Deanne wrote (on the choice of whether mothers accept an epidural, or not),
"The same is true of breastfeeding...if, after careful explanation and
education, a mother chooses to bottle feed with ABM ..  One cannot stand
over a mother and insist that she breastfeed ...  Like all other health and
human issues,
breastfeeding remains a personal and private choice which we can improve and
facilitate but not mandate.  My  complaint is when a mother has chosen to
breastfeed and either she, herself,  or the nurses, or her doctor, or a
family member sabotage that decision with poor advice and information."

Amen to that!  But, you know, there's a couple more things that go towards
helping her make that "choice".  1) the assumption that there IS a choice,
2) an environment that presents different choices as equal, or nearly-equal,
and 3) the easy availability of breastmilk substitutes - as long as
hospitals have formula and bottles and go on providing mothers of healthy
babies with the means *not* to breastfeed, then there will always be those
mothers who seem to "choose" not to breastfeed.

I'm not talking about those (very few) medical indications for formula for
sick/prem babies in the first couple of days until the mom's milk is in,
inborn errors of metabolism etc, but about your normal, average, healthy,
full-term baby.

This is a story about a mother who was *not* provided with a choice.  An
expatriate mom who was so frank with me that it has been a joy to work with
her. Referred by her concerned OB, she phoned about a week before her baby's
birth to say she was not at all sure about breastfeeding. She didn't like
the thought of it, and she was worried about how she would be treated in the
private hospital where she was booked to have a Caaesarean delivery - known
for it's In-this-hospital-the-babies-are-breastfed Policy.  She thought she
would like to give breastfeeding a try, because she knew it was best for the
baby, but booked me for hospital visits, and we arranged that I would
intercede for her with the hospital staff if, having done her best, she
still wanted to abandon breastfeeding actually in the hospital.

At the first visit I found the staff impatiently waiting for me because the
mom wouldn't put the baby to the breast without me.  The baby, bless her,
latched very easily and was one of those babies who are "demanding" right
from the beginning, so mom had to breastfeed a lot in the first 24 hours in
order to keep the baby happy.  By the second night mom was ready to throw in
the towel.  On the morning of the third day I found her with gooseberry eyes
from all the crying she had done the night before as she tearfully related
that in ........(country of origin) things would have been so easy - the
hospital just brought the baby for feeding *and* a bottle at the same time
and asked the mother if at this "feed" she wanted to breastfeed or
bottle-feed.  I sympathised and repeated my offer to explain her feelings to
the nurses, and to the paediatrician.  Meanwhile, we covered expressing
colostrum into a spoon and mixing this with a very small Qx of glucose water
(a la Jack) until she could phone her husband to bring the bottles and the
formula into the hospital.  She *still* wanted to do the best for her baby
however, and thought she could carry on breastfeeding just a little longer
...  By the next morning I found a mother transformed -  she was all smiles
as she described how in the middle of the night she "just decided to get on
with it and breastfeed". Result: the baby was extremely relaxed and mom knew
now that she *could* breastfeed.

This week the baby is a month old and the parents came to return the pump
I'd provided on the fifth day to deal with engorgement and for them to use
for EBM-feeding if they still wanted not to breastfeed.  They told me with
some considerable pride of the baby's weight gain, mom looks *wonderful*,
and - guess what - she's still exclusively breastfeeding!  It's a little
miracle.  Facilitated, I'm sure, by a hospital which made *not*
breastfeeding so difficult at a really critical time, that the mom simply
had *no* choice.

Pamela Morrison IBCLC, Zimbabwe
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