My dear babysitter, who covered our walls with artwork she did with our
son, went back to school to finish her program so she can open her own day
care center and I've been too traumatized to even consider getting another
one.  So, I've barely kept up with reading the Lactnet postings and have
not been able to keep up with any comments that I might normally have
considered posting for about three weeks.

Diane Wiessinger actually made a request almost a month ago regarding how
my mentors use tube placement on supplemental nursing systems and I haven't
had time to respond until now.  Rather than describe what they are doing at
this point, I'm actually going to ask your opinions on how to get funding
to actually test out the hypotheses behind their changes in tube placement
and an additional hypothesis that I formulated while observing their work.

I had originally wanted to do a study comparing the use of various
alternative feeding devices and their impact on the duration it would take
and the extent to which women could breastfeed without these devices after
once needing to use them. (All those terminologists please help me out here
because these women can't really be described as exclusively breastfeeding
if they had supplemented at one point in time). What drove me to consider
this was the fact that my supervisors could not provide mother's with a
concrete answer of how long it would take before they could breastfeed
without these devices - they could only give approximate ranges based on
their anecdotal clinical experiences. And, I realized that as someone
starting out, I might not be able to reproduce their success rates until I
gained much more experience.  The other issue is that my supervisors are
very comfortable with certain devices and rarely use others and I've
noticed that there is a great deal of variability in the types of devices
that lactation consultants use and are comfortable with.  I might learn ot
be skilled in the use of some devices and have great success with those,
but if I don't learn how to use other devices, I might never use them very
successfully.  So, it seems to me that success is highly dependent on
skill.  Unfortunately, the more I looked at designing this type of study
the more complex I realized it would be.  This is not the type of study to
undertake while working part time, and even devoting yourself to a study of
this kind on a full time basis would be complicated. I satisfied myself by
drawing an enormously complicated chart of all the potential factors that
could lead one to use such devices, all the factors that could influence
the effectiveness of their use and all the other confounding factors that
could influence the breastfeeding relationship.  I'm sure if I posted this
ridiculously complicated diagram, any one of you would add to it, subtract
from it, and challenge me on any number of items.

So, instead I have an almost completed study protocol on three simpler
questions that I think is feasible for me to undertake - the tube placement
issue mentioned by Diane Wiessinger.  My dilemma is that, although I've
raised tens of millions of dollars for international nutrition programs, I
was very very familiar with appropriate donors for those programs.  It is
tempting to consider the manufacturers of supplementing devices as
potential donors. I assume, however, I would lose the credibility I would
need to conduct studies comparing various devices and their success rates
if I had previously received money from one particular manufacturer. I'm
not as familiar with funding organizations that would be interested in such
practical aspects of breastfeeding management and for the small amount of
money that would be needed for this study.

Any ideas?

Susan Burger, PhD, MHS

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