Well, I felt I had my act together with visual aids, etc. to be able to have a brief Q&A session with any family members who showed up for my first scheduled short class on the first open-late Monday in January. Alas, no one showed up. So March is the next trial. (or I plan to provide it by appointment, too.)


I need to have a huddle with my colleagues to brainstorm ideas on how we can best "advertise" the existence (and potential value) of such a class to families, through the pregnant mothers when they come in for regular WIC appointments and Infant Feeding Classes.  


I looked up the "Mothers and Their Families" excerpt from Executive Summary: The Surgeon General’s Call to Action to Support Breastfeeding:


<Mothers and Their Families 

The first section of The Surgeon General’s Call to Action to Support Breastfeeding focuses on Mothers and Their Families, calling for two specific actions:

Action 1. Give mothers the support they need to breastfeed their babies. 
Action 2. Develop programs to educate fathers and grandmothers about breastfeeding. 

Encouraging women to discuss their desire and plans to breastfeed with their clinicians, family and friends, employers, and child care providers is key. When a woman has decided she wants to breastfeed, discussing her plans with her clinician during prenatal care and again when she is in the hospital or birth center will enable her clinician to give her the type of information and assistance she needs to be successful. Family members—including spouses, partners and the baby’s grandmothers—can play critical support roles, both with regard to assisting in decision-making about how the baby is fed and in providing support for breastfeeding after the baby is born.>


Do you think posting this somewhere on a waiting room bulletin board, or as a small stand-up sign on a nutritionists desk would be of any use?? Is the actual wording simple enough for at least part of our WIC mothers?? 


One of the staff has already made a lovely 8x11 flyer that I want to keep displayed on the bulletin board in each of our 4 clinics, plus encouraging the peers to talk it up a little in their infant feeding classes for the mothers, and also in routine prenatal calls. Someone wondered "How can we expect them to remember the date to tell their families??", and suggested giving the flyer out when the nutritionist talks to them. But there is only so much paper we can expect folks to keep around and bring to someone's attention. Any ideas or tried and true systems would be welcome.


I don't want to "upstage" the important work of the peers in any way, but I would like to make mothers more aware of the fact that we have a number of IBCLC's on our staff. It doesn't seem to me that very many of them are aware of that, at least prenatally, and what potential help is available. Some breastfeeding challenges can be foreseen, but this requires prenatal assessment and planning to prevent unnecessary postnatal problems. This is not to criticize the rapid strides being made in better hospital breastfeeding initiation in our community. But it is my impression that very few physicians in our locale seem to be even examining breasts prenatally, let alone saying anything about obvious things like inverted nipples, ISG, etc.  


(IME, the conclusions of the Main trial were quite "paternalistic" and simply seem to have let prenatal caregivers "off the hook" in this respect.) I feel very strongly that mothers deserve more choices in advance planning on ways to get off to the best start, especially if such a potential situation exists. It seems like a "rude postnatal awakening" for mothers to learn some of these things that could have been foreseen.


Several of us have had extensive previous experience providing prenatal breast assessments. I would like to word this in a non-threatening way such as "If you have any questions or concerns about your breasts or nipples, call for a private prenatal assessment." When a mother is willing, I find that the prenatal breast makes one of the best teaching aids because of kinesthetic learning potential. I have found that offering to teach actual hand expression prenatally while the mother is alert and excited has advantages over assuming that her hospital nurse or LC is going to teach her when she is edematous and sleep deprived, and perhaps very worried over her baby's condition, perhaps on a holiday weekend when the census is high.  I have not seen anyone providing a choice for such a service in our locale. 


Besides expanding our offer of these services to mothers, I'd like to offer the chance for any of our newer LC's to learn to be confident enough to provide that service as my colleague and I "age out" of service. I'd be interested in hearing how realistic or unrealistic this strikes various interested Lactnetters, and in receiving suggestions about bringing about some of my "flights of fancy" and even how the whole idea may thoroughly "turn off" staunch supporters of the conclusions of the Main Trial.


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC     Dayton OH

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