Heather you have brought up some interesting points and these are my  
reactions.
Breastfeeding is far more than just feeding a baby.  If people are not  
familiar with Nil Bergman's work, please check it out.  He is one of the  frontiers 
on kangaroo care and skin to skin.
I encourage ALL mothers to hold their babies skin to skin.  I am  trying very 
hard to educate the staff I work with on this and there are many  walls I am 
hitting.  
The assumption is that if you encourage or ask a mother to place a naked  
baby on her bare chest you must be wanting her to breastfeed her baby.  Of  
course there are many a baby who try's to seek out the breast but this is not  the 
reason I encourage STS.
If a mother asks me about only pumping and not breastfeeding, I try to get  
an idea why they want to do this.  I honestly tell them the steps on how to  do 
this giving the down side of the work involved and the upside of her baby  
enjoying the benefits of breast milk.  
I hear of health care providers giving mothers "permission" to make the  
decisions they make.  I am not comfortable with this.  I do think we  need to 
acknowledge to a mother that we hear what she is asking and her issues  but 
ultimately she is the only one to make the decision.  Once she has  stated all her 
issues and how she has come to a decision, than we can reflect  back to her the 
question "is this what you want to do?"  We should  acknowledge that we hear 
their issues and what their  decision is but we do not have to give them 
permission  to make their own decisions.  
I also feel it is important to encourage them to keep all options open for  
the future.
Ann Perry, RN IBCLC
Boston, MA

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