Gonneke wrote:
"Is it not so that a baby at breast is a far more effective means of
increasing a good enough milk supply?"

Well, it may be heresy - but the current pumps (as opposed to those that
were available in the 70's when I was breastfeeding, 80's when I was solely
a La Leche League Leader and IBCLC and 90's when I began running a
breastfeeding clinic) ARE more effective than MANY of the babies _I SEE_!  

I no longer see normal - except in my La Leche League group.  The moms I see
have serious issues of anatomy (moms or baby's), development (moms or
baby's), or health (usually baby's, but also mom's).  

AND many of the current pumps, I find DO get more milk that premature or
neurologically underdeveloped or "uncoordinated" babies.  

Again, - another heresy - thanks to the new scales I've SEEN what babies can
transfer - and what pumps can transfer.  Babies can really fool us into
appearing to swallow much more milk (or less milk) than they really do.

Are we asking a lot of these moms? Yes, we are - but we give them the
opportunity to make the decision for themselves: Alternatives 1, 2, 3...then
we discuss what are the goals and consequences of each.  At times, as with a
cleft palate baby - choices are more limited...

Another problem I believe may be different in other countries:  in the US we
have a very small window that MD's demand to see improvement - if the baby
is losing weight, we can't allow this to continue for long.  It appears that
in other countries there is not such a stress - but here, formula would be
recommended immediately.  For us, the answer is, feed mom's milk - again she
is given alternatives from SNS, cup, and bottle - is MUCH better than
formula.  

So we go by the (Linda Smith's I believe) rules:
1. Feed the baby
2. Protect the milk supply
3. Fix the breastfeeding.

...and finally...yes, Janice, the goal IS to have those beautiful, relaxing
breastfeeding moments ... But the road to that point may be much more
circuitous for some...and some may never get there (another heresy?) but I
believe that those babies are STILL better off than if they had never had
their mother's milk!  

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA

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