IMO you kind of answered your own question :-)  Living in Miami, Florida,
and working for WIC here as an IBCLC, I see what you're describing virtually
every day of my professional life :::sigh::: Most of my clients are
Hispanic, and most state that they want to "do both".

Many, as you've already figured out, do it because they think they don't
have enough milk.  THAT is the reason why.  They don't necessarily *want*
to.  They think they *have* to; they think they *need* to.  They don't
believe that their bodies work the way they're supposed to.

Many moms have other reasons as well, cultural/social/parenting ones.  They
think the bottle is their guarantee that the baby won't become "too
dependent" upon them.  Or they're just not ready yet to commit to the idea
of fully and solely breastfeeding - the responsibility seems like a great
one.  Or "doing both" sounds like the socially correct thing to say; they
don't want to be thought of as strange or fanatic.  Doing both is the way to
breastfeed and **"still be normal"**!

But you've hit upon what I often do in these situations:  ASK WHY!  I ask
why a lot, in my practice.  For practically any conclusion or opinion a
mother gives me about her nursing, I'm likely to ask her WHY she thinks
that.  I can't undo a myth I don't even know she has.  Asking WHY she holds
a particular belief or opinion about her nursing experience reveals what her
myths are....what I need to teach her about!  Hence:

Me:  "So, you're planning on doing both, breast & bottle?"
WIC Participant:  "Yes, I am."
Me:  "May I ask why?"

What she says next will give you something to go on.

If her answer is,

"Well, because I'm just not sure that I'm going to make enough milk, and I
want to be sure that the baby gets enough to eat."

Then my next question is, yet again, "why":

"Why is it that you think you're not making enough milk?  What makes you
believe that you're not producing enough breastmilk?"

That one stumps some women, but I ask it virtually every time a woman tells
me she's not making enough milk - my presumption, to her, is that her body
WORKS, and she IS making enough milk.  Therefore my question is why does she
THINK she's not?  Because the baby nurses so often?  Because he cries after
she puts him down?  Why? What's she basing that conclusion on? (Hand in hand
with this, of course, you have to teach her to count diapers, discuss weight
gain, etc)

If her answer to your initial "why" question is something else, like, "I
want to do both because I'm going back to work soon, and I need the baby to
be able to accept the bottle, too" then you've got a whole other
consultation on your hands.  In short, what you do and say to handle the
situation does not depend upon why you or I think she's going to "do both",
but on why SHE has decided to do that.  She's got reasons.  Find out what
they are, and go from there.

One more thing:  Warn them about the problems that they might end up coming
back to you with 3 weeks or so down the line.  Tell them that there is a
downside to doing both breast/bottle prior to age 4-6 weeks (nipple
confusion, breast refusal, reduced milk supply, etc).  Chances are good they
DON'T know this; suggest that they wait a month to 6 weeks before going to
the formula.  With some follow up phone calls, many women end up NOT going
to the formula at all anyway, but either way they're entitled to make that
decision with a full set of information.

Just my $.02.  This is a subject of some fascination to me, since I deal
with it dozens of times a month.  Pat yourself on the back for caring so
much, and let me know how it goes with your clients!  FYI, I won't be in the
office again until Tuesday, so you or anyone else can email me at home till
then ([log in to unmask])
Regina Roig Lane, BS IBCLC for Miami-Dade County WIC

-----Original Message-----
Feeling cranking in chicago today.....I am seeing way too many women who
want to "do both" and start giving bottles at birth. Usually it is the
Hispanic ladies who do this, because they think they have no milk in the
beginning. But I would like to know WHY people want to do this and what
they see as the benefit. When I worked at a "yuppie" hospital, no one
did this. It's really hard to be accepting and explain in a rational
way; yesterday I just wanted to say, "so, you only want to give your
baby PART of the benefit of being breastfed?" Can others share with me,
whether or not this is happening in other areas? How you deal with it?
When the moms have problems, then they expect me to fix it! Maybe this
would be a good article for Consultant's Corner in JHL?
Mary Kay Smith, IBCLC
Romeoville IL near Chicago

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