Hello all,
 Here in Israel we have "well baby clinics", which virtualy all children
attend. They do pregnancy followup, their nurses do housecalls to new
mothers, babies are wheighed, given immunizations, advice on feeding,
dressing, playing at different ages, and so on. They also have periodical
pediatrician's checkup, and if there are any health problems discovered the
baby is referred to their own doctor. These clinics started at the early
years of the state of Israel (and maybe earlier) when there where
immigrants from many countries, some of them with very high infant
morbidity and mortality. These clinics have done a lot to improve infant
health, nutrition, immunizations (more than 90-95% of all children in
Israel are immunized). BUT, according to the knowledge of the fifties and
sixties, many mothers coming from other than western cultures were made to
understand that their milk is inferior to ABM, and where suplied milk for
the babies at arrival to Israel. The same has still been done to immigrants
from Ethiopia in the eighties and nineties. In Hebrew these clinics are
called "Tipat Chalav", meaning "drop of milk". They tried to change the
name to Family Health Clinics, but they are mostly known by the old name.
The nurses at these clinics are formaly supporting breastfeeding, but there
is a lot of missing knowledge about bf - like you all describe in other
settings - hospitals, NICUs, pediatrician offices etc.   Most mothers in
Israel start bf in hospital, but often ABM supplements are started early
and result in early weaning. The reasons are all the regular reasons -
insufficient milk (real or perceived), slow weight gain , baby crying too
much or sleeping too little, etc. Usualy there is no real action taken to
treat bf problems, and of course there are no LCs on the staff.
I have been asked to give a lecture about bf to a group of these nurses,
and would like your input how to make the most of it. This is a very
sensitive subject, as many of these nurses feel that they are doing a great
job, and that mothers have objective problems. THEY are doing their best. I
don't know yet how much time I will have, and maybe I can talk them into
letting me give more than one lecture.
I will be grateful for any suggestions. I also asked for the help of a
local IBCLC.

Mira Leibovich, MD
Kibbutz Hama'apil
Israel