It will be interesting to see where the research leads on this, but many LCs
do notice problems breastfeeding when moms have had fertility issues.
Sometimes those issues are related to hormonal imbalances that may also
affect breast development (perhaps as far back as puberty).  It would be
wonderful if the babies whose mothers really couldn't produce normal vols.
could all get some weeks of exclusive human milk feeds from milk banks
(altho the demand would then seriously out-strip supply at present levels).
It would also be wonderful if the infertility docs and the docs who do
pre-natal surgeries would refer these at-risk mothers for bf counseling and
close support pp.

Jean Cotterman has a good point when she says that the only way the docs can
perceive things is to feel they are playing the guilt card when they urge
bfg and the moms fail.  The docs need to do more than suggest.  They could
advocate for inclusion of an LC in their managed care groups.  In Austin,
several of the HMOs have contracted with various local LCs.  In the plan I
am connected with, two priv. pract. LCs serve all the OBs and Peds in the
group.  If one of the docs has a mother who needs special help, they fax
over an authorization # and a diagnosis code.  I go see the mother, collect
a co-pay, and bill the HMO.  Fri. I saw a 51 yr. old inducing a lactation
for an adopted baby.  It cost the mom her $10. co-pay, and my report to the
OB facilitated her getting a script for metoclopromide.  It is such a great
model, and the doctors are the ones who make it work.  This deal was set up
by a bfg friendly pedi when he took over as chief of peds.  The leadership
has to come from the ones with the power.  Then we have to be ready and
skilled enough to deliver the goods.  That's when no one has to feel guilty,
because the support is available.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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