When working with normal populations it can be difficult to remember that
the mortality rate for infants prior to antibiotics and safe water supplies
was very high (and still is in some parts of our world).  I have historical
records (old diaries) in my family of mothers losing children who were
breastfeeding.  My husband's grandmother almost died of a breast abscess
during early lactation -- her infant was kept alive on homemade formula
after her breast turned black during the time (prior to antibiotics) that it
took for her to recover (about 3 months).  If you read about the effects of
starvation during the Civil War in the US or during the Seige of Leningrade,
or the hunger in the Netherlands during the Second World War, we can read of
babies starving at the breast.

So it is a romantic notion that all babies are normal, all environments are
normal, and that all babies can breastfeed.  Yes, better birth practices are
desireable, but even were all birth settings perfect, there would be some
difficult births producing injured infants and some would be born
dysfunctional feeders for other reasons.  Many, if skillfully handled, will
recover and become functional feeders.  Working with OTs  and CSTs is a good
thing.  It is also good for LCs to go to OT and Speech Pathology seminars
and workshops to learn strategies for working with babies who resist easy
transition to breast.  The book by Wolf and Glass, Feeding and Swallowing
Disorders in Infancy, Therapy Skill Builders, Tucson, AZ, 1992 is an
excellent book describing the problems and solutions involved in assessing
and assisting dysfucntional feeding babies. In my opinion, this is a book
that should be required reading for all LCs.

One of the things that happened rapidly once I started into private practice
was that I had to surrender the notion that all babies could breastfeed and
that all mothers could make enough milk if only they wanted to.  My job is
of course to give over all the intelligence I have to assisting the return
to normal, but, failing that, to help achieve the maximum positive outcome
for the dyad with respect to intake of human milk.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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