To Angela in the Azores--
Whew, you definitely have your work cut out for you! You, and the person who
wrote a few days ago about her situation with a 25% bf initiation rate. I'm
shocked to hear stories like this--I'm almost embarrassed to say that I work
in an area with an 85-90% initiation rate and feel discouraged some days
because our duration rate isn't great!!!

In situations such as you two are in, you just have to make progress one
mother at a time, one health professional at a time. Remember the Stages of
Change (there's some stuff in the archives from several years ago that I
posted on this) and that trying to push people through them too quickly
gives lots of resistance. You need to introduce ideas, let them sit, and
then talk about them again.

Starting an LLL Group will be one of the best things you can do, since the
mutual support will help to empower the mothers to ask questions and be
assertive when barriers are put up. Their successes will help other women.

Next come gentle steps with the professionals. Canada has a couple of things
you might find of use to you. Health Canada's Post Partum Support Program
tries to ensure that information that is given to mothers after birth is
consistent. I don't entirely agree with all the breastfeeding information,
but in general it's pretty good. There's a questionnaire that mothers can
fill out and a manual for the HCP to use to answer those questions. There's
quite a few breastfeeding questions, although it seems more geared towards
the community health nurse rather than the acute care nurse or doctor.

The one I like for use in the hospital, as well as the community, is from
the Canadian Institute for Child Health and is called National Breastfeeding
Guidelines for Health Care Providers. Health Canada distributed copies of it
to all the Post Partum Support Program sites. What I like about these
resources is that the information isn't just coming from me, the resident
breastfeeding fanatic, but from our government. That might not weigh heavily
with American health care providers, although it might be useful to mention
to naysayers that Canada has a pretty darn good breastfeeding rate,
especially when compared with the US (overall initiation rate somewhere
around 75%; in western Canada it's in the 80-90% range. That's not entirely
due to the Canadian government, but government support and interest over the
years sure hasn't hurt. Health Canada has a social marketing campaign called
"Breastfeeding: Anytime, Anywhere" that has helped put breastfeeding front
and centre in many communities.

If you think these resources might be useful, contact:
Canadian Institute of Child Health
885 Meadowlands Drive, Suite 512
Ottawa, ON  K2C 3N2
Phone: (613) 224-4144
Fax: (613-224-4145

Good luck with your new purpose in life! Funny how situations can take us
onto paths we never dreamed we'd walk.

Leslie Ayre-Jaschke, BEd, IBCLC
Peace River, Alberta, Canada
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email: [log in to unmask]
-----Original Message-----
From: Angela Howell <[log in to unmask]>
Date: January 4, 1999 12:11 PM
Subject: Promoting Breastfeeding/Rocking the boat! (long)


>I hope this is coherent as I'm typing one-handed.  (The other hand is
>hanging onto my nursing gymnast!)  Plus, this is my first ever LactNet
>post, so please be nice.  :)
>
>I have been hearing about LactNet for a few years now, and received
>snippets in my email from a friend on the list. (The "meconium heads"
>comment was priceless!) I was a medic in the Air Force Reserves while
>attending nursing school (that I just can't seem to finish with all the
>military moves we've made!) and am now a LLLL.
>
>The Air Force moved my family to a tiny island in the Azores, about 800
>miles off the coast of Lisbon, Portugal.  There is no WIC here, yet
>breastfeeding is poorly represented.  Generally, the people on this island
>are poorer than the people in the US, yet I see more babies with bottles
>than with breastfeeding moms.  The Americans here who are accustomed to
>receiving WIC foods and formula are finding themselves in financial
>problems, and the peds clinic on the base sees many babies who get
>overdiluted formula.  Today even, I stopped to admire a new baby girl who
>was 5 weeks old and asked the mom if she was breastfeeding... she looked
>almost ashamed and said yes, since she couldn't get WIC!
>
>In October, one mom delivered her first baby while on this island, and
>since the US clinic is out-patient only, she was sent "dowtown" to the only
>hospital on the island.  They pronounced her dry one Day One pp since they
>squeezed her nipples and no milk streamed forth.  Bottles of formula are
>routine for new babies, despite the fact that moms are breastfeeding.  They
>also don't provide things normally found in US hospitals, like a bedside
>pitcher of water, so this new mom went without until the visiting hours...
>only 2.5 hours total for each day.  She had also become afraid to drink
>much water worried that she would have to urinate, and at that time, the
>staff hadn't taught her about treating her perineum with a sitz bath,
>peri-bottle or anything!  When I went to visit her, she had only tried to
>breastfeed once, and the nurses brought her a bottle of formula, so she
>gave up.  She was clearly disappointed that she wasn't able to breastfeed
>and had "no milk."  During my visit, we discussed latching the baby on, and
>finally tried a "new" position with this mom, the cradle hold, and got a
>wonderful latch-on.  Just a short time before he woke to latch on, she had
>a small drop of colostrum on the tip of her nipple and broke into tears of
>joy knowing that she in fact wasn't "dry."  She's not given a bottle of
>formula since that day and has a thriving son, complete with a double chin
>and dimpled hands.
>
>
>In addition to pronouncing new mothers dry, there is very little
>encouragment of breastfeeding in this Portuguese hospital.  I was admitted
>for what we thought might be mastitis when my son was 7 months old - during
>World Breastfeeding Week this past year - and was amazed to learn from the
>nurses that they do not encourage breastfeeding. (They would all come in,
>shift after shift, and stand at the foot of my crank-style bed in amazement
>as I nursed my baby!) The maternity nurses referred to books with Nestle
>products all over them.  One nurse got angry that I wasn't offering many
>solids (she said "soups"!) to my 7 month old.  The OB told me that if I
>hadn't been breastfeeding, I wouldn't have mastitis.  The surgeon who
>performed a needle aspiration couldn't understand why I wasn't interested
>in weaning.  It turned out to be a lymph infection and was cultured to be
>effective with some antibiotic they wouldn't prescribe while I was nursing,
>so of course, they said I must wean.  Needless to say, I showed the OB some
>info on medications during lactation, and became an outpatient receiving
>TID IM injections of gentamiacin.  We had only been on this island for a
>month when this transpired. The GPs on the American base quickly became
>aware of my desire to breastfeed.  :)
>
>For the progresses that have been made in the US hospitals, and those in
>other coutries, we are very fortunate!  Those on this base who have been
>wonderfully receptive to promoting breastfeeding have listened with
>interest to ideas of removing books from those given out to new mothers
>(can I say the "What to Expect" series?), to promoting our monthly support
>groups, to having a donor milk bank on the base for interested families, to
>pursue setting up a Breastfeeding Resource Center, and to promoting
>articles in our local publications that encourage breastfeeding.
>
>
>Some of the obstacles I am facing are from the pediatrician, who encourages
>or "gives permission" to mothers with 12 month old babies to wean and give
>cow's milk.  She recommends giving 15ml of formula following nursings to
>babies with jaundice.  She recommends supplementation frequently, according
>to her, and indicated bad experiences with LLLL's.  However, on the
>up-side, the RD has attended meetings, particularly when our discussion
>revolved around weaning and nutrition, and has done further reading since,
>that supports not substituting breastfeeding with foods of lesser value.
>The Family Advocacy Nurse (FAN) pursued setting up a BRC, and has asked me
>to introduce breastfeeding tips during their OB orientation classes. She
>was most concerned to learn that some bf literature/videos they distribute
>could sabotage a mother's successes with bf.  But, she also said that
>they're pursuing setting up some sort of voucher system for formula as
>well, and that if given a choice, she thinks many parents would pick
>formula over donor breastmilk.  One of the Family Practice GPs has become
>one of my biggest allies.  He offered to write letters to supervisors to
>allow pumping time for employed moms, or make appointments for moms to come
>to the clinic to use the in-house pump!
>
>Collectively, I hoped that you could provide some suggestions to me for
>introducing ideas that support and encourage breastfeeding to those who can
>make changes on this base.  The FAN is coordinating a "conference" with the
>Pedi, herself, the RD and myself, to discuss management of breastfeeding so
>that "we'll all be giving out the same information."  I figure this will be
>the best opportunity I'll have to get my foot in the door, so to speak, on
>getting some of these ideas actually implemented.  Then hopefully once it
>becomes a reality here, the military may take notice and set forth policy
>to allow/encourage the same programs at other bases, especially with the
>books given to moms!
>
>I've enjoyed reading the ideas you all have had on teaching opportunities,
>and making "infant care" classes assumed breastfeeding.  :)  If you have
>other suggestions on what to do, when and how, please let me know.  Thanks
>in advance.
>
>Angela Howell, LLLL (other initials pending)  :)
>and to think I resisted becoming a bf advocate!
>