In response to Teresa's question regarding our experience of working with premature babies who come home before they know how to nurse. 

Infants who display signs of nipple preference are essentially saying that from their perspective the bottle or any other apparent feeding object represents a "giving" object. On the other hand, the unfamiliar and comparatively slow flowing maternal breast object becomes the bad or withholding object. Combine this with the infant's sense of being attacked, as is the case with most premature infants. These infants are therefore, severely emotionally traumatized as are their parents for that matter. 
 
Some parents might be able to cope with all of this baggage in addition to trying to teach a baby to nurse on their own at home. For example, a family that I worked with recently (family gave permission to tell their story) were eventually successful. They had a month old premature baby who outright refused his mother's breast after an established routine of receiving pumped milk in bottles. Despite that the mother had established a very successful and close relationship with her breast pump, she STRONGLY felt that this was not nursing. She TRULY mourned the loss of a real nursing relationship. The mom was EXTREMELY DETERMINED to get back the nursing relationship that she felt that she and her infant deserved. She was GENUINELY  supported by her partner, family and professionals as she took steps to recreate the prematurely lost uterine environment and to reframe the maternal breast as the "giving" breast. 

Now, this family worked very hard and they eventually met their goal of nursing at the breast but how many families are as fortunate to have the determination and support that this family had? I think very few.

It has been my experience that mothers are sent home with a pump, baby and bottles and for some reason are expected to cope with all of this. The transition to parenthood poses enough challenges without the addition of additional obstacles such as coping with trauma, pumping and trying to work with an often resistant baby. How overwhelming! I have a very strong sense that many families are understandably unable to meet this challenge even with the best intentions. 
 
So in response to Teresa's question, I agree that many families continue to struggle after they come home from the hospital. I think that you should be commended for strongly supporting your daughter in-law and son to avoid bottles! 

Keren Epstein-Gilboa MEd BScN RN FACCE LCCE IBCLC
PhD (Candidate)   

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