A recent correspondent described a situation in which a mother who is
     breastfeeding 14 month old twins and has no menses was told by her
     doctor that she is a high risk of osteoporosis.  So the LC has asked
     LactNet if there are any reliable studies that show permanent loss of
     bone density with protracted lactation ammenorrhea. That's a good
     question, and I hope others can answer it.

     But would it not also be helpful to educate mothers to ask their
     doctor the responsive question?  Maybe we could help them practice, if
     need be.

     "Doctor, that is something I had not thought of, and I would really
     like to track down the articles that have given you that information.
     If you don't have them on hand, will please give me the references?
     I'll get them through interlibrary loan and discuss them with my
     family. I don't want to make this decision until we all understand
     much better just what the science is."

     The medical professional is reminded of his/her responsibility to
     provide the client with the scientific basis for a recommendation, if
     requested.  It is wonderful that this mother also has a Lactation
     Consultant to strengthen her, and to help her and her family
     understand the articles if necessary.  But the mother's own skills at
     being treated respectfully by the health care system will be further
     developed if she can telephone the doctor herself and make the request
     for fuller scientific information direct to him or her.

     Many doctors were trained to limit the information that they give so
     as not to overload the person who really does not want to know all the
     nitty gritty. But most of them are also pleased to respond more fully
     to people who request more information -- and it sounds as if this
     mother of twins is in that category.  She may not yet realise that she
     is totally within her rights, and not being rude, to ask the doctor to
     lend her or tell her how to get the key articles from which his/her
     recommendation is derived.  If she does this once, she will be
     stronger forever in dealing collaboratively with not only this doctor
     but with all kinds of systems and authorities.

     Best of luck in keeping these twins and mother going, and growing!

     Helen Armstrong IBCLC

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