Moms who say they want to do breast and bottle are often trying to 
appease everyone. They say breast because they know it is better for 
baby, but they are also hedging towards bottles as "easier" and more 
socially acceptable. "Breastfeeding" can also mean pumping some and 
bottle feeding all feeds, both formula and human milk. So it is 
important to ask more questions to know what mom's goal really is.

I might suggest hospital staff ask moms what method of feeding they want 
to use in the hospital? Emphasis on the words feeding method in the 
hospital. When it comes down to it, women who say breast and bottle or 
"both" are giving permission for staff to use formula. Having parents 
sign a permission form to give formula would make their intentions 
really clear but I don't think many hospitals in the USA do that!

I work for WIC and we want staff to ask more questions to avoid problems 
later and to know how to address the counseling. When I am assessing 
moms, I ask moms what their feeding goal was during pregnancy? Breast or 
bottle? When they say both, I ask "what does that mean?" and let them 
explain. This opens up a discussion and lets you give the information 
that mom really needs rather than lecturing her or not addressing her 
needs.

But getting staff to ask more questions and take more time in assessment 
is like climbing a huge mountain. It is easier just to skim the surface 
and ask one question than to take more time and really find out what mom 
is thinking or planning or willing to do or commit to.

Kathy Eng, BSW, IBCLC

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