Dear Freinds,

I have to rant.

I have just had yet an other phone call (permission to share granted) and
an other consultation from a mother in our area, who was advised (over the
phone, with NO personal or visual contact) to use a plain bottle nipple
to "help" a baby with latching problems attach. (It was the only advice
given.)

I get several calls a month of this variety. It is invariably from the same
source. Some of the mothers take the advice before calling myself, an other
LC or a LLL leader, and run into trouble (no doubt!) others seem to have
the foresight to not follow the advice and call someone who knows what to
do. (I mourn those who take the advice, fail at BF and never had an inkling
of what went wrong.)

We all know that even a well designed, THIN, nipple sheild needs a
throurogh examination, consultation, and warnings to the mother before
being tried. This source seems to dispense this advice in cycles (I am not
sure why, I have clusters of these calls, and them nothing for a month or
so.) I am hard pressed to find a situation where a THICK, rubber or
silicone device, designed for use with a feeding bottle could benefit a
mother and baby who need a consultation, and a proper evaluation of the
situation. Even in a case where an inexpensive and easy to come by nipple
sheild WAS warrented!

Yet the "advice" continues.

My conundrum involves being a nonRN community based LC, in an area with a
number of large hospitals, and a lot of "lactation specialists" and
CLEs. (Often the names of these "specialists" are either not remembered by
the mothers or not actual IBCLCs when I do get names.)

Any suggestions for non-confrontational, non-adversarial ways to dialogue
with the offending parties, without my simply being simply taken off of
their literature and referal and call lists? If these mothers don't call
me, or the other community base, private practice IBCLC, or a LLL leader in
the area, these mothers will never get the help they need. I have felt a
bit helpless and even intimidated approaching a hospital "expert" about
this subject. My fear is that I will simply be taken off of the call list
and literature the hospital gives out, leaving both the mothers and myself
none the better.

I once approached a Chicago children's hospital, (and had support of some
floor nurses) about their lack of ANY IBCLCs on staff, and some issues with
client's babies as patients there, which came up because of their lack of
an IBCLC on staff. I was never had my calls returned by the people in
power, and haven't gotten an indentified referal from said hospital since.
You can see my reluctance at this point.

Please help.

Thank you all so much. Thank you for letting me rant! I hope my rant hasn't
offended anyone.

Mary Jozwiak IBCLC, RLC, LLLL, AAPL
Private Practice

ps (again permission granted) the client had an almost indistingushable
nipple on a large areola and large breast. I sheild WAS needed (tiny baby,
short tongue, too sleepy from jaundice to draw tissue into nipple himself.)
We got the baby on with the Contact Sheild (no financial interest in
product) and he got a full tummy for the first time in his entire four days
here. No one SAW this lack of discernable nipple before? Anyway, so far
good, but guarded prognosis, mom, baby and dad VERY motivated. One good
feeding made all feel much better. Baby's MD (today before my visit) told
mom also to not use bottle nipple, not to supplement (yet!) and see me
and "keep trying." No one, however, not OBGYN, hospital staff, Ped,
mentioned VERY obvious lack of discernable nipple. sigh....

The bottle nipple, in the area, is suggested to a variety or latch
problems, usually without an evaluation. The person who suggested bottle
nipple to this mother never saw this mother in person, and mother wasn't
aware of the state of her nipples when this "once size fits all" suggestion
was made.

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