I've really appreciated so far all the good advice I've gotten from all of
you.  I'm wondering more on a philosophical level today, as I've been
looking over my delivery record for the last year.  I am a family physician
who also does deliveries.  I've been quite pleased with my OB patients'
breastfeeding iniation rates (73% this calendar year, pretty high for our
area) but have been pretty disappointed with how many are still
breastfeeding for any duration.  I'm wondering if any of you have
suggestions for helping to increase duration.  Currently, I give all my
pregnant patient's a letter from me about prenatal care and my practice
philosophy, along with a packet of information that includes several LLL
tear off sheets on the why to breastfeed issue.  I also include a patient
education handout from the AAFP on breastfeeding, and a list of the relative
risk of various illnesses with formula feeding (from the AAFP position
statement on infant feeding) and also a LLL flyer from the local group, with
their phone number and meeting times.  At each birth, I always stay to see
baby feeding for the first time, practice breastfeeding supportive practices
as much as possible, and give out local LLL phone number, and the number to
our IBCLC at WIC (who is also available for consultations if there is a
problem, although not at the hospital regularly.)  I remind them that I am
always available for emergency breastfeeding help, also.  At every well baby
visit, I reinforce the importance of exclusive breastfeeding, try to praise
and support moms who are doing well.  I list all this just so perhaps you
can tell me what else, or what instead perhaps I could do to encourage
longer duration.  Currently, I have a lot of moms that wean partially or
completely within the first few months, many for what seem to me fairly
casual reason.  I have very few babies exclusively breastfed for 6 mos, even
fewer still nursing at a year.  There is very little breastfeeding culture
here in rural central Illinois, so many of my patients have so little support.
So, wise ones, any ideas on what else I can do to help my patients to
continue breastfeed?  Anything you think I can add (or should subtract,
perhaps?)  I'd appreciate any input on what has worked for anyone else, also.
Jennifer Tieman
Family Physician
Mom to 3, and new baby #4 expected 5/31/03

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