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From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 17 Sep 2012 09:24:45 -0400
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Dear all:

I suppose I am in a state of shock over what I consider to be a byproduct of a fee for service, short term profit approach to medical care.  My 22 year old niece was recently diagnosed with PCOS.  She was told by one nurse practitioner that after all the test results were in she would be referred to an endocrinologist.  Instead she met with another nurse practitioner for about 10-15 minutes who:

a) prescribed birth control pills from a company that has recently had a major recall of one of their products
b) told that she would never have children.
c) told that a trainee would be in the room with the nurse practitioner
That was the entirety of her visit. 

She was not offered:
a) informed consent and the right to refuse the trainee who made her feel uncomfortable
b) dietary counseling
c) exercise counseling
d) endocrinological testing 

When my niece asked about seeing the edocrinologist she was told it wasn't necessary.  When she asked about the birth control pills she was told it would keep her from developing cancer (with no discussion of any other risks).

 My niece's father was overweight and died when she was only 1 year old from heart problems.  Her step sister  (same dad, different mom) is morbidly obese.  My niece was relatively slim until she hit adolescence and in the last year has tipped into obesity.  She lives in California where (as in most of my former home state) there are no walking paths and you pretty much need to use a car to get anywhere. It seems to me with these risks factors -- birth control pills are a mere bandaid that won't get at the real risks she faces.  

Her case is a perfect example of an oversimplified approach to a complex and complicated problem.  Complicated because it will NOT be solved overnight.  Complicated because there will be many decisions about ambiguous approaches to figuring out how she can lose weight, improve her physical fitness and decrease her endorinological imbalances.  Birth control pills for life is not THE solution for her many problems.

I think there is often the same sort of oversimplification when we face the real problems and impediments to improving the continuation rates for breastfeeding not just in the United States but globally.  Even if you reduced the C-sections to 5%, banned formula bags throughout all the hospitals, reduced the typical serving size of sugary drinks to 8 ounces (rather than what I think is an outrageously large 16 ounces) and had peer counselors available to every mother who wanted to breastfeed -- we would see fewer problems, but we would not eliminate the problems.  One of the problems we face is an epidemic of obesity unprecedented in human history. You can point to small populations where obesity was prized (like in Northern Niger where high class women were literally stuffed with cream and fat like ducks to make them beautifully enormous) but these were small pockets.  And while it is more pervasive in developed countries, it is increasing in developing countries.  And YES, morbid obesity is a systemic problem that does impact breastfeeding because of its profound impact on endocrinological systems.   The solutions to such problems are complex, complicating and will require MANY avenues of intervention.

Breastfeeding is complex.  Breastfeeding problems are more complex.  Formula is simple, but it doesn't solve the problems.

Best Susan Burger

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