Barbara writes:
"Their problem is not  going to be solved by this particular tool.  I
say again that there are serious deficits in LC training, and one area where
this is very visable is tool use."

I would agree with this completely. But, it isn't just LC's. We have a ped practice in our area that has a pat solution for every situation. Give the mother a feeding tube and tell her to finger feed the baby supplemental AIM. After that, who knows? The practice rents pumps, but they almost never suggest using the mother's own pumped milk, either. As a matter of fact, the number of babies who come home from one local hospital with the same solution is astounding. No, these moms are not told how to stop using the device, nor are they always refered to an LC. 

An interesting thing happens with the babies from the ped, though--many of the moms do have a better outcome with bf'ing b/c they are getting the message from the ped that bf'ing matters, even if the particular solution is not the best for a given situation. The same is not true of the hospital--I wonder if having the devices being given so early on gives them the impression that bf'ing just isn't going to work for them. I think it is more likely though that having seen an LC and not succeeded with bf'ing so far gives them the feeling that seeing another LC isn't going to improve things much. I have noticed that these moms are often less willing to give things enough time to turn around. I tell moms that babies are low-tech people, so they rarely need high-tech solutions. Unfortunately, in my community, most moms already have received many of the high tech solutions as gifts at their baby showers.  
Jennifer Tow, IBCLC, CT, USA