Dear all:
My next comment may not be a randomized controlled trial -- but anyone who has studied the philosophy of science and how causality is established knows that the randomized controlled trial really is NOT the gold standard.  Building up a solid evidence base of both Plausibility and Probability from many research studies is what develops the case for causality.  

So using an evidence base from a premier researcher on mother and child attachment, Dr. Beatrice Beebe who has established that behavioral interactions between mothers and their infants at four month olds is predictive of attachment disorders in adults -- is in the field of psychology.  My husband often will complain and wonder why I can't limit the time of my visits the way he does in his practice -- because psychologists have strict limits on the visit.  The difference is that patients are locked into weekly visits if they are doing psychotherapy or 2-3 times a week visits if they are doing psychoanalysis.  Dr. Beebe initially approached her assessments the same way.  She found it was IMPOSSIBLE to do any assessment of the interaction between a mother and baby in less than 2 HOURS. This is because she is not dealing with an individual -- she is dealing with a dyad.  And this was mentioned on on

Now, as for the claim of others that you can do an thorough assessment in an hour.  Perhaps this might work if you have minimal problems AND if the baby is actually hungry at the time of the assessment (which you have a 1/3 chance of occurring if it is a baby who eats 8 times per 24 hours -- or 1/2 change of occurring if it is a baby who eats 10 times per 24 hours) --- then you might be able to do a decent assessment.  If you push the baby into a different routine where the baby is FORCE FED in order to comply with your visit or the baby is HELD OFF in order to comply with your visit -- then you are not getting a true assessment.

Marsha, the UNIVERSAL complaint I hear SPONTANEOUSLY from 95 % of my clients was that "the LCs in the hospital TRIED to help me but they couldn't spend enough time with me" or "I went to the breastfeeding group at the hospital but my baby didn't wake up to feed).

We have a crisis in the United States.  The crisis is NOT in the initiation phase.  It is in the continuation phase.  This means that we need to start paying attention to what women do OUTSIDE the hospital.  The backlash and misunderstanding about the formula bags stems from LACK of adequate care when women return home.  And while peer counseling makes a huge difference for many mothers -- we have had La Leche League as our best example of this for years (CLC only uses role plays which is NOT sufficient for counseling) -- it is also NOT sufficient.  Just because one component can make a difference doesn't mean that ADDITIONAL support isn't needed to completely deal with a public health crisis.  You need to put ALL the components together. 

So, in having listened to women talk about support groups as part of an assessment of the Peruvian health care system when I was doing my Masters Degree -- the peer support system leaves out mothers who have significant problems as well as mothers who are not accepted by the alpha moms in the group.  These mothers need a different system to be successful.  I really should to a literature search on this topic, but to my knowledge, no one has really looked deeply into the possibility that the problem we are having with the rates of continued breastfeeding may be due to the fact that peer support is not sufficient for many women who need more in depth help.  Since there is a HUGE imbalance between in hospital and private practice IBCLCs there is not a sufficient pool from which to draw to determine if such help could make a difference.  

Personally, looking at this from my public health background, I can't think of any other health care problem which has a big hole in the middle between hospital and peer support.  It would be as if you ONLY had access to pediatric care through the neonatologists in the hospital who were far more prevalent than pediatricians and then moms set up peer support groups to deal with specific pediatric concerns.  It doesn't make sense at all.

If anything I should think that 2 year minimum recommendation of breastfeeding deserves at least double the amount of IBCLCs in the community as it does for the first 2-4 days in the hospital.   

Sincerely, 

Susan E. Burger, MHS, PhD, IBCLC

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