Hi all, Coach Smith here again.

Swimmers must compete without equipment. However, they often use a variety of
tools during training - fins, handpaddles, pull buoys, etc to improve their
technique. This is good coaching - to pick the specific training aid to
accomplish improved performance.

Scales, pumps, supplementers and yes- bottles and teats and ABM - are tools.
 They are designed for a specific purpose and work best when they are (1)
accurate and effective, and (2) their use is limited to specific situations
where other approaches have not worked. There is no substitute for clinical
judgment regarding when to use a gadget.  Gadgets can interfere with the
mother-baby relationship, the baby's ability to obtain milk at breast, or the
mother's supply if used incorrectly.  Before any gadget is used, informed
consent should be obtained from mother.  Since the end goal is direct
breastfeeding, gadgets should be used as a last resort and for the shortest
possible duration to reach or return to that goal.

That doesn't mean that one should always "go without." Devices are not
inherently evil. It's how they are used - too soon, too often, without
thinking of the consequences, etc.  Using the right device at the right time
is appropriate use of technology.  Throwing a gadget at a problem because
someone doesn't want to think through the issues or thinks that always using
a gadget is OK is inappropriate. Keep your eyes on the end goal - direct
breastfeeding.

And regarding frenotomies - who could win a marathon with his shoelaces tied
together? Every coach knows that full range of motion in all body parts makes
for excellent performance. Much training, stretching and even theraputic
surgery is done to improve range of motion. Frenotomy has a great
risk-benefit ratio, and is so simple to do (for someone trained). Once you've
seen a clip done and heard the mom say "Wow - no more sandpaper," it becomes
very hard to justify not doing the procedure when the frenulum inhibits
proper tongue motion.

Linda Smith, BSE, FACCE, IBCLC - from Dayton OH, where the auto workers can't
figure out how to get along with General Motors. Maybe they should lock 'em
all up at the Hope Hotel at Wright-Patterson AFB till they get it worked out
- sure worked for the Bosnian negotiators!