Dr Jack - My commiserations at your frustration, expressed on 17th Jan, when
you wrote a helpful answer concerning a nursing strike and advice being
given by e-mail, and said,  "This is also getting bloody embarrassing that
everyone is posting about problems in Toronto and area, where we have at
least 12 hospital
based breastfeeding clinic, where we have terrific LC's around and so
on.  How come these mothers know to e-mail to the UK and Louisiana and
who knows where else, and can't find help locally?"

Seems even when these mothers CAN find help locally they may assume they
don't need it!  Let me share a recent rather unnerving experience.  A mother
attended an ante-natal breastfeeding class which I recently taught.  She
delivered a 34 week gestation baby who was placed in an incubator suffering
respiratory distress.  On day 4 postpartum she called me for assistance to
provide EBM for the baby so I made a hospital visit to review manual
expression, provide a breast pump and recommendations to resolve breast
engorgement.  There were a couple of phone follow-ups, then she requested
another hospital visit because the baby was doing well and now the
paediatrician was anxious for her to start breastfeeding.  Another consult
in the NNU revealed that breast engorgement was fully resolved, mother was
pumping more EBM than baby required, and was keen to take the baby home.  We
went through positioning and latching the baby at the breast, and practised
spoon-feeding and finger-feeding.  I also outlined anticipatory guidelines
for feeding this sleepy little premie in the first days at home.  We agreed
she would phone me if there were questions/concerns.

Imagine my surprise 9 days later when I received an e-mail from my client
asking where she could get hold of an electric breast pump.  The only people
who know my e-mail address are Lactnet subscribers!  A couple of phone calls
and a bit of sleuthing later revealed that my client had obtained said
address "from somebody in S.A. via somebody in U.S.A." and had been sitting
at her computer receiving breastfeeding advice from "many other mothers on
the internet with similar problems" while her baby was "not sucking properly
.. becoming more and more lethargic .. resorted to bottle-feeding .. only
able to express 15 ml/session .. ready to give up!"

A further courtesy call to my client to see if she required a follow-up
consult has produced a polite I'll-get-back-to-you response.  That was 12
days ago. I have no idea how she's doing, but no doubt somebody out there
does and - having kindly supplied my client with my e-mail address - might
care to let me know?

Obviously if a mother chooses to seek advice via e-mail and chooses not to
follow-up with her LC then what can we do?  But this was a special at-risk
case which ideally should have received specialist assistance, and didn't.
One more baby is NOT being breastfed as a result.  I feel frustrated about
it.  Thanks for listening!

Pamela, Zimbabwe