Thanks to those who have already written about how their
hospitals/societies encourage high breastfeeding rates (w/o alienating
moms), and thanks in advance to those others I hope will do so as well.
Susan's list of ways to educate staff/community, Lisa's info on how she
interact with formula-feeding mothers and in the community, and Rachel's
caveat to get the baseline data to show that BFHI helps, are particularly
helpful.

Key elements seem to be:
(a) making sure that breastfeeding is an "old song" to mothers by the time
they enter the hospital for their baby's birth -- at this point it is
usually too late to change their minds through discussion/education (though
not always, esp. if it turns out the reluctant person is actually the
baby's *father*, and though there is still the last-minute possibility of
immed. postpartum turnaround initiated jointly by HCPs and baby); and
(b) assuming that breastfeeding will be the mother's preference, while
leaving her room to express doubts, fears, unwillingness if that is how she
feels.

I think one reason our hospital's rates are as good as they are is that our
physicians do very clearly recommend breast.  One even spoke recently of
the disappointment he personally feels when a mother decides to
bottle-feed, and how he has to remind himself "you can't win them all".

I never, ever ask women which they are planning to do.  During pregnancy
they fill out a  prenatal form with a nurse advisor (Yay Lisa L who started
that!) who gives them the LLL "Bf Makes a Difference" booklet.  The form
goes into the chart for me to see before I meet with them, and alerts me to
some things I might want to discuss.  That form doesn't ask which way
they'll feed the baby either (I wrote it).  It asks about breastfeeding
experience, support, plans, questions...not "whether".  The ones who don't
want to, say so.
In childbirth class I talk as if they are all going to breastfeed, while
also eliciting and talking about all the possible reasons someone might
decide not to, or end up quitting before they'd meant to.
When I meet a woman for the first time and introduce myself I say "I'm the
lactation consultant.  I'm here to help you with any questions you might
have about breastfeeding."  So far it seems to work pretty well.  If this
is a prenatal visit where I'm actually meeting with them, we go on from
there.  If I'm seeing them in the hospital, either because they're in for a
procedure of some kind or else they're in labor and I never saw them
before, if they say they have no questions I don't discuss it further.  I
can usually tell from their demeanor whether they are making a mental note
that I am someone they may need to talk to again, or someone they feel will
be irrelevant to them.

I have spoken during their pregnancy with women who, on paper or according
to another care provider, have been saying they did not plan to bf or were
doubtful, but who readily accepted bf info from me and asked a few
questions, and who later came into the hospital stating their intent to
breastfeed.  If everyone along the way just asked "which will you be doing"
I think these women would very often bottle-feed.

If a woman does say she doesn't intend to nurse the baby, I ask if she'd be
willing to talk with me a little more about it.  (I try to make it clear I
want to hear *from them* not talk *at them*.)  I say that in my line of
work it's really helpful to understand why women decide to bottlefeed, so
if they feel like telling me a bit about their thinking/feelings, I would
really appreciate it.  This has worked fine so far.  I want to start asking
two more questions, based on my experiences so far: is this their own
decision, not a family member's preference?  Is it based on anything that I
might actually be able to help with, like a fear of sore nipples or a need
to go back to work soon?

Mothers haven't complained yet, but some of the nurses are still nervous!
As a way to address their concerns I am thinking of putting an extra
question on our phone follow-up.  We already ask "Is there anything we
could have done differently to make your stay better?"  Maybe I'll tack on
"Did you feel you were given good help learning to feed your baby?"  Or
something.  Hopefully this would be an opening to learn about any problems
that either bf or formula-feeding moms have had, including if the ff moms
feel anyone was "too pushy" about breastfeeding -- *and* maybe we'll get
some feedback about the times the bf info is conflicting or half-hearted.

Elise

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html