This thread about the need for pumps has made me rethink some other issues
as well.  We all work in a variety of settings, different cultures,
different socioeconomic status, etc.   I think it is important to adapt to
each particular situation as best as we can.  I was born and raised in
Nicaragua, an extremelly poor country.   There, I would not even think about
mentioning pumps.  I'd focus on hand expression.  I'd do the same when
working with low income populations here in Spain....But I'd also focus on
hand expression when dealing with affluent, health councious Spanish women
with naturalistic approaches.  Some women are genuinely interested in this
approach, for others it is just a fashionable trend...not my business to
judge.

However, when dealing with well educated women of a certain socioeconomic
status, who will certainly go back to work after their four months maternity
leave, I'd take Gail's approach and talk about the different kind of pumps
and encourage them to purchase one.  The Social Security system here do not
cover them, but since they are not buying all the equipment needed to bottle
feed, they do not find the cost of the pump to be a problem.

But the gist of it is not only socioeconomic status.  As much as I
personally hate consumerism, I live and work in a very consumist (not sure
about that word) society...and there are certain women that like to buy
stuff: the nursing pillow, the bed extension, the nursing bras and tops,
various types of slings....and the pump.  And they are very committed to
breastfeeding, but need the gadgets....so I provided them with information
about them!

By the same token, there are some women that absolutely need to have
something for sore nipples.  They would work on posture, look out for
thrush, etc, but if I mention that something such as ultrapurified lanolin
exist, they will go and buy it....use it, and feel much better.  Of course I
know that in most cases, the change of posture will take care of the
problem, but some people need to BUY the cure!!

My point is: how many nursing relationship could we save if we just give
them what they want?  The galactogogue, so they can really see milk flowing,
finally realize that they HAVE milk and silence outside criticism (of the
not very subtle type I'm afraid, like "You are starving that kid"); the
oxytocin nasal spray, the ultrapurified lanolin, the breast pump, etc.  Some
women need these things for specific physiological reasons, some other women
need these things for more emotional/psicological reasons. I think both kind
of reasons are valid.  I know that to make them work on the "basic" reason,
self-confidence must of the time, is much more empowering....but then there
is the time constrain.

It ended up being too long.  Sorry about that.

Lavinia Belli, LLL, IBCLC
Madrid

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