<<What is the ethical and legal implications of advising a breastfeeding
mother over the phone and telling her to do something against what her team
of care providers who are counseling her, examining her,  working with
her everyday and multiple times during day while still hospitalized?>>

Unless you are a health care provider specifically certified, you do not
have prescription rights in the US. If you are advising someone to do
something, that is basically prescribing, from what I understand.

Imparting information, on the other hand, is acceptable. You state the
facts. "Nursing 8-12 times in a 24 hour period is normal. Listen for the
baby to swallow to help you know there is milk transfer. Your newborn should
have x numbers of wet/dirty diapers in a 24 hours period..." 

What I did not say was, "You have to nurse the baby 10 times in 24 hours" or
"Don't give the formula, you have plenty of milk, you just don't realize
it." 

Give the mother information, she chooses which information to accept. It
helps to have current resources. The LLL BAB is becoming old, (published in
2003 - many consider a resource older than 5 years to be "old") but as far
as information goes, it is most useful. If the mother chooses poorly, based
on her resources, that is her choice. Many women do not research
breastfeeding before the birth of their child, even though it has the
potential to last for years, yet they prepare for childbirth, although this
stage only lasts for 24 hours (typical rule in the US, after the water is
broken.)

<<I am baffled by this phenon I'm seeing...Where is the milk? Are there new
 Trends that are being researched?  But sadly yes, I see many many mothers
3-5 days
pp with no clinical signs of lactogenesis. I am referring to mothers that
report
absolutely no breast growth during pregnancy,>>

That, I don't know. However, many birth practices disrupt normalcy in the
breastfeeding couplet. Some too tired, some too injured, some too confused. 

<<Unfortunately, those babies need supplementation.>>

Number one rule - Feed The Baby. It would be great if the mothers could
latch their baby. It would be good if moms could express their own milk. It
is nice to get donated milk. It's a 4th choice to use formula. Formula is
not equal, it is inferior to human milk. That is not a value judgment, that
is fact. And, yes, a baby may require supplementation with formula, but it
would not be the first choice.

Sam Doak
Marietta Ohio

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