Dear Cynthia:

I am sure that I don't have any stunningly brilliant answers for you, but I'd
like to share the place where I have finally evolved (and I have found that I
do not get into as many problems....).  I find myself quoting Linda Smith's
"Rule #1 is Feed the Baby" to anyone who will listen!  Ideally, this will be
accomplished at breast.  Next best is with breastmilk in a way that will make
BFas  easy as possible to resume (I did not understand what having an IV has
to do with BF other than making one more "thing" to worry about with
positioning). If there is not enough breastmilk, then abm may need to be used
because insufficient calories will cause poor feeding behavior.

In my opinion, you need to get out of the middle. You are being placed in a
no-win situation.  Relationships are best ironed out between the 2 people
involved.  Perhaps you could offer to host a meeting where some general
agreements could be worked out between the peds and the LCs...... Like:

1. Babies must be adequately fed (I agree with those who say that babies
should be returned for weight checks in the first 3-5 days)
2. Mothers who express a wish to breastfeed should be fully supported to
accomplish their own breastfeeding goals. (Perhaps a check list of when to
call for BF help would be useful) Even if there are problems getting things
off to a good start it is important to keep the mother's long-term goal in
mind.
3. When feeding cannot be done at the breast for whatever reason, the
following must take place: C= calories must be provided to the baby
                 A= action must be taken to preserve and increase the
mother's milk supply
                 T= time elapse will help the baby mature (especially if skin
to skin is encouraged, and any other medical problems are treated)
4. Coordinated team effort to assist in "back to the breast" behaviors,
frequent contact and follow-up with the BF dyad.

This type of "common ground" will hopefully pave the way for the future.  It
might be helpful to give this physician the feedback that the LC needs to be
aware of medical problems that would impact breastfeeding or the baby's
caloric needs.

It is unfortunate that the exchange took place in front of the mother. A
future thought might be to ask the physician to step outside for a
consultation.

Hope this helps.
Martha Brower, RD LD IBCLC (who actually received the feedback from my BF
class on Saturday that the class provided a forum for examining ideas in a
non-threatening way -- I had several women who had not been successful
breastfeeding their first babies and felt it was important to give them lots
of support publically.)