is not quite as hectic. While I still attend meetings and have teaching responsibilities, I’m sure to make time for self care, as well as growing, networking, and managing Primrose Newborn Care – a newborn medicine home visiting service that I opened in the greater Cleveland area in 2018.
2. You place a lot of emphasis on “4th trimester support.” What does that mean to you and why is it so important?
In our culture the newborn baby is the main focus of attention during pregnancy, labor and delivery, and the postpartum period. I personally experienced this as I spent my entire first pregnancy preparing for the arrival of my daughter (i.e. putting together her nursery, figuring out what to put on our baby registry, reading books about breastfeeding and newborn care, and figuring out what to pack in my hospital bag). It was not on my radar to think about or plan for my own needs during the postpartum period.
This emphasis on prioritizing the needs of newborns over their mothers’ needs, combined with a prevalent belief that women should be able to quickly bounce back to their pre-pregnancy lives after having babies, contributes to unrealistic and, in many cases, unattainable expectations for new mothers.
We are finally recognizing that new moms need to be nurtured and taken care of, not only to promote healing from labor and delivery, but to also promote mother-newborn bonding and ensure a successful transition to motherhood. This “4th trimester” paradigm recognizes that the weeks and months following pregnancy and delivery are a major physical, mental, and emotional transition for all new mothers and that supporting the mother-newborn dyad (not just the newborn) is of the utmost importance for maternal well-being.
3. You’re in the process of becoming an IBCLC. As a physician, why did you feel drawn to pursuing this certification?
Becoming an IBCLC will give me the tools to provide lactation support to all of my NICU moms and home-visiting clients. The majority of moms I interact with are pumping and very few are in the position of having all of their babies’ feedings be directly at the breast. The breastfeeding education that I received during my medical training was very basic and is also rather outdated. In addition, although I have experience as a breastfeeding mother, my own experiences do not really apply to other moms, as each breastfeeding journey is unique. I am becoming an IBCLC to enable me to provide individualized, high-quality support to all of the breastfeeding mother-infant dyads I work with and to help support them no matter what their breastfeeding journeys end up looking like.
4. Tell us about your personal experience navigating the realities of breastfeeding and postpartum.
My postpartum experiences with all four of my babies were vastly different, so I will describe each as briefly as I can!
I had my oldest, Grace, when I was 28 and in the middle of intense pediatric residency training. I had plans to exclusively breastfeed her, but we had unanticipated difficulties with getting her to “latch on” after she was born. She had poor weight gain and developed jaundice, so I ended up in the position of having to “triple feed” her. This meant that I would feed her at my breast(s), followed by a supplemental bottle, and then would need to pump to empty my breasts and have milk for her next feed. Grace was diagnosed with a milk protein allergy and I was diagnosed with postpartum depression (PPD) when she was 2 months old. I made the decision to stop pumping at this point so that I could get longer stretches of sleep at night (as the lack of sleep from triple feeding exacerbated my PPD), and her allergy was severe enough that she was prescribed a special formula called Neocate that she was on until she was a year old.
My second, Tommy, was born two years later when I was in the midst of my NICU fellowship training. He was initially sleepy with breastfeeding and lost a lot of weight, so I did need to pump and give him supplements until he regained his birth weight. I pumped when I went back to work when he was 8 weeks old, but the intensity of my shifts impacted my ability to pump as often as I needed to. One night I got called to attend an emergency C-section of a preemie when I was in the midst of a pumping session. I had to run to the OR immediately, and in the process of unhooking myself from the pump, I tripped and knocked all of my pumped milk onto the floor!
I gave birth to my third child, Gabrielle, right at the end of my neonatology fellowship. Despite arriving a month early, Gabby latched on right away, thrived on breast milk, and I was able to breastfeed and pump for her until she was 9 months old. My youngest, Claire, who was also born several weeks before her due date, breastfed well and I had a pretty uneventful breastfeeding and pumping experience with her.
While I would never say that breastfeeding was easy, it went much more smoothly with my youngest two than it had with my oldest. I used to feel like a “failure” when I’d reflect on my breastfeeding experiences after Grace and Tommy were born, since I did not breastfeed them for the first 6-12 months of life. Now, when I look back, I celebrate all of the breast milk they received, as opposed to what they did not!
5. What words of wisdom or encouragement do you feel are important for new and expectant mothers?
I encourage new and expecting moms to be gentle with and nurture themselves after giving birth. Know that the beautiful newborn-mother photos that permeate on social media feeds do not at all reflect the reality of caring for a newborn. I can’t even start to count how many new mothers I’ve worked with who have thought they must be doing something wrong since they’ve found it so much more difficult to take care of their newborn than they had expected it to be.
I like to remind new moms that the sleep deprivation, bodily discomforts, and hormonal fluctuations we experience as we heal and recover from childbirth and transition into motherhood are extremely difficult. It’s okay to ask others for help. Another reminder to new mamas is that they know their babies the best and a lot of advice that is shared with them does not always apply to experience with their own newborns. I encourage all mothers to trust their intuition when it comes to knowing what is best for their baby.
I also want moms to know that there is not at all a “one-size-fits-all” approach to breastfeeding and that there are incredible benefits to receiving any breast milk at all. I celebrate every ounce of breast milk that my NICU moms, and my home-visiting moms, are able to pump for their babies.
Lastly, it’s important for a new mom to recognize that her newborn loves her just as she is. A newborn doesn’t care if their mom has lost her pregnancy weight or not, if their milk is from a breast or bottle, or if their mom is still wearing the same clothes as she was yesterday morning. Likewise, a newborn does not care if they were delivered vaginally or by C-section, if their mom had an epidural or not, and so on. All that a newborn really needs is to be loved. The rest really doesn’t matter.
