The Breast Whisperer

MOTHER’S MILK Freda Rosenfeld, a lactation consultant, works with a client and her 6-week-old baby.

By ELISSA GOOTMAN - Published: February 19, 2010

AMY BRILL, a writer who lives in Windsor Terrace, survived nine months and six days of pregnancy, then 40 hours of labor. But after a few days of nursing, she was in excruciating pain, crying every time her baby latched on. Ms. Brill’s pediatrician wrote out a phone number as if it were a prescription. “Call this woman,” he said. “She’s seen every new mom in Brooklyn.”

Not quite, but over the last five years this woman, Freda Rosenfeld, has seen some 2,000 new moms, some of them multiple times, and many with multiple babies at once.

Ms. Rosenfeld is part medical professional, part therapist and part sleuth; a hand-holder, tongue-coaxer, savior of sore nipples. At 52, she wears her chestnut hair in an ageless ponytail and bangs, dressing in long denim skirts — the better to get spit up on — and cruises the borough with a “got breastmilk?” bumper sticker on her minivan.

A certified lactation consultant, she swoops in at one of the most vulnerable moments in many women’s lives, charging $200 ($160 if you come to her) for help with what is supposed to be the most natural and instinctive of acts but often is simply not.

“Once you go home from the hospital, you’re on your own with this little alien creature, and you have to figure out how to keep it alive,” Ms. Brill, 39, recalled of her daughter’s birth 16 months ago. “So you put it on your nipple and wait for it to eat, and hope all is right. But you really have no idea. Are they doing it right? Are they not doing it right? Are they eating enough? Are they starving?

“It really, really hurts to have someone sucking on your nipple like 10 times a day, partly because there is a right way and a wrong way,” Ms. Brill said. “So you call Freda, and she comes in and saves your life.”

About 74 percent of American mothers tried breast-feeding their newborns in 2006, according to the latest figures from the Centers for Disease Control and Prevention. That was up from 58 percent in 1985 and 27 percent in 1970. But many struggle to make it work and give up — by three months, a third of infants were exclusively breast-fed in 2006; by six months, 14 percent.

Enter the lactation consultant. Ms. Rosenfeld was certified in 1990; there are now some 20,000 worldwide, including 582 in New York State.

She has coached novices so anxious they tried to schedule a session before giving birth (“Just enjoy being pregnant,” she counseled) and Hasidic women suddenly unable to nurse baby No. 7, 8 or 9. She has succeeded with babies with Down syndrome, despite their poor muscle tone, and with adoptive mothers, using a gizmo called a supplemental nurser to bring in their breast milk (“Isn’t that cool?” she marveled). She has rooted out problems like reflux and thyroid disorder, and stroked thousands of tiny tongues in service of “the perfect suck.” She prescribes teas and herbs to increase milk supply, along with exercise regimens for newborn mouths, and sometimes recommends that a doctor clip a baby’s frenulum, the tissue beneath the tongue. In 2007, she worked with 80 sets of twins.

“I get paid to be neurotic and hold babies,” she said. “Who could ask for more?”

A century ago virtually all American mothers nursed their babies, but by the 1950s, formula was the norm. Then a group of breast-feeding evangelists formed La Leche League to teach what they saw as a lost art, promoting its health and emotional benefits. Their efforts were helped by the natural childbirth movement of the 1970s.

As more women tried nursing, more women had problems nursing, and La Leche volunteers — many of them mothers who found breast-feeding as natural as breathing — could not always solve them. The International Board of Lactation Consultant Examiners was formed in 1985; since then, its exam has been translated into 20 languages and administered in 87 countries (more than 4,000 people took it last year).

Theirs is a beleaguered profession, on the one hand dismissed by doctors like Michel Cohen, a celebrated New York pediatrician who mocked the tongue exercises in his 2004 book “The New Basics,” on the other challenged by uncredentialed freelancers seizing on the demand for breast-feeding advice.

“These books are so black-and-white, and life is so gray,” she said en route to a client one bitter winter day. “It’s like, if this is happening, try Chapter 6, but if you really think it’s more this, try Chapter 7, because Chapter 6 might be, I don’t have enough milk, but Chapter 7 might be, my baby’s colicky, and Chapter 9 might be, like, reality check, what should I expect from a newborn? Who would want to read a book that big?”

Over the years, Ms. Rosenfeld has become less dogmatic about lactation land mines like the F-word — formula. Her credo: Rule 1, enjoy the baby. Rule 2, feed the baby.

“She doesn’t lose the mom in the process, she respects her need for sleep, etc.,” said Amy Glaser, a pediatrician in Park Slope. “But she also doesn’t give up until the mom is ready.”

After calling in a state of near panic, the Park Slope mother pulled up in front of Ms. Rosenfeld’s Victorian in the Ditmas Park section of Brooklyn. She would have been there sooner, but in the mix of sleep deprivation and flooding hormones, she had gotten confused between the $160 fee and the address, initially heading to 160 Marlborough Road.

Ms. Rosenfeld laughed, unfazed.

The baby boy, 10 days old, was crying uncontrollably every afternoon. The mother, 31, feared that a breast reduction had diminished her milk supply. Memories of the agony she felt nursing her daughter, now 2 1/2, were flooding back. “It was not a labor of love at all,” said the mother, who asked not to be named.

Ms. Rosenfeld began her customary checklist: Fertility drugs? Epidural? ( “No” might prompt a “You go, girl!”) Medications?

She put the baby on a tiny butcher’s scale, watched him nurse, weighed him again: he was several ounces heavier. Then she slipped on a glove and examined his little mouth. He pushed his tongue out past his lip, a good sign. She squeezed his cheeks, tapped his lower lip: baby mouth yoga.

After an hour, Ms. Rosenfeld advised the mother to drink two cups of raspberry leaf tea each day, starting at noon. To keep a log of her diet, to weed out possible triggers of digestive issues for the baby. To do the tongue exercises before each feeding to “open his suck,” and burp him before, during and after. And to nurse for no longer than 12 minutes on the first side, 18 on the second.

“In the hospital they’re saying let him nurse for 45 minutes,” the mother interjected, exasperated. “It makes a person a little crazy to hear two very different things from two professionals.”

Rule 1, enjoy the baby. Rule 2, feed the baby.

“If you’re going to be sitting there and not enjoying nursing because you’re counting and you’re this-ing and you’re that-ing, then what have I given you?” Ms. Rosenfeld asked. “I may have given him breast milk, but I haven’t given you an awesome breast-feeding experience, and that’s what I’m here to do.”

Aside from a year studying in Israel and another in Ohio with her husband, Howard Wallick, who works in real estate, Ms. Rosenfeld has spent her whole life in Brooklyn; she knows alternate-side parking regulations well enough that she schedules appointments in certain neighborhoods at odd times, like 10:10 or 11:35.

A religious Jew, she starts each day with morning prayers, followed by yoga and 20 minutes jumping on the trampoline in the basement. Her face is makeup-free, usually framed by dangly earrings. When things get tense in a session, she lightens the mood by cooing, making faces and uttering ridiculous nicknames like “Bu-ja-boo!”

Having raised eyebrows as a teenager by going vegetarian and swearing off soda, Ms. Rosenfeld took a job after graduating from Brooklyn College at a nutrition center for low-income women, where her devotion to breast-feeding began. “To me, the breast-feeding was not just about better health for the baby, it was about these young girls realizing their baby is important,” she said. “I had 14-year-olds, and here was my opportunity not just to make these babies healthier but to make these mothers caring parents.”

In the decades since, she has taken classes with speech therapists to better understand the mechanics of the mouth. She picks up tips from crazed mothers and calm mothers, women with serious medical problems and women with whom she has to throw up her hands and explain, “Sometimes babies just cry.” She taught a woman with one functioning arm to nurse one-handed and has, with clues that manifest themselves in breast-milk production, detected thyroid problems and retained placenta.

“Some people call themselves consultants simply on the basis that they have two breasts and maybe had a baby,” said Felina Rakowski-Gallagher, who owns the nursing supply store Upper Breast Side. “The consulting numbers have tripled in terms of people who just put their shingle out there.”

And while Ms. Rosenfeld is lionized in online forums, she has her detractors. Lisa Eisdorfer said she was disappointed in her session with Ms. Rosenfeld and gave up nursing a couple of months later, frustrated that she could not produce enough milk for her twins.

“Her name is just everywhere within the twins world and outside of it,” Ms. Eisdorfer said. “I know that she has helped a lot of people, but just not me.”

In any case, she is one of several consultants in New York with cultlike followings, some charging as much as $350. Catherine Watson Genna, based in Queens, is also the author of two well-regarded breast-feeding guidebooks, while Beverly Solow, known in certain Manhattan precincts as the Goddess of Lactation, runs several crowded support groups each month.

Ms. Rosenfeld, who relishes the good anatomical pun, said that if she were to write a book it would be called “You Suck,” but that she preferred homing in on individual cases to dispensing generalizations.

“A hundred years ago, a lot of babies we have today were not born,” she noted. “Forty-five-year-old women having babies, that didn’t happen then; now it does, and sometimes if it’s because of fertility drugs, they’re not going to have milk. I worked with a 1-pound 14-ounce baby who’s a beautiful, delicious child right now. A hundred years ago, that baby would have never survived.”

Typically, new mothers have one session in the weeks after coming home from the hospital, with follow-ups by e-mail or phone. Some call long after they get the hang of nursing, for pediatrician recommendations (“Does it have to be a Russian doctor?” Ms. Rosenfeld asked a Russian-born client the other day), advice on whether to vaccinate, even sleep training. One client recently e-mailed to ask Ms. Rosenfeld’s philosophy on night lights.

She has had celebrity clients, though sometimes Ms. Rosenfeld, who watches only one television show at a time ( “Law & Order” recently made way for “Bones” ) does not recognize them, and other times she pretends not to, because they are, as she put it, “here as a mom.” Once, though, after a client left, she broke into a gleeful chant: “I had an Oscar winner in my house! I had an Oscar winner in my house!” (No, she would not name names.)

The only trouble she had nursing her own children — now 17, 20 and 22 — was giving it up.

“My oldest stopped nursing on his first birthday, and I was crushed,” Ms. Rosenfeld said. “And my husband said, ‘You believe in baby-led weaning!’ ” The youngest hopped into their bed at age 2 and declared, “ ‘I don’t think I need to nurse anymore, Mom.’ I was like, ‘O.K., go ahead, break my heart.’ ”

Was she drinking? Was she starving? Was that a gulp or just a murmur? Was that an “I’m famished” cry or an “I’m tired” cry? And how do you burp a baby, anyway?

These were some of the questions Abby Sher found herself asking, often in a frenzy of tears, after the blissful first week of her daughter’s life ended and the reality of Week 2 set in. “Especially in Brooklyn, it’s like, ‘This is going to be another challenge that I do all naturally!’ ” she recalled thinking. “ ‘And I know other people have challenges, but not me, because I do yoga!’ ”

Ms. Sher, a writer and performer who lives in Fort Greene, dragged her husband to a breast-feeding class, where they watched videos. “He was like, ‘That was fun,’ ” she said. “ ‘Now can we please call that nice lady that we heard about?’ ”

Ms. Rosenfeld did not diagnose any disorder or perform any magic — she watched Ms. Sher nurse, plopped the baby on the scale, and showed the couple some exercises. Rule 1: Enjoy the baby. Rule 2: Feed the baby.

“It was a lot of saying things that we just needed to hear: ‘She’s O.K., she’s eating, she’s going to grow, she’s beautiful,’ ” Ms. Sher explained. “She’s really just somebody everyone should be near after giving birth. It’s almost like she’s breast-feeding you.”

Leba Ringel, a Hasidic birthing coach, nursed eight children successfully, but when her ninth was born in 1998, she found her milk had dried up because of medication she took for pneumonia during her pregnancy. Ms. Rosenfeld taught Mrs. Ringel how to use a supplemental nurser — a tube taped to the nipple that dispenses formula, teaching the baby to suck for sustenance and, in the process, building up the mother’s supply. Mrs. Ringel, 51, not only now recommends Ms. Rosenfeld to her own clients, but also pays for a consultation with her each time a daughter or daughter-in-law gives birth for the first time. (Three so far.)

“ ‘Freda’ is a household word in our house,” she said.

Ms. Rosenfeld has consulted via e-mail with mothers as far away as Chicago, Hawaii and Switzerland, and has peered into the cultures of the world from her perch in Brooklyn. One small discovery: The belief that almonds enhance breast-milk production is cross-cultural.

“I’ve had Inuits from Alaska, I’ve had a couple from Nepal, I’ve had Japanese, Chinese — they all say almonds,” Ms. Rosenfeld mused. “Can I prove it? No. But I like almonds, so why not?”