I have been following this thread and feel very concerned about several of the "fine lines" that have come up.  Of course, if a mother is truly adamant against BF AFTER she is FULLY informed of the risks involved in artificial feeding, it is counterproductive to try to force her to do so.  We ARE ethically obligated, IMO, to give her a complete picture of the heath and financial risks involved in formula feeding, whether her initial inclination is to artificially feed or not.  The VAST majority of mothers do not have access to accurate information regarding infant feeding.  We are obligated to give that information to ALL of the mothers we work with.  That is the "fine line" for me; I cannot change a mother's mind, nor should I try; I SHOULD make sure her decision is an informed one.  That is certainly not a waste of time; it could impact her baby, her future babies, and those of anyone she meets who hears what she has learned.
  I totally agree that we are making a mistake in mystifying BF, to the point that it is often presented more in the context of a wonderful EXTRA mile vs. simply the normal and therefore best thing for babies, and I agree with Karleen(?) that mothers, once informed, may very well BF for the baby's sake, just as they change diapers and clean messes, and read that one more story at night... this goes right back to all the discussions we have had over the years about guilt, information, and other health behaviors.  
   I also agree that we need to continue to work for social change, and I think this is one reason the ethical issues currently being discussed are such "hot buttons" for us; as long as society sees artificial feeding and all that goes with it as unimportant, or even worse as normal, we will continue to see mothers who feel fine about formula, doctors who do not refer to LCs, employers who do not give the flexibility for pumping, airlines who kick mothers off planes, etc... and our profession will continue to have an uphill battle for LC only (non-RN)  employment, professional respect, insurance coverage for mothers, etc.  I think this is why accepting the formula hawkers goodies feels like such an ethical and professional selling out to many of us, and why we react so strongly to it.
  The other "fine line" to me is when we accept that a mom should not BF due to some socioeconomic factor.  I have worked with a wide range of mothers as well, in terms of age and socioeconomic level.  I have SEEN teen moms in particular be better moms because of the decision to BF; and surely in a family with limited means a normal and appropriate nutritional start for baby is even more essential, when later access to good nutrition is also in question??
  Sorry if I am rambling!!
   Esther Friedman, IBCLC, RLC, LLLL, MS, Mom of 2 
   www.firstgiving.com/tylermom
There is no greater accomplishment than helping a child...

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