Pat wrote, "Too many babies in US have little or no follow-up.."  I must
agree with that statement.  It has to do with our health care system that
puts many people in limbo.  They don't have enough money to afford health
insurance but make too much money to qualify for Medicaid.

Although, one gets the impression that this mom would not have used the
system anyway.  It sounds like she was very fearful of it(many are and  with
some justification).  Even those who use the system can slip through the
cracks and tragedies can happen.  When I worked for the WIC Program, I
encountered a situation that troubled me.  I did a home visit with a client
that requested a breast pump.  The baby was struggling to gain weight and the
mother(her third baby and 2nd breastfed baby)was concerned that the baby
wasn't latching well. The baby had been seen by the pediatrician and the baby
was receiving formula.  After watching the baby attempt to nurse, I realized
that this baby was getting very little breast milk.  When I asked her how
much formula in a 24 hour period she had been giving this baby, she said 10
ounces and 2 ounces of breast milk.  This baby was 4 weeks old, had been seen
by the pediatrician and the mother had been counseled at the clinic.  This
mother had told everyone she was breastfeeding(NOT--baby could barely
latch-on). No one asked her how much formula she was giving(despite the fact
that this infant was not gaining).  No one else watched this baby attempt to
nurse.  After I explained that the baby had to have more than this amount,
the mother immediately began giving the baby more formula(we used an sns--the
baby could not bottlefed well either).   With a better pump, she was able to
produce more breast milk.  This episode revealed to me that assumptions are
sometimes made by health care professionals.  When one hears a mother say she
is breastfeeding, one really needs to know what the mother means by
breastfeeding(better yet watch her breastfeed).  When a mother is doing both
breastfeeding and formula, the hcp needs to know the amounts of formula being
given.  Some mothers who are doing both breastfeeding and formula are giving
far too much formula(which means that breastfeeding usually gets abandoned
before these moms want it to).  And some moms like this mom aren't doing
enough.  Most mothers in the US are not "exclusively" breastfeeding and so I
believe we need more information in this area for not only mothers but for
hcps.  Valerie W. McClain, IBCLC

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