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Lactation Information and Discussion <[log in to unmask]>
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Mon, 8 Dec 2003 22:08:07 +0100
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Elise Morse-Gagne asks for input from an industrialized country with high BF
rates, about how it is handled when a woman doesn't want to breastfeed.

We don't ask in pregnancy whether they 'want' to breastfeed.  We assume that
they do and that they will speak up if that's not the case.  If it is someone
we've worked with before and we know she had a bad experience, we will talk
about how to avoid the bad stuff (whatever it was) this time if possible.  If
we don't know anything about her past BF experience we do ask about that, as
in 'Is there anything you want to tell me about your previous BF experience?'
or 'Did you have any difficulties with BF?' and then exploring them if the
answer is yes.

A woman saying in pregnancy that she doesn't intend or want to breastfeed will
be given multiple opportunities to discuss it, with the aim of finding out
what she bases her decision on.  I think it is done with respect though I
don't have hard facts to back that up.  If it seems she has made up her mind
it will be noted on her prenatal record, which she carries herself, and she
will likely mention it when she comes into hospital to give birth.  At my
hospital we may, depending on how advanced she is in labor, have a short
conversation about it but no effort is put into trying to change her mind at
that point since we assume she has done all the consideration she is going to
do, in pregnancy.

If she is among the less than 1% giving birth at home it's extremely unlikely
she won't plan to breastfeed, but if she weren't planning to, the midwife
would be respect her wishes there too.

It is rare to meet a woman who will say outright that she doesn't want to
breastfeed, possibly because that is not really a politically correct choice,
but possibly because women usually do want to breastfeed.  Most women choosing
bottles give other reasons, such as fear that their previous problems will be
re-lived, or medication use (Lithium or high doses of antidepressants).  This
is not an exhaustive list by any means.

For me this is a balancing act, between being brutally honest (honestly
brutal??) and living what I preach, which is that women have the right to
respect for their choices even if I think the particular choice is
regrettable.  In the long run I think erring on the side of respect is better,
because I am known as a fierce advocate for breastfeeding and if I can show a
woman respect, she will remember that, and even seek help from a BF advocate
later.  If she perceives that I have written her off, she will never forget it
and she may hold it against anyone she meets who is working for BF.

I am sorry to have to report that women's efforts to BF still do get
sabotaged, and not always behind a veil of good intentions, in hospitals here.
 BF that fails because of lousy, baby-unfriendly help from maternity staff
bothers me infinitely more than a mother who has come to her own decision not
to breastfeed.

One of the most serious mistakes we made when implementing baby-friendly here
was not collecting good baseline data from each institution.  It paved the way
for so much ill will from staff who felt they were being browbeaten into
changes that they didn't see the need for, that we are still suffering from it
in some places.  If we had been able to get the baseline data, we could have
shown the need for improvements, because they were there.  That chance was
lost and will not come back again.  Our initiation rates have been stable for
about 140 years, around 99%.  It's the continuation rates and the exclusivity
rates that have fluctuated.
Rachel Myr
Kristiansand, Norway

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