Debbie:  From what I am reading on your posts, I wonder if there is not
another problem going on, either the mother feeling she must/should
breastfeed or the father (when others aren't around) is making
unsupportive/negative comments toward breastfeeding. When added to a
less than normal situation, either of these can overwhelm mother to the
point that she may opt out for feeding formula. I also find that either
the "I've tried everything" or when things work when I'm there, but
don't when I'm gone, may also indicate mom wants to wean and is trying
to get me to say, yes you've tried everything and it hasn't worked, go
ahead and wean. I can't (personally) do that with a baby younger than 3
months, just my own heart won't let me do it. And I don't want to be the
one to ever say to a mom, go ahead and wean. It is a hard situation to
be in, because you get frustrated, trying to help and wondering what is
wrong that you are missing. Yet at the same time, you can not be
expected to help with a problem, when all the circumstances are not told
to you.
    I try to explain to mom, that a major change in the household -
moving, a parent going back to an outside job after being at home full
time, the birth of another sibling, etc. impact greatly on the nursling
and to add another major change (going from breast to bottle or from
breast milk to formula) adds even more stress onto the infant. I
encourage mothers to continue to nurse at least two weeks after the
major event before even considering making a change in the infants
feeding style or substance. (I include this with mothers who are
employed and going back to the job too). Too much stress (emotional or
otherwise) on the infant, usually leads to an illness, which just
another stress on the mother/infant/family.
    Usually when moms realize how these issues impact onto each other
and can 'snowball' if you will into more problems, they are willing to
hold off weaning until things at home have settled down. Perhaps getting
the mom to talk about her feelings about breastfeeding may clarify for
you, if this is indeed an issue about a problem nurser or a mother with
issues of her own. This will then make the advice and recommendations
you give this mother more useful.
Re: HCPs giving/doing things against orders or parents desire, and
another important consideration to remember. One of the other major
things to remember when advising parents after an event such as this, is
the emotional/mental state of the parents at this time. After my son was
born at 24 weeks and ended up dying of something totally unexpected, I
was an emotional basketcase, not primarily from his death, but from the
2 and half days of wanting him to live and do everything to that end,
and wanting him to die because my heart and soul were being ripped apart
every minute of every day. It took me a long time to get it together and
be able to think straight and clearly. I certainly wasn't up to lawsuits
or even writing letters at the immediate time. Later when we had to pull
medical records together (and some that had been 'missing,' mysteriously
appeared again), I was able to piece the whole situation together and
realized that on Oct 17th (baby was born Dec 23rd) the condition that
caused his premature birth should have been diagnosed and putting me on
bedrest with no physical activitiy at all, may have enabled the
pregnancy to progress far enough to deliver a viable infant. When I
realized this, I talked with both an OB and a legal advisor. Both stated
that because he did not die of the prematurity and simply how incredibly
hard it was to win a lawsuit involving birth issues (this was 1984), a
lawsuit was virtually out of the question. I did realize that I should
at least attempt to write to a governing board to let them know that
this clinic failed to diagnose a serious condition that led to this
premature delivery, but even months after the event, I was still not up
to the 'fight,' if you will. When a serious birth situation occurs, our
system should supply the family with a counselor/social worker/advisor
to help them negotiate the situation. It is unfair when faced with life
and death situations and decisions to dump it all on parents who are
usually shocked, stunned, and certainly emotionally wrung out. But I
guess this is the ideal, something perhaps for the future.
    Parents writing letters about inappropriate care or treatment is
wonderful and the ideal, but in some situations, without support - it
may be impossible to even consider.

Leslie Ward, LLL, AAPL
Vine Grove, KY
"I do not do great things, I do small things with great love." Mother
Theresa