I'm a chronic proofreader and that ought to be hemorrhage, but I'm
leaving it as it was in the subject line to keep the thread together.

I'm not a devotee of telling women so specifically what problems to be
on the lookout for unless there is a clear, consistent cause and
effect relationship between something in her history and a particular
complication in establishing breastfeeding.   This is hardly ever the
case.  But in my opinion it is sheer madness to cease follow up of a
new mother and her baby before about two weeks have passed, no matter
what her birth was like, what her breasts look like, whether her
mother succeeded at breastfeeding, whether the moon was on the wane
when the baby was born, whatever!

Women who've had reduction mammoplasty are no less likely to fail at
breastfeeding than any other women giving birth in typical hospitals
today.  There are dozens, if not hundreds, of ways we can undermine
women, with bad information, the wrong information, the right
information at the wrong time or presented in the wrong way, bad
policies, understaffing, and I could go on and on but it's too
depressing.  I'm not saying that all women whose breasts have been
surgically reduced in size will be able to exclusively breastfeed (I
am so NOT saying that!).  I'm saying that giving birth in a typical
hospital obstetric care setting in any of the countries where we work
is in itself a gigantic risk factor for breastfeeding failure.  And
that is part of the reason we should follow all mothers and babies
until breastfeeding is established.  The other part is that women and
babies deserve to be given attention; women should be treated kindly
and competently after giving birth because not doing so puts them at
risk for depression, which affects the way they respond to their
children.  Since those children are going to take care of us when we
get old and feeble, it's a good idea to see to it they are treated
well.

ALL new mothers should know what the signs of normal breastfeeding
are, and what to expect if things are going normally.  They should
expect breastfeeding to work and they should be confident that if it
is not working, they will be able to tell, and they can get good,
timely help.  They should ALL have someone to call, day or night, if
things aren't going as expected.  And ALL new mothers should have
direct access to competent help for at least the first two weeks, if
only in the form of a daily phone call to ask very focused questions
in order to determine whether an actual visit is needed.

A woman whose blood loss was not sufficient to keep her in the
hospital more than 48 hours after the birth should not expect to have
more trouble establishing a plentiful milk supply than any other woman
experiencing routine hospital postpartum care in most of the
industrialized world.  And no woman, certainly no primiparous woman,
should be simply cut loose on day two after giving birth, with no
follow up. no matter how little she bled or how normal everything is
after 48 hours.

My hesitation to tell women very specifically all the things that
might go wrong because of certain events or features in their history
comes from more than 20 years of seeing the most unlikely women
produce plenty of milk and have no problems, while those I would never
have identified early on as high risk, struggle and struggle and end
up stopping BF early.  Blood loss slightly over the arbitrarily chosen
limit of normal, 500 ml, does not correlate with BF problems, in my
experience.  It may be a contributing factor but almost never is it
the deciding one.  The same goes for breast surgery, hypothyroidism,
polycystic ovaries, and breasts with an odd appearance.  Most women do
fine at breastfeeding if they get competent care, and aren't
undermined before they get started.

I don't think this is a patronizing attitude; I'm not advocating that
we pretend everything will be fine no matter what, only that we not
pretend to be able to predict the future - and that we acknowledge
that most of the settings in which women give birth today are a bigger
threat to breastfeeding than blood loss or anything else related to
the individual woman, so why waste energy on it and undermine her
confidence in the process?

Rachel Myr
Kristiansand, Norway

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