1.  c-section
        How soon after a c-section can a mom breastfeed?  Do you have to
worry about the anesthetics passing through the colostrum?

2.  Abusive relationships
        I appreciate all the comments on what is always a complicated
situation.  Since the majority of domestic violence is men against women
that is what we all focus on since that is where the intervention can be
effective.  By educating ourselves about the Battered Wife Syndrome we can
hopefully understand the dynamics of such a situation.  That does not mean
we negate all other forms of domestic violence including men against men,
women against men, women against women and adults against children.  But
my patient was a woman who told me her circumstances( which included
her husband beating her, and bruises have been witnessed by other
professionals)  and as her health
care provider it is up to me to listen to her story (which is subjective
no matter what the issue), help her to understand her choices, and support
her as best I can, even if I don't agree with her decision.  I don't live
her life and I cannot judge her, the same way I help patients who eat a
high fat diet and have heart disease, continue smoking and have lung
cancer, continue drinking and are alcoholics...My job is to educate and
encourage healthy lifestyle choices.
 My real question was how to balance two conflicting health care needs
 - in this case the desire to breastfeed with the concern of not wanting
another pregnancy and wanting to use hormonal birth control.  I wanted to
know exactly how much hormones decrease milk supply, so that I could give
an educated suggestion to my patient.

Thank you for the opportunity for discussion.

Michelle Elisburg, MS3
University of North Carolina School of Medicine