Hi again,
I've just fininshed looking at posts over the past few weeks and just 
wanted to enter my 2 cents. I too see many young women that want to bottle 
feed their babies breastmilk but do not want to consider breastfeeding or 
when it begins to be a struggle they would rather pump. I am fortunate to 
have a peer counselor at WIC that when I refer these moms to her she will 
get them a manual pump and continue to follow up with those WIC clients. I 
will loan a hospital grade pump if I can to get them started. We also have 
some that there insurance will cover 80 to 90% of the cost of a PIS in 
which I refer them to a DME. I work as a LC on the OB unit. I get a 
referral on each mom that plans to breastfeed. Those that want to breast 
and bottle or those that plan to bottle feed EBM. We do STS immediately 
after birth. Some of these moms will refuse STS or ask to have the baby go 
to the warmer or get a bath, etc. I have discouraged all staff from 
bathing the baby until the first breastfeeding has taken place. It works 
most of the time. But Mom has first place in any decision she makes. If 
she wants the baby supplemented she can but she is told that if he hasn't 
gone to breast it may delay him in doing so. She is also told before her 
epidural or Stadol pain medication in labor that it may affect her baby's 
ability to latch well. She still over rules and I try to fix whatever when 
amill. I try my best to see where she is at. Teach her what I can. I let 
her know up front that pumping and feeding is alot of work. That she may 
have to supplement with formula if she isn't able to produce enough breast 
milk. I really try to refrain from her having to feel guilty for her 
choices. I figure that will come with maturity and I don't want that 
responsiblity. 
I send out surveys approx 3, 6, 9 and 12 months. About 40-50% return them 
but I have been trying to keep records of how long our patients 
breastfeed. Initially we have 72-85%. 30% seem to drop off after they 
return to work. I do have 2-4 that breastfeed beyone 1-4 yrs. I would like 
to sit for the IBCLC exam next July. I couldn't this year because I needed 
a new hip instead. Reading Lactnet has helped me learn so much. I still am 
afraid it might not be enough. We deliver approx. 400-500 births a year. 
We only have 3-5 OBGyns at a time. We are undergoing a big renevation so 
they think that will bring more to us. I want those credentials to go with 
me. I do a ton of referrals. 
I had a client call me her pediatrician suggested she start pumping so 
that she knows how much the baby is getting. Her baby is 7 months old and 
has been slowly falling off the charts. She is breastfeeding and eating 
solids. She refuses formula (her ped suggested she give it). I asked her 
to come in and do a pre and post weight. That is the only accurate finding 
I know to see how much she is getting. Because of her age I didn't watch 
the baby nurse since I am a stranger to her, I left her and her mother in 
a private room and returned about 25 minutes later. She gained only 3 
ounces post. She was 13# 15 oz. pre and 14 # 2 oz. post. Mom is picking up 
her fluid intake and calories. Also just started Mothers' Milk tea three 
times a day. I referred her to a dietician to see if she could help her 
with higher calories in the baby's solids. I asked that she nurse her at 
different times than when she nurses since I read that solids can alter 
the nutrients in breastmilk. She has her solids at meal times with the 
family. She was also getting weighted again at the Pediatrician's office 
two days later. So she has same scale weights to go on. Any other 
suggestions?
Bless you all,
Terri Klein RN CLE CLC

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