Karleen is on to something when she notes that there is a difference between disregarding a real problem or handling it inadequately on the one hand, as in the case of mothers with insufficient glandular tissue who simply got the standard advice for any woman with low supply, without regard to the particulars of their case, and on the other hand having a policy of assuming that breastfeeding will work, while being prepared to deal with virtually any problem that can arise. The first is a pretty good description of malpractice; the latter is best-case scenario care. If I were seeing a pregnant woman who had undergone bilateral mastectomy at menarche and who fully expected to bring in a full supply by day three post partum I would be concerned that her expectations were at odds with the likely outcome - but I would support her in breastfeeding while making sure there was a watertight plan in place to make sure the baby didn't starve. But I know women without visible breasts except gumdrop nipples, who have breastfed all their children exclusively. I know so many women with hypothyroidism who have breastfed exclusively that I have lost count, ditto women with PCOS, and diabetes, and high body mass indices. Most of the women we see nowadays who have had breast surgery of any kind, are already convinced they will not be able to breastfeed at all, so my biggest problem is bolstering their confidence just to give it a go. I'd like to add my few drops' worth to the discussion, on whether one would prefer to know in advance of problems that might arise. I'll grudgingly admit to being a control freak, but for me, part of having control is being able to admit that in fact, I don't control everything and it's really better that way. For example, I am very glad I did not know until he was born that my son had an unusually large head. I knew he was presenting by the vertex, which bolstered my confidence, but I would not have been helped by knowing his head circumference beforehand, nor by knowing how my labor would proceed. On the contrary, in fact. I am also glad I did not know when I was 20, that both my parents would be dead before I turned 30. I am really glad I had no idea what it was like to study midwifery as a new immigrant in a country with a language other than my native one, while co-parenting two young children, because had I known, I never would have attempted it. But once I did it, I've never regretted it. I'm glad I didn't know about so many of the challenging, gruelling experiences that lay in store for me, because I am the type to fret and worry and defeat myself before I even get started, and had I known about all of them I would probably just have curled up and read children's fiction full time for the rest of my life. I like to think the world is a better place than it would have been if I had taken that route. I'm now actively, consciously thankful that I have no idea what the future holds for me or those I love. In all the adverse circumstances I have been in, I have been grateful for getting the good help I have received. I believe it was the help that got me through them. I won't waste time here on the people who made things harder, just as I try not to let them occupy undeserved space in my life now. So rather than tell a woman 'you have such and such a condition and it *may* be a barrier to the easy establishment of breastfeeding' I would say 'stay flexible and make sure you have access to excellent support'. The exception would be if I knew there was something she could do then and there that would improve her chances, which of course I would let her know (seek out a baby-friendly birth environment and abandon plans to give birth somewhere renowned for its cozying up to formula reps, for example). But I would say the same thing to ANY woman embarking on parenthood, and any man too, for that matter. One of my colleagues, who struggled with milk supply, and sore nipples complicated by Raynauds, said when her son was eight months old and they had been breastfeeding happily and painlessly for two months that she had been unprepared for how long it would take for the problem to resolve. She also said that had she known it would take so long, she might have stopped at two weeks, and when we had this conversation she was overflowing with gratitude for the richness of her relationship with her son because they had kept on going, and she couldn't imagine stopping anytime soon. I reiterate what Karleen said: lying to women or giving them bad care in the face of an obvious problem is NOT the same as refraining from describing every possible complication that might arise with breastfeeding, or might not. Women do need to know how to recognize problems early on, and they need to know where to get good help. You don't need to be an IBCLC with a special interest in BFAR or atypical breast development to know that a baby who isn't happy or producing abundant used diapers or gaining weight despite being well latched 22 hours of every 24, is a red flag. I wonder how many women who had serious obstacles to breastfeeding, as in the MOBI group, would have been able to change the outcome by any means other than having had better care in the first week of their childrens' lives, including someone who made sure they got connected to other mothers in like situations. Teetering on the edge of my soapbox, so I'll step down now, Rachel Myr Kristiansand, Norway *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]