This discussion is pointing up the different circumstances for women giving
birth in different parts of the world.  If your government has decreed that
Baby-Friendly care is the minimum standard of care in maternity
institutions, which are all, every one of them in the country, public
institutions staffed by state employees, then you have a very different
situation from what someone working in a free-standing private practice in a
country without universal maternity care coverage, where pregnant women are
e-mailed spurious Enfamil Lipil adverts and encouraged to sign up for home
delivery of same, or where simply purchasing diapers with a debit card can
lead to a carton of ready-to-feed breastmilk substitute landing on your
doorstep the next day.  The last is a real-life example from this list a few
years back.

My circumstances are more like Heather's in the UK, in that there is
universal coverage for maternity care.  There is no co-payment.  Uptake of
the service is as close to one hundred percent as you can get, the
exceptions being some of the women who have reason to fear their baby will
be taken from them at birth and women who are not aware they are pregnant
until labor begins.  We don't have the comprehensive in-home follow-up after
birth that the UK does, but on the other hand, we don't have the fear of
breastfeeding in public either.  There is virtually no advertising of
breastmilk substitutes to consumers.  The system we have would definitely
find the starving babies in short order, though the advice and support for
mothers of such babies is a mixed bag.  The cultural norm to breastfeed is
strong, and especially in the first few months it is rare to find a woman
who willingly abandons the effort, even if not well encouraged by health
personnel to continue. She will seek support from other quarters, mainly on
line or by phone to the mothers' organization, and go back to the health
services armed with new information on what to demand from them.

Our routine care will find the babies at risk long before things are
critical, so I see nothing to be gained here where I work, from informing
women who haven't asked me, about the things that may turn out to be
obstacles.  I can see why someone in the US would have a chronically
heightened level of preparedness, since the deck is stacked against
successful breastfeeding from long before the baby is born, from the culture
you grow up in, to the system you give birth in, and the entire
socioeconomic order that surrounds you.  So, in my opinion, while we support
the individual mothers with their specific problems by giving them good
practical and clinical care, we should be looking at the framework within
the problems arise, and doing whatever it takes to make the framework more
compatible with normal nurturing.

Rachel Myr
Kristiansand, Norway

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