Hi! I have been catching up on the posts:

1. Jean, Great comments on nipple retraction. I would like to see the
categorization of nipples(Flat, Erect, and Inverted) replaced. These
categories do not provide any helpful information regarding the function of
the nipple and can make a woman feel that she is abnormal or has "bad"
nipples or a deformity.  I would like to see them categorized as extendable
or non-extendable as measured by a "press" (as opposed to "pinch")test. Or,
you could classify them as retracts or does not retract, but I like the
more positive category. What do you think?

2.  Regarding education of nurses and physicians. Education doesn't equate
with behavior change. Check out a lot of the research done on Continuing
Education.  Many states are doing away with mandatory CE for nurses because
of this research.  I thing there are two points here:
        * We need to identify what barriers we each have regarding breastfeeding
just as C. Bryant did with mothers in Florida. If you recall they did a
massive education campaign on the benefits of bf in Florida to increase
their bf initiation rates. After the program their rates(already very low)
went down.  After they targeted their promotion based upon researched
barriers their rates came up.  What beliefs and feelings do health
professionals have that prevent them from helping mothers bf?

        *We need to help implement change.  We can be authoritarian and educate,
but the best way is what Haffer(1986, Facilitating Change:Choosing the
Appropriate Strategy, JONA.16(4):18 )calls Normative-Reeducative. In the
first two the change agent decides what needs to be changed. The third
strategy is participative.  I am giving a workshop this month. I have
surved the nurses at the hospital on the "Ten Steps". At the workshop I
will give them the scientific rationale, but they can read that. Mostly, I
will be having them work in small groups to brain storm how they can
accomplish the steps they are having problems with. Will let you know how
it goes. When it is "your" idea, you are more likely to do it!

3.  Lastly, this debate about accepting gifts from formula companies and
giving gifts packs et. IMHO this is unethical and unprofessional behavior.
(I say this not being "pure" in the past. Years ago, I was a speaker at a
bf conference and was paid by a formula company.) But from where I stand
today, that is what I think. On a practical note we are not being paid by
formula companies to market their product---that is what we are doing when
we give a gift pack(with or without formula). And it is not a part of my
nurse practice act to advertise for commercial companies. By the way, I
mean that about all commercial companies not just formula companies.

Thank you all for all your entries!

Carol L'Esperance, RN, MSN, IBCLC
Albuquerque, NM 87106 USA

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