I am catching up on a week's worth of LactNet and have found the discussions
of saline compresses  very interesting.  Is this in widespread use?  Does
anyone have a protocol?  I have also read with interest the subject of
lactation failure.  On the subject of insufficient milk supply, I feel I must
add some comments.
    First, I am not sure why we care so much about the 5%.  When I am
speaking to a mother who might be at risk, I would never undermine her
confidence, but I sure am going to follow up.  If she states she had failure
before, I encourage her that we will pull out all stops.  As Barbara reminded
us, we can use good communication skills.  However, for the woman who is not
producing enough milk, there is some reassurance that she is not the only
woman who cannot produce a full milk supply.
    Second, in response to comments like, "How would the species survive?"
Many babies can die and the species survive.  In a country where there is a
high infant mortality rate, how do we know some of it is not from lactation
failure?  Also, in the literature, there were always wet nurses.  Do we
assume this was always for convenience of a wealthy woman or were some of
these out of necessity due to lactation failure?
    Third, we tend to bring our own experiences into practice.  Most of us
who are LC's or La Leche League Leaders or PC's have been successful
breastfeeders.  Many have overcome difficulties and continued to nurse with
success.  We see such postings all the time.  There are serious implications
in these attitudes, mainly, "If I could, you can."  I adore Dr. Jack and feel
his comments on our basic bottle-feeding society are something to really take
to heart.  So many women give up when we could help them "fix the problem."
We live to do just that!!!!  We cannot make the decision for an individual
however as to how much they are willing to do to be successful.  I have
worked with moms who would do anything.  I have worked with moms who have no
problems and quit anyway.
    Fourth, when we cannot "fix the problem," we need to help women through
their grief.  For those of you who were successful in your breastfeeding, I
encourage you to think about a few things other women experience. Consider
the quote posted:  "-one who gives birth is partly mother, one who nurses is
fully mother."  Thanks a lot from women who are unable to breastfeed for any
reason.  I did a presentation for Lactation Education Resources in the Fall
on this subject.  The evaluations were very positive except for one woman who
stated that she did not think this was an appropriate topic for a lactation
conference!  It is so easy for us to blame the terrible system, to complain
about the one bottle the baby received, or even the lack of commitment.
Alas, there are some women who give all and are still not successful.  One
woman who had a baby in NICU and could not get more than drops of milk said
to me, "I should not be his mother.  He should have a real mother who can
make milk for him."  She wanted to provide the best for her baby.  Her
breasts did not cooperate.  She and many others really believe in the
superiority of breastfeeding.  Do we realize how hard it is for these women
to give second or third best?  They are concerned that all of the advantages
of breastfeeding will be denied their child.
    Finally, I will share my own experience which also  influences my
practice.  My experience in breastfeeding is one of lactation insufficiency.
My children were born to an unmedicated mother.  Both nursed freely with no
hospital interference, in fact my second child and I went home at 6 hours
post delivery.  With my first, I repeatedly sought advice from LLL counselors
locally and at headquarters.  I was told to work on all the basics which I
was already doing.  I taught breastfeeding.  I had published research on
breastfeeding.  I knew those things.  My son had no bowel movements.  I was
told that was O.K..  My child who was 8 lb. 2 oz. at birth weighed 6 lb. 12
oz at 2 and one-half weeks of age.  Devastated is a mild term to describe
what I felt.  I ended up feeding "both ways" for his entire infancy.  With my
second child, I sought an LC in the newly formed profession.  I again did
everything recommended at that time with no better results.  My baby would
sleep all night and I woke up twice to pump!  (and we didn't have double
pumping in those days.)  The literature on insufficient glandular tissue was
not yet there, but I believe that this was indeed the problem.  I do not
accept that I am not fully mother.  I was there to kiss boo boo's.  I was
there for night terrors (Of course I was, we all slept together).  I love, I
care, I cry.  Breastfeeding is wonderful.  I dedicate my professional life to
helping others be successful.  When they are not, I cry with them, help them
choose options, and offer support and perspective on their loss.  I can still
feel sad that my children had mostly formula.  I still held them and nursed
them, but did not provide all of their nutrition.  They are wonderful, loved
kids in High School now.  I don't know about per cents, but there are enough
of us out there to warrent concern and help.

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