I always tell my couples in breastfeeding class that we are the only 
mammal who goes to a breastfeeding class. That always gets a laugh (and 
hopefully, starts them thinking).

I was glad to be reminded about the high proportion of older primips and 
those now pregnant who have had major fertility problems.I had not thought 
about this group as one who might have more problems with lactation but it 
certainly makes good sense.

I do think, in the long run, however, that part of this is due to the way 
many young women in our society CHOOSE to manage their breastfeeding 
experiences today. Presently, daughters of two of my friends are fully 
breastfeeding (and having no problems) but chose to introduce bottles 
earlier than I would certainly recommend. These two young mothers are both 
Masters prepared in their occupational fields. One had to give bottles 
because mother was acutely ill right after birth (is fine now) and the 
other chose to introduce a bottle by two weeks (even though she is nursing 
very well). That one complains of lots of fullness but I only mentioned 
once the possibility that this might be due to her pumping for these 
(unnecessary) bottles (which we all here would discourage,I know). It is 
not my place to make further recommendations because the mother is 
satisfied with her own management plan.

So, as lactation people, we see the gamut: the "failures" along with the 
successes. I feel that we need to take each mother/ baby couplet where 
they are and work with the supply they have (for whatever reason). if we 
can improve or "fix" the problem, that's wonderful,  but if not, it is our 
job to give Mom the best experience possible, keeping in mind that each 
mother's "ideal experience" will be very different (and more than likely 
very different from our own).

I learned long ago to take that necessary "step back" and meet the patient 
where she is. Many times, I have had to bite my tongue because the 
mother's plan is so different from what I would do. But again, I remind 
myself that there are many ways to breastfeed a baby (or at least get 
breastmilk into the baby). Taking "the road less travelled" does not mean 
that the lactation professional is "wimping out" as some have inferred in 
the past. It doesn't mean we are settling for less. It means we are 
quiwetly going about our job and probably getting farther in the long run.
 
I know that personally, if I make sure I do some good teaching for Mom 
(about latch or what have you) in front of the pediatrician who happens to 
be standing there(who I am hoping to teach), that doc absorbs what I am 
saying and doesn't even realize it. I would rather do that and make a 
small difference than be outspoken and confrontational and then have that 
same doc completely tune me out (then and in the future as well).I 
accomplish far more "going in the back door" as it were and benefit all my 
mothers that way.

Betsy Riedel RNC, IBCLC
Connecticut

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