Karyn-grace wrote:

>
>
>1.  LLL is only available for the women who *choose* to use it's services
>(meeting, phone counselling, etc.) regardless of if the service was
>recommended to her or if she found out about it herself.  It is not enough.
>
>2.  LLL does not provide enough Leaders in every community to truly serve
>the needs of EVERY mother and child.


<snip> 

>
>3.  The very mothers who are most at risk for weaning early (or not even
>initiating breastfeeding) are the very ones who likely will *never* set foot
>in a La Leche League meeting, regardless of whether or not they have been
>informed.


<snip>

You are right about LLL, but *not* about peer support, Karyn-grace. 
As I described in my post, peer support  (at its best)  meets the 
challenge of reaching the people who are hard to reach - at its best, 
peer support programmes reach out to train women who can then  reach 
out in their turn to mothers in their own neighbourhoods.

Peer support programmes work best when they are flexible enough to 
cover one-to-one  support ('buddying up') as well as group support 
(*not* in someone's  home, but in a community venue) and when  they 
work with the existing health/social care services.


>.
>
>4.  We live in a medical-model culture, not a role-model culture.


I couldn't disagree more :) Breastfeeding is massively influenced by 
role models - there is an impressive literature showing exactly that 
- it *matters* when a mother's own mother, friends, sisters and 
others breastfeed, and this has an enormous influence on whether she 
chooses to do it, and how long she does it. The healthcare 
professionals she comes into contact with can facilitate this 
influence, or undermine it, but they will not change it.

Please don't let's ever capitulate to the medical model for bf 
support - some lactation situations benefit from medical model 
interventions, of course, but most do not.

>   The
>majority of women receive information and health care counselling from
>professionals who work within the medical-model


Well....that's a mistake.

>, and it does not appear to
>me that this will change anytime soon.  LLL and the like are not enough.
>
>5.  The health care community will never treat LLLL's on an equal footing
>because they are *volunteers* (please, ladies...I mean no offense - this is
>just a fact and one that I understand well:  "Are you an LC?"  was a common
>refrain from the PHN's and doctors I come in contact with)


This is not the case everywhere, though. Very few people in the UK 
have even heard of lactation consultants, or LLL(they might have 
heard of NCT). But in any case, it doesn't  matter. Why would you 
worry about the healthcare community treating LLLLs on an equal 
footing? Diane's point, and mine, is that volunteers *do a different 
job* from the healthcare professional.

It will  never happen that every mother will have her own IBCLC, and 
more importantly, nor should it.

This would not be a desirable state of affairs.

Most women do not need specialist medical-model lactation support. 
Most women do need friendly encouragement and a normalisation of 
breastfeeding. That is probably best achieved by volunteers or 
para-healthcare professionals working in a non-medical model way.

Heather Welford Neil
NCT bfc, tutor, UK

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