Having lived and worked in developing areas of the world from 1980 - 1999, where there were seldom gadgets -- breastfeeding problems were assisted by conursing (among cowives or kin or wetnurses) and when the problems weren't solved babies failed to thrive or died. Since the immediate cause of death would be listed -- for instance, dehydration from severe diarrhea when a mom finally succumbed and fed her baby watered down camel's milk with fermented millet -- no one was taking a detailed history to figure out what set that baby down the path.   

When one in five babies dies before age 5, no one is really investigating whether the severe iodine deficiency that leads to hypothyroidism and poor fertility in the mom and slow cognitive development and sometimes even cretinism in infants contribute to suppressed milk production and/or poor sucking ability.   Similarly, I don't think anyone is looking for tongue or lip dies in areas where surgery for clefts in lips and or palates are rarely done.  Undernutrition is common so who really knows whether a 7% or the 10% weight loss contributes to poor gains in these infants or whether infants who lose that much have an underlying condition that caused them to lose the weight and continues to make it difficult for these babies to transfer enough milk.  Clearly there were less iatrogenically induced problems.  Nevertheless, I wouldn't assume that there was ever a perfect time and a perfect place when breastfeeding went swimmingly well for all women and infants.  

Best, Susan Burger

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