In a message dated 12/6/0 6:39:27 PM, [log in to unmask] writes:

<< It makes me wonder if this is really the solution it seems to be (pumping
following feeds, then feeding pumped milk)...<snip> Certainly it's
appropriate at
times, but it's starting to seem to me like this route is also overused, when
it would be possible (in *some* cases) to simply have mom nurse...then nurse
again (instead of giving the supplement after nursing). >>

Katherine,
You say this is the typical mom you hear from. She has been told to feed for
10 minutes at breast, then pump and bottle EBM or AIM. The typical call I get
is a mother whose baby has lost significant weight and was sent home finger
feeding EBM or AIM after putting baby to breast. There is almost never
follow-up and mothers usually do not have any idea how they are supposed to
get out of this cycle. Typically, they have a low milk supply due to improper
pumping and incorrect latch (which is usually the reason for the problem in
the first place). These babies are usually flutter sucking, often have had
trauma at birth and really like the finger feeding (bottle feeding if it is
the other big hospital).
    I think it becomes very easy when you are overworked to resort to a
well-used answer that looks like it ought to support bf (ie, it is not the
typical just give AIM in a bottle til your milk comes in or some other lame
answer that an LC would cringe at). But that is not the end result at all.
The missing days of follow-up before I see the mother wreak havoc with the
mother emotionally and it is hard to overcome her fears, her low milk supply
and the perception that she must be doing the right thing b/c, after all, she
saw an LC in the hospital!

Gretchen responded:
<<In private practice I have the luxury of spending a couple of hours with
each
mother baby pair compared to attempting to see 10 - 12 moms and babies in a 2
or 3 hour period. >>

IMO, a hospital-based LC can only really be effective when the culture of the
hospital supports bf *or* she has several hours to spend with each mother.
When a mother sees an LC under the conditions you describe, it is a
dual-edged sword. On the one hand, the mother is (hopefully) getting bf help
from someone who is qualified to help her. OTOH, she is getting what she
imagines is the best possible solution since it is coming from an LC. So when
we only have a few minutes and/or bend to the influence or pressure of HCP's,
then I believe the mother receives a dangerous message from us both as it
pertains to the quality of the information she believes she is receiving and
the importance of bf.

<<snip> <<maybe I get 10 minutes with her and explain how bottles
aren't the best solution for X problem, but then she is later inundated by
conflicting info from other staff trying to help her get her baby fed.>>

I would rather spend 3 hours with one mother and do a good job than spend 10
minutes with 10 mothers and leave each one thinking they just had a consult
with an LC when all they had was a brief visit. I believe that when a mother
sees an LC in the hospital and gets poor or incomplete info she is *more
likely* to quit bf when things do not resolve quickly than if she does not
see an LC until she is home. This is especially true if she sees an LC in
private practice later who tells her she must do things that seem much harder
than what she was told before--ie--stop the bottles, use an SNS, etc.

<<Protecting breastfeeding often falls below feeding the baby - far below.>>

What a powerful statement. Don't you wonder why the two aren't synonymous?

<<So, it may not be that the hospital LC is actually recommending excessive
use
of bottles (or perhaps it is) but that there are others encouraging the use
of all the bottles. <snip> now have had the chance to see how understaffed
and overworked many nurses are, plus their breastfeeding info may be rather
limited - even if their intentions are very honorable.>>

This is the rationalization that, IMO, maintains the status quo. It is not as
if we do not have ample information today about the dangers of AF. How can it
be honorable to risk the success of bf by not following protocols that
protect and support bf? I understand that nurses are overworked, and that it
cannot be easy to have the paperwork aspect of the job shoveled on top of
you, while the nurturing aspect is either lost or given away to others to do.
(I can imagine this is part of the attraction of becoming an LC--the care of
mothers and babies as priority rather than paperwork.) But, I also know that
some nurses choose to go to bf conferences and others do not. Some choose to
read about bf and others do not. Some attend in-services with an open mind
and others do not. Some welcome outside help and freely refer to LC's or LLL
and others do not. I cannot understand how this can be an excuse for giving
bottles. I have observed that it takes no longer to feed a bottle than to cup
feed, dropper feed or finger feed and only a little longer to teach these
techniques or teach the use of an SNS. IME, this is more about attitude and
willingness than anything else. Wouldn't you still have to teach the mother
to use a bottle safely? Why do we assume bottle feeding is safe and easy to
learn. I am personally very adept at every feeding method I know of, except
bottlefeeding. Big confession--I have once in my life fed a baby a
bottle--one of my staff was in a car accident and her toddler's jaw was
broken--we fed the baby with a Habermann for a couple of days until she
nursed again--I showed her how to use it--once--had to read the instructions.
    I once taught a nurse to cup feed in about 10 minutes and she then taught
all of the other nurses *who were willing to learn*! It really was considered
*up to them whether or not they would learn such skills*, based upon their
comfort level! This still amazes me to this very day. Believe me, I saw first
hand very overworked and understaffed nurses. But I also saw that among them,
some managed to give accurate information and teach and learn what they could
and others did not. If every single person who interacts with a mother pp
acts as if bf is the most important aspect of their job, then it will be the
most important job for the mother as well. Maybe then, it wouldn't matter so
much if bottles were used for supplementation, but today, in the US at least,
it does matter.
Jennifer Tow, IBCLC, CT, USA

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