about mothers who present with no milk whatsoever, i tend to treat this as an
emergency. after all, if you wake up one day and find you can't urinate,
would someone tell you to come in next week, and just use a catheter in the
meantime? i think early and serious help can often change these situations.
of the various mothers i have now seen with no milk whatsoever, only one had
her prolactin levels checked, and they (as the mother mentioned in the post)
were completely "wrong" for the baby's age. she persevered with what i call
"the program" - tincture, pumping, feeding at the breast with a tube device,
domperidone - after almost nine weeks she had an MRI (because of continuing
concerns about her pituitary) and called to ask me "how long do i have to
dump my milk?"

despite my having told her the week before that she wouldn't have to pump her
milk at all, she had been told to do so for 48 hours. she had just dumped 1
1/2 ounce of milk down the drain, she reported. i said "WHAT - how much?" she
had not even realized how much she was making because she had quit daily
pumping and was feeding at the breast with the tube device. when she told me
how much she supplemented in a day, it was clear she was making about 50% of
what the baby needed.

other moms have had varying results. its still a mystery to me what the
causes are, but i think they always warrant immediate and thorough treatment,
if the mother wishes (of course they do if they see me). that means
everything, no waiting around to see if things get better, because if its
four or five days or more postpartum, and the mother gets her milk late,
well, that's wonderful. usually, though, i see moms later and its painfully
apparent there's no milk there.

about the shopping, i believe most hospitals here have stores and sell
things. some time recently what some hospitals charged l to rent pumps was
outrageously high (i don't know what they are charging now). it seemed like
victimizing a captive audience (we can't fix the breastfeeding, and you can't
leave the hospital without a pump, here it is, pay up). i feel barbara is
entirely correct that by selling things, LCs are compromising their ethics.
however, as someone who has a big pile of stuff to sell and rent now, i view
it as merely further proof of how impossible it is to operate as an LC in
private practice.

 " In many ways, there is no cleaner way to proceed than for LCs to primarily
divorce themselves from direct sales and refer people to stores or medical
supply houses."  this would be lovely except there is no reciprocity in this.
competition for business means that when i did not sell things myself, i had
to pay retail price for them to a store, in order to have something on hand
that a mother might need and i would want to have at a consultation (nipple
shields come immediately to mind as the kind of product that needs skilled
instruction, and NOT something a mom should need to go buy and return with
for another visit). the stores never, ever referred to me for anything, as of
course the hospitals do not either, because they all have their own lactation
people.

"In fact, if we ever lose the
confidance of consumers we will quickly learn the difference between the
fast nickle and the slow half dollar."  (both these quotes are from barbara
wilson-clay's post) - i feel that this has already happened, and i can give
endless anecdotes to back up this statement. i often think it is a tremendous
leap of faith for someone to see me who has already had an insufferable
experience with someone ELSE with the same title as me. it shows how much
women want to breastfeed, but i don't think it speaks well of our profession
to have such a tremendously varied level of practice.

in other words, when someone calls me and the first thing they say is "i want
to talk to someone who won't tell me i 'have to' give a bottle and formula to
my baby like the lactation nurse at the hospital said," well, how wonderful
and terrible all at the same time!  i've been on this soapbox before, but i
must say that selling things may make it easier for me occasionally when
someone truly needs something i can provide and it makes their treatment
easier, or when i "use my powers for good" and help someone who has financial
difficulties, but its apparent that "making a living" is an elusive and
probably not attainable goal. and the temptation to sell things just to make
money is always there.

there's a joke quite popular in communities where ranching or the oil
business is common, its the interview of the person who wins the lottery and
is asked "and what will you do with the money?" - the person replies "well, i
guess i'll just keep ranching (oil business, whatever) until the money's
gone." me, i'll just keep doing lactation work until the money's gone.

carol brussel IBCLC, trying not to be the shill of just one company by at
least trying to spread the business around

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