We have a significant Hmong (Laotian) population in our town.  Most bottle
feed during their hospital stay; rumor has it that they breastfeed at home
when their milk comes in.  I don't know how many actually do start
breastfeeding, but I know that most that breastfeed at all mix bottle and
breast, and wean early.  Back home in Laos, of course, everybody breastfed,
but until their milk came in they would have another woman breastfeed the
baby.  Here, the bottle is the substitute.

Last week I worked with a Hmong prime who has been in this country since she
was 5, and is well-educated.  She did breastfeed her baby in the hospital,
but insisted on following up with the bottle.  By the time she left at 24
hours, baby was already starting to resist the breast.  When her milk came in
she got terribly engorged, which made the baby even less willing to latch.  I
ended making a home visit after work to help her pump and work with the baby.
 In the Hmong culture it is the mother-in-law who is kind of in charge after
a baby is born, so she was there and we chatted (via translation).  She has
only been in this country about 5 years, so all her children were born either
in Laos or the refuge camps in Thailand.  She told me she had never seen
anybody with breasts that were engorged and tight like her daughter-in-laws.

So, if these moms don't normally breastfeed at all until their milk comes in,
why don't they get engorged?  I assume the MIL knows what she's talking
about.  Might we be making the situation worse by encouraging moms to
breastfeed the first few days if they're going to do it infrequently and
follow it up with formula?

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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