Again, I heartily agree with Gonneke and Jennifer, that normal healthy breastfeeding is
NOT a medical issue. While there is a short intense window during the hospital stay
where the practices in the hospital can either disrupt or enhance the ability of a mother to
breastfeed, most of the breastfeeding relationship begins long before and continues long
after the hospital stay.
Mothers are influenced long before they even think about having a baby by the culture,
community, and family environment in their opinions about infant feeding AND in their
experience watching how it is done. When they are pregnant there is a brief window to
partially influence this early training. This NEED NOT BE medicalized. Much of it is
simply body mechanics. A good physical therapist might actually make an excellent
trainer for body positions that make mothers comfortable.
Then, for those that choose a hospital delivery or need a hospital delivery when there are
complications at home, there is the window that the vast majority of our profession sees.
I, however, see the aftermath. When moms come home and are clueless what to do next
or have to overcome some of the hurdles they encounted during the early period. Too
often, I have to explain to mothers that I can help get them back in sync with their baby
after they think its all over because the first 2-4 days didn't go well. BUT that
relationship continues for a very long time. And most of the advice is NON Medical. The
important piece is knowing when it is and is not a medical situation. I keep thinking
about a mom I saw recently with post-partum depression. She did NOT need a medical
intervention, she really needed therapy.
All these pieces need to fit together. It is not an either, or situation. But the profession
right now is out of equilibrium. Since the duration of breastfeeding is far greater than the
short window in the hospital... we should have far more private practitioners than at
present and that given the duration of the breastfeeding relationship, there should
probably be more out of the hospital than in the hospital. And this is in full recognition
that I still think there should be more support in the hospitals. If you have a chair that
only has one leg, it will collapse. If you have one leg that is shorter than the others it
will be unbalanced and teeter. We are currently teetering dramatically.
And again, what I am seeing in Manhattan is a trend to FEWER private practitioners.
Some, even before the SOP debate were already discouraged from the certification
process and the recertification process.
I'm sure you all have read that I think psychology is a good model of independent
practitioners that will collaborate with medical practitioners when necessary, but are not
medical themselves.
Susan E. Burger, MHS, PhD, IBCLC (at least for a little while longer)
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