I have not read the article yet, but it does seem to me that 
the "determination to breastfeed" factor is very hard to control for. It seems 
to me, that women who opt to deliver without pain medication, also a strong 
and determined crew, may  be inclined to stick with breastfeeding through 
thick and thin. They may be a self-selecting bunch of fairly tough women. 

I have clients who blow me away with their ability to stick with breastfeeding. 
Women who will continue despite abcesses and sensations that there is glass 
in there nipples everytime they feed, through stabbing and burning that 
sometimes goes on for what seems to me (wimp that I am) intolerable time 
periods. I admire them enormously and know that they are stronger than I am, 
and that they persevere long after I would have introduced Similac.

I truly believe that determination is the prevailing factor in successful 
breastfeeding, though obviously we can introduce factors that interfere with a 
successful outcome. How do we control for determination?

Kathy Lilleskov RN IBCLC

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