The limiting of suckling time, and the frequency, are two of the practices
most to blame for the failure of breastfeeding in most institutions.  There
has never been any scientific basis for these recommendations, but they are
slow to die out.
Thus it is with pleasure I report the following:  I had my first baby in
1981 in Seattle, WA, at a hospital owned and run by a not-for-profit HMO.
My daughter was kept with me from birth on, except for bathing to wash off
the huge amounts of meconium she passed after her first feed at my breast,
which began in the delivery room and continued well into the recovery area.
Her father went with the nurse who bathed her.  We ALL slept in my bed,
which was in a four bed room and all the other beds were occupied.  The
staff were *glad* my husband was there because they were very busy,
occupancy was over 100 % that day, and I was tired after a long first labor,
including 18 hours on a Pitocin IV, and he could help me lift her and
position her for feeds.

When I asked how long she should stay at the breast, the nurse said, 'As
long as it doesn't hurt, she can stay as long as she and you like.  We have
actually stopped recommending limits to frequency and duration of
breastfeeds.'

My water broke 43 hours before the baby was finally born, and this mandated
monitoring vital signs on both of us for the first day or so.  No nurse EVER
suggested that it would be simpler for them if the baby were in the nursery.
They checked us both at my bedside.

When we left the hospital 48 hours after her birth I was getting a bit
engorged and she was passing yellow stools.  I have no idea how many times
she nursed in the hospital - you could almost say it was just one continuous
session at the breast, interrupted when I went to shower or to the toilet.
The discharge gift pack did not contain any items inconsistent with
baby-friendly practice either.  Not one!

My second child was born in Norway in 1986.  I had to get very firm with the
staff person who informed me that he would be given sugar water two hours
post partum as a routine measure, and say that my son was not going to be
subject to that routine, and then I had to endure being told that I would
end up bleeding from my nipples if I breastfed him ad lib.  Not once did
anyone actually systematically observe me feeding him before issuing this
dire warning.  I was also told to be sure to give him a BIG bottle of
commercial breastmilk substitute the day before his PKU was to be taken, so
it would be valid!
I managed to get early release from that place and went home 24 hours post
partum, where I could just advise myself.  We didn't have any problems that
time either and I never practiced *any* of the outdated, wrong advice I was
given.  I didn't bother telling them I was a volunteer BF counsellor either
as I didn't want to embarrass them.  They had in fact provided me with
excellent, family-centered birth care which was my main concern.  I knew I
could manage by myself once the baby was out.

Even as late as 1989 I heard experienced staff, my colleagues, telling
mothers '2 minutes per side the first day, increase by one minute each day
until you are up to 10 minutes per side, which is all anyone needs'.  And
this is the country where 80% of women are still breastfeeding after 6
months in 2001.  In a breastfeeding culture, even silly mythology isn't
enough to suppress the natural drive to breastfeed our babies.  That doesn't
make it OK for health workers to be ignorant, but breastfeeding will survive
the most amazing - and unreasonable - challenges and obstacles.

Teresa Pitman notes in 'Pregnancy and Birth- The Best Evidence' that
practices often become widespread without evidence to support them, but it
is extremely difficult to eradicate them even when the evidence for doing so
is overwhelming.  It's hard for us to admit we were wrong, so we keep doing
the same old stuff, even when it's no longer in good faith.  I think this is
one of the crucial areas to work on in maternity care, and certainly in the
care of breastfeeding dyads - how to change practice without needing to feel
guilty.  Diane Wiessinger's 'Watch your language' essay is good here, to
distinguish between regret and guilt.

cheers
Rachel Myr
Kristiansand, Norway

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