First, I want to thank Beth Fitzpatrick for her courage in posting on behalf
of other mothers whose children have been the result of rape, as well as
others who have reiterated that if a woman has decided to give birth to the
child, what reason could we have for not encouraging breastfeeding?

Betsy Riedel started the thread when she wrote:
"If some of you who do not work with large groups of the general public
could 
see the calibre (or lack thereof) of some of our parents of this generation 
coming up, you'd realize that it is probably good that there is an
alternative to 
breastfeeding. That is not to say that there aren't individuals from all
walks of 
life who wish to breastfeed and are successful, but there are those for whom

this would not (and should not) ever be the choice."

Kathleen Bruce asked whether there is some specific group to whom Betsy was
referring, who should not, ever, have the choice to breastfeed, since what
Betsy posted, cut and pasted above, seems to say just that.  Betsy seemed to
backpedal in her following post, saying we shouldn't be coercing anyone to
breastfeed: 
"I just feel that in working with all socioeconomic, cultural, and ethnic
backgrounds 
coupled with ages of moms varying between about 13 and 45, there are some 
women who just plain are not interested in breastfeeding and believe it or
not, 
some of them do know the risks of formula and do know what's what and they 
still choose NOT to breastfeed. It is not my place to force any issue on
them."

But the post which elicited Kathleen's question didn't seem to be addressing
that.  I, too, perceived an implicit judgment that some women ought not to
be offered the choice, triggered in me by the use of the word calibre, and I
was also curious about which mothers Betsy meant, particularly since her
opinion both times was presented as a result of working with a heterogeneous
population, as though someone working with people who all come from similar
socioeconomic, cultural and ethnic backgrounds, would be less likely to
encounter mothers of a lesser calibre.  So I wondered, how do we define
calibre?

Oddly, no one has mentioned HIV in this discussion, despite the fact that in
many places mothers with HIV are prevented from breastfeeding by being given
lactation suppressants or even having their babies withheld from them under
threat of permanent removal if they should attempt to breastfeed.  I am not
endorsing this practice, merely mentioning that it occurs.  

I appreciate those who have pointed out that **some** of the women for whom
breastfeeding might be ill advised, are those who probably should not have
custody of minor children at all.  The very disturbing example of a young
teenager who seemed very traumatized by giving birth to a child fathered by
a family friend more than twice her age, strikes me as an example of a case
in which her own parents should not have had custody of her, and certainly
not of the baby.  I am quite sure that a thirteen year old in such
circumstances where I live, would be being cared for by someone other than
the parents who allowed her to be abused by their friend.  A twelve or
thirteen year old is in fact not legally capable of consenting to having
sexual intercourse where I live, and impregnating a child of this age is by
definition a crime here.  Surely, even if the statutes are different where
she gave birth, we can see that there are two minor children in need of
protection in this situation?  I agree, confronted with such a scenario, I
would not rush to institute skin to skin contact between mother and baby and
start talking about the risks of artificial feeding.  I would be more
immediately concerned with the physical safety of the newborn and the new
mother both in the short and the long term.

Since the general public consists of more than a billion of us, I doubt any
of us can say that we work with large groups of it.  Where I work there is
no one with an economic barrier to seeking care because maternity care is
universally available to anyone in the country, but there are very
definitely inequities in the system and not all babies come home to an
equally safe or loving environment.  The only care on offer is the public
care, so we see literally everyone who has a baby, in my unit only about
2000 mothers each year, admittedly a very small fraction of the world
population, but still the entire childbearing public in my region.  It is a
serious offense not to report a birth to the census as well, and no midwife
who intends to keep her license to practice would dream of concealing a
baby's birth, should she happen to attend a birth that doesn't take place in
an institution, whether by plan or by chance.  We are the ones who report
all the births in the country; even when an obstetrician has performed a
c-section it is the midwife who is responsible for the mother's and baby's
further care from the time of division of the umbilical cord and who gets to
do the bureaucratic paperwork.  The number of unrecorded births here is
probably microscopic, even the most stigmatized women do show up for
maternity care and certainly when they are in labor.  They expect to be
cared for kindly and with the same professional quality as everyone else and
I hope they are seldom disappointed.

Current policy in Norway is to give cabergoline to HIV-positive mothers at
birth and instruct them in artificial feeding.  I personally do not support
this as the only option, but I am not in a position to change it in the
short term, nor to circumvent it.  Women whose ability to care for a baby at
all is a matter of concern, are followed up for that reason, without regard
to whether they are breastfeeding.  Some of them are, some aren't, but
ability to care for a child in other ways is not a factor in whether we
encourage breastfeeding, nor is breastfeeding automatically taken as a sign
that a woman is a fit caregiver.  Women with chemical dependencies other
than nicotine are heavily stigmatized in Norway and probably face the
biggest risk of losing their children permanently if they continue their
habits.  They are still not discouraged from breastfeeding.  

My realization that it is good that there are other foods to keep babies
alive when breastfeeding is not available to them, has nothing whatever to
do with any judgment I may make about the 'calibre of some of our parents of
this generation coming up'.  I work with the entire spectre of parents in my
community and even most of our high income, well educated career
professionals seem to adapt to meeting the needs of their babies, if given
adequate support.

Rachel Myr
Kristiansand, Norway

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