Kathy - Your posts are always so thoughtful!  I love reading and learning
from them.  If you don't mind I'll add a few comments to your latest -

"Several said we can fix nipple confusion later on. I would question how
easy this really is."
Agree.  Fixing nipple confusion may be a bear.  However, avoiding it is
usually not a problem.  Careful selection of nipple and consistent,
breastfeeding-friendly technique make a world of differences.  Some parents
do this so well that they fix the sucking problems that wrecked mom's
nipples and caused them to bottle in the first place.  Very nice.

"So many babies adapt to bottles by not sucking. They look like they are but
they are really only swallowing. So 
you put them on the breast and they don't suck or suck shallowly and in 
too short of bursts and no milk is removed or MER triggered."
Indeed.  Parents need to understand that they are teaching, not just
feeding, when they use a bottle.  Again, technique and nipple choice make a
world of difference. 

"She needs to be told that bottle fed babies often stop sucking well enough
to remove milk at the breast."  
Hmmm.  Perhaps I've been fortunate.  I don't like to see a mom pump/bottle
unless there's zero option but have seen moms do this up to 12 weeks and
have baby return to brst beautifully.    

"And be told that she may or may not have difficulty maintaining her milk
supply on a machine."
Interesting.  The Breastfeeding Answer Book on p 226 has some stats on
exclusive pumping that mirror my experience - right pump and right schedule
= loads of milk (assuming no fundamental problem).  Moms can often maintain
100% on quite light pumping frequency throwing in some more diligent days if
they need a boost.  I remember a mom of twins who pumped 80 oz/day on 5/day
and 50 oz/day when dropped to 3.  A lot depends on mom's motivation and I
may work with an exceptionally motivated bunch - 99% of them want to be
breastfeeding but something is preventing it.
 
"I have had women report to me that the LC said just pump and bottle feed
and this makes some of them very angry."
I am very nervous about reports of what the previous LC said! Just last week
I was chatting on phone and said to mom "one option might be renting a
scale."  Mom yelled over to her husband "she says we should rent a scale."
No. No. No! I suspect the majority of those claims that the prior LC said
something atrocious are inaccurate to say the least.  I notice that some of
the moms I see will reconsider what they claim their referring physician has
said when I comment that I just read that physician's chart note.  I guess
that's human nature. 

Cheers!
Joanna Koch MBA IBCLC (N Ca)

 

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