The discussion about whether it's permissible to teach women about bottle
feeding in groups has gotten a little sloppy.  I'll try to clean up.

First, the WHO Code which deals with guidelines for ethical marketing of
breastmilk substitutes and teats and feeding bottles does not deal with how
mothers who need such products, learn to use them safely.  It addresses the
issues of behavior by manufacturers and merchants and to some degree by
health practitioners.  The short version of that part is that a health
practitioner is not to be a go-between for a company that manufactures or
sells products covered by the Code, and parents.  

The WHO-Unicef Baby Friendly Initiative defines the criteria an institution
must meet in order to be certified Baby Friendly, a copyrighted term.  The
institution must respect the WHO Code.  In addition it must provide care in
accordance with the Ten Steps to Successful Breastfeeding.  It must have
written policies delineating such care and it must demonstrate convincingly
that it sees to it that all staff have appropriate training to carry out
such care.  One point in every assessment is to check that there is no GROUP
TEACHING of women in how to carry out bottle feeding, and no materials
promoting bottle feeding lying around for mothers to take.  This is in
keeping with practice that assumes breastfeeding as the norm, and bottle
feeding as a special situation warranting one to one attention.  It is
acceptable under Baby Friendly criteria to offer group teaching to mothers
on breastfeeding basics, but another criterion is that mothers know where
they can get help if they have problems.  Baby Friendly criteria require
that each mother be offered help if needed to get baby to the breast after
it is born, and again within six hours of the first offer, and that help be
available as needed for the entire time the mother and baby are in the
hospital.  They require that mothers who are separated from their babies be
shown how to establish and maintain milk production by  expressing milk.  

If you are a practitioner in a community where learning to bottle feed in a
way that may be less damaging to breastfeeding is a common need, and you
have ascertained this for each woman through prior individual contact with
her, there is no sanction anyone can impose upon you, and it may well be an
appropriate measure, to offer a special group for 'how to optimize your
chances of breastfeeding as long as you want, even when you have to be apart
from your baby for work' or something like that.

I agree with Heather on the safety part.  Learning how to hold a bottle and
let the baby pace the feed is one thing and I personally feel it is very
important that on cue feeding be practiced whether babies are breastfed or
not, but learning to mix powdered formula correctly and clean the equipment
adequately is much more complicated and exacting and should be done one to
one.  A hospital that does not realize it is making itself vulnerable by
neglecting its duty to ensure the safety of a baby who is not breastfed, is
a hospital that is asking for a lawsuit when a baby dies of diarrhea or
kidney failure from inappropriately prepared feeds, if the parents were
known to be formula feeding on discharge and were not shown the correct way
to do it.  

Rachel Myr
Kristiansand

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