Amy, I enjoy reading your posts and often feel I could have written them!
I face this situation so often, and because I am a family doc and also
provide OB care, sometimes I've been working with mom for months and months
and it makes it so much harder.  I also have to see newborns in the delivery
room rooting and cueing all over the place and point these things out to
their parents only to have them look at me like I've grown 2 heads and still
refuse to offer the breast, even one time.
I recently did prenatal care for a mom who borrowed and read all of my
pregnancy books and breastfeeding books, asked me a billion questions,
talked all the time about how excited she was to be having the baby.  Then
at 35 weeks she decided breastfeeding wasn't for her.  Baby was born, never
put to breast, was one of those desperate little souls who is always sucking
their hands and rooting all over the place.  Mom callled at 5 days of age
for advice on how to deal with baby straining and crying when stooling,
spitting up all the time, crying and passing gas a lot, and by the way, what
should she do about her full and leaking breasts!  It's all I can do to not
shout on the phone sometimes.
Then there are all the moms who quit when everything is going well and baby
is thriving because it isn't for them, or they are returning to work.  Or
second babies in a family where the AIM-fed first child has allergies,
multiple ear infections, hospital admissions for gastroenteritis, and I
encourage mom to breastfeed the second to avoid some of these things, and
they won't even hear of it.  And moms who work 4 hours a day 3 times a week
who can't even consider pumping at work because they don't have time.  (And
my own nursling has never had formula, despite ridiculous work hours and
attending births at all hours of the day and night.)
Not to worry, I never rant at my patients like this, I save it for rants to
like-minded people, but some days it is hard.
I've done several things to help myself cope.  I remember that I can only
offer the best information I can, and be the best support I can.  I am not
responsible for the individual decisions people make.  When faced with a mom
that quits, I try to be as positive and encouraging as possible.  I want the
lines of communication to stay open and I want the mom to remember their
breastfeeding relationship as warmly and positively.  I want moms to think
of me as a support person they could turn to again, not as a disapproving
authority figure who couldn't understand where they are coming from.  I also
don't ignore the facts, though.  I try in my language to patients to always
portray breastfeeding as the norm.  When I see an AIM-fed kid with their 3rd
ear infection in 3 mos, I mention that otitis is more common in AIM-fed
kids.  I always include breastmilk as the normal food for infants when I'm
talking about feeding at all.  So I always say babies need nothing other
than breastmilk for the first 6 mos, and can thrive on breastmilk alone for
longer than that, and that even AIM-fed infants need nothing else until
around 6 mos also.  I feel that mentioning breastmilk as the norm all the
time keeps parents aware that it is a normal way to feed infants.
And of course sometimes there are wonderful successes.  I have a new mom now
happily breastfeeding her 6 week old very successfully who "failed" at
nursing her first, lasting just 1 week, and who told me at the first
prenatal that she didn't think she could ever go through that again.
Instead of spouting some info about breast being best, I said instead "It's
so hard, isn't it, to be a new mom, and then feel like you aren't doing well
with even the most basic parts of it.  It must have been so hard for you!
Can you tell me more about what happened?"  And several more conversations
down the line she was saying maybe she'd try again, and now everything is
going wonderfully and she told me she's so happy I kept talking with her and
supporting her decision.
Sorry this is so long, I got a little carried away, but this issue comes up
so often for me and I feel passionately about it!
Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose

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