Andrew @ RAINBOWpeds-

Thoughts about relatives, friends, neighbours vs. LC's docs, nurses, etc. as
source of BF info:

Isn't this the basis for peer counseling? Peer counselors, appropriately
educated and supervised, fill both roles; they are "peers" (folks in the
community),plus they have some of the authority (stemming from both
knowledge and experience) of the dreaded HCP's. Do we have studies showing
the efficacy of peer counseling in BF promo and support? Yes, I think so,
and if you'd like I can dig around and try to find some. We do know (and
again, I'd have to go dig for the numbers) that in the New York State WIC
program, peer counseling was adopted, and indeed mandated, statewide, as one
of the key aspects of its BF support program. This was decided upon after a
series of pilot programs in several agencies throughout the state (in maybe
1992 or so - before 1993, anyway) tried a variety of different methods to
increase the numbers of breastfeeding women in WIC; peer counseling was
deemed most effective. Since then, every NY state WIC agency is required to
have a Breastfeeding Coordinator and/or a Peer Counseling Coordinator, who
are responsible for maintaining peer counseling programs in each county.
Breastfeeding rates have risen dramatically since peer counseling has been a
required part of WIC. And we know from another study (again, I'll dig out
the citation if it's helpful to you) that it is among the population WIC
serves that breastfeeding rates have risen most dramatically in recent
years.

Is there a direct cause and effect relationship between the initiation of
peer counseling in WIC and increased BF rates? That's not so clear to me. As
the former Breastfeeding Coordinator for Tompkins County WIC, I ran a peer
counseling program. I think that peer counseling is probably more relevant
to supporting BF duration than to increasing BF initiation. But I know from
years of hearing the same story over and over again that there is definitely
a ripple effect around BFing: if a client is encouraged by a "professional"
who takes the care to establish a good rapport with her to "try"
breastfeeding (a term I dislike), and if she gets enough support that she
feels happy with her BF efforts (whether her definition of "success"
consisted of nursing the first few days so the baby got the colostrum or
nursing till the child self-weaned at age 4), she will be a more powerful
influence among her friends and family for BF'ing than a HCP can expect to
be. And the reverse is certainly true as well - if Jane found BF'ing to be a
miserable experience, it's pretty good odds that her cousin won't give it a
try!

So what am I saying here? Women listen to each other more than to "pediatric
nutrition counseling", when you get right down to the nitty-gritty. So it
seems incredibly important for us "professionals" to help women, on a 1:1
basis, have a positive BF experience, so that those women act as BF
advocates in their own circles of community and family. They don't need to
be converted into Lactnuts or Zealots or whatever - they just need to be
moms for whom nursing their babies has "worked". I think it's vitally
important for us to recognize that the definition of "working" is defined
different ways by different peer groups - it can mean anything from "I tried
it a couple of times and it didn't hurt, but it just wasn't what I wanted to
do" to "I nursed for 6 months and my baby was never sick, but my cousin
bottle-fed and her kid was at the doctor's office every couple of weeks" to
"I had to go back to work at 6 weeks, so I just nursed at night" and on
through the spectrum to full LLLism.

Cathy Bargar, RN, IBCLC

-----Original Message-----
From: David A. Green [mailto:[log in to unmask]]
Sent: Wednesday, December 16, 1998 3:35 PM
Subject: Mother's info on breastfeeding


"Who taught you what and when to feed your baby?" is a common question that
is
used in pediatric nutrition studies including breastfeeding.
Usually the answers are their own mom, an older aunt, an older sister, or a
neighbor as the primary source.  Geez, I just love those "my neighbor told
me...." responses! <g>
As you can see, the primary source does not include LC, nurse, dietician,
physician, baby book or whatever.
I was wondering if any LC knows of any recent study showing that LC's and/or
others are having an impact on bridging this serious gap in pediatric
nutrition counseling?
TIA
Andrew MD FAAP
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