I make what I call "quality control calls" every so often.  I get such
candid and valuable feed back and I really try to change my behavior when I
see through a mom's eyes how I could have been more effective.

I made 2 such  calls yest. and they really tie to the discussion of nipple
confusion, so I'll share them briefly.

Call one:  Primip delivered early -- some dispute on the gest. age of baby,
but felt to be between 4-7 wks pre-term.  Birth weight 4 lb 8oz, and hospt.
stay not too long or complicated, however baby had never really successfully
breastfed when I saw her at about 3 wk. pp.  Parents were frightened about
slow weight gain since leaving hospt and sure she would never nurse well.
Indeed, baby couldn't really make anything work at breast -- had skinny
little cheeks, weak little suck, eyes closed. Parents very guilty about the
occasional bottles they were "sneaking" trying to keep weight on her --
voicing the thought they had to make a decision to feed by one method and
stick to it.  I urged them to stop worrying about nipple confusion.  Baby
will nurse when strong enough and able to make it work.  Just give EBM by
bottle for now, but practice nursing at every feed, use breast as pacifier,
skin-to-skin, etc.  Mom reported she really "Heard" the advice to just wait.
In another couple of weeks, about a week after the original due date, she
lay down with baby -- both naked -- and baby nursed.  From that moment on
never had another bottle.

Case two:  Baby born term to primip.  Tight frenulum identified by hospt.
helpers.  Mother claims she was told her baby would never successfully nurse
unless fren. was clipped, and by 6 hrs nurses insisting on finger feeding
and pumping so baby wouldnt get dehydrated. Much hysteria.  Pediatrician
stated fren. not a prob. which hospt.LC cont. to dispute vehemently to
parents.  No effort made to actually get baby to breast. Baby seen in my
clinic by my assoc.Laurie Smith. Frenulum observed to be tight and nipples
flat. We explained why this challanged the baby and described other outcomes
we'd seen with some frenulums needing clipping, others seeming to tear loose
or stretch on their own.  Mother urged to cont. to try to breastfeed at
every feed.  Nipple shield employed.  Not much success.  Mother pumping and
bottle feeding with encouragement to just wait and not give up.  This
continued for 3 weeks.  Again, while resting in bed and just allowing baby
access to naked breast, baby latched onto the more elastic nipple.  One week
later he took the other side and is very chubby and still nursing 3 mon
later. Fren. has not been clipped, although mother open to idea that it may
ultimately need to be for speech purposes.

 Mother stated that it was important for her as a new mom to trust her pedi,
and the undermining of his opinion undermined the mother's development of
trust and made her confused.  She felt finger feeding was very intrusive and
the hospt's lack of confidence in the eventual success of breastfeeding was
upsetting.  Her feeling was that the frenulum loosened up from bottle
feeding because baby used his tongue pushing up on the long teat she used.
Finger feeding held the tongue down.  This was her impression.

My impression is that babies who won't breastfeed are babies who can't.
Just keep the door open however you can and keep trying. Dogmatic
pronouncements make parents crazy and are so often not true, which
undermines LC credibility. Try to figure out WHY the baby can't make it work
and do what you can: try excellent and creative positioning or equip or
therapy or medical care to help baby recover.  Reassure parents -- they feel
terrible!  Midwives and LLL Leaders who get mad at LCs who feed the baby
need to remember that there is a difference between the normal baby and the
baby with a feeding problem.  The one does not need interference; the other
needs intervention. We work as a team with other hcps. We need to carefully
respect the partnership the mother is forming with these other caregivers.
Its ok to suggest a 2nd opinion, or to voice one.  Its not ok to trash the
doctor.



Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html