Dear all:

I wish I had Heather's experience of being able to count all the babies who truly are 
suffering negative health consequences on one hand. I would say I see a serious case at 
least once a month in my group --- often missed by other health care practitioners or 
falling through the cracks between visits.  I also see cases where mother has received 
false reassurances because everyone dismissed the possibility that something was wrong 
because the baby was at the bottom of the weight gain "normal" limit.  

This is where focusing on the weights alone --- "oh, it's a little low, but within normal..."  
instead of how the baby is behaving (sleepy, lethargic, then moving on to miss 
developmental milestones), or mom's history (insulin resistance, etc) or care taking 
behaviors (sleep training, rigid schedules, pacifier use..) play a huge role in detecting 
what is really going on.  There is nothing worse than seeing a baby at birth weight at four 
weeks whose mother was given false reassurances, when the signs were clearly there at 
two weeks.  Nudging at two weeks is so much easier than full scale interventions at four 
weeks.

The difference could be the environment, Baby Wise is still out there along in revised 
form with a slew of other books and I just had a mother who deviated from her 
pediatrician's advice and brought her baby back into bed after reading "Our Babies, 
Ourselves".  She is so much happier and so is her baby.  Now everyone is getting sleep 
after she defied her pediatrician's advice to go to a sleep trainer that had a rigid schedule 
that made everyone miserable.  This mom is taking "Our Babies, Ourselves" to her 
pediatrciain along with James McKenna's new book.

Plus, I suspect, if someone did a really unbiased study that the C-section rates here in 
Manhattan are probably hovering around 50%.  More importantly I think than the type of 
delivery is what happens afterwards.  It is quite routine in many hospitals for nurses to 
supplement without even asking the parents even if a card is on the baby's isolette saying 
don't supplement.  

I'm sure there is a selection process and I am sure see a disproportionately higher 
number of the cases of failure to thrive than Heather does because of that selection 
process and because of the populations we see.

I know most of the other IBCLCs in the city and have a great deal of respect for them and 
know they always do their best to ensure babies are thriving --- with one exception.  She 
routinely allows babies to lose well OVER 10% and will yell at mothers for using 
supplementation under any circumstance.  I say this on the basis of MANY reports from 
clients as well as a childbirth educator I know who reported her to the hospital where she 
gives classes after one of the childbirth educator's client had a baby that lost 2 POUNDS 
and was yelled at when she supplemented her baby. Independently, I saw a mother who 
was friends with the mom of the 2 pound weight loss case who told me exactly the same 
story.  I see a lot of this IBCLC's  "victims".   This IBCLC charges by the hour and often 
will stay for three hours chatting racking up $450 fees.  I'm finally getting a family with 
twins back on track after they were told to "throw out the pump" in the first week when 
the twins were barely transfering milk with the expected result that mom ended up with a 
50% supply.  She now coming closer to 100%.  This type of "purist" approach without 
really evaluating what is going on can lead to completely unecessary use of formula.  I 
know this mother of twins would have made enough had a proper assessment of milk 
transfer been made and had she been helped to remove the impediments to pumping 
efficiently.  

Machines are efficient inanimate objects.  Babies should never be expected to be 
efficient, they should be lovingly cared for and nourished (with more than food) and 
allowed to develop as they need to develop.  Perhaps I say this because we are in the 
crazy world of Manhattan where kids at age 2 are asked what 200 + 200 is in order to get 
into nursery schools (I am not kidding about this!).

I have a family practice resident shadowing me and it dawned on me that I had many 
babies in my group last week that had similar intakes, but the advice I gave was very 
different for each mother.  That's because the fuller picture was very different for each 
one.  The distracted four month old who was really excited about the new babies,.... the 
slow feeder who took the entire 2 hours to finish with a mom who is generally 
supplementing with 1 oz after feeds, the 6 day old who finally perked up and started to 
feed from the breast....   

I am a number cruncher at heart having studied epidemiology up the wazoo, but numbers 
alone are really not enough!!!! 

Best, Susan Burger.

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