I'd like to share some thoughts on the comments about the hospital based
LC's who didn't seem to recognize hypertonic babies or provide for
followup.  This is not to excuse this lapse, but perhaps to try to
understand it.  I have worked in hospital settings in the past, and know
how stressful it can be.  Add to this the current "downsizing" and
"speedup" phenomena that leave hospital-based nurses and LCs to deal with a
huge caseload, with less support and more pressure on them than before.
Sometimes a lone hospital-based LC has few peers to share  and
problem-solve with.

A few years ago our local LLL leaders arranged a meeting with the area WIC
breastfeeding coordinator, representative public health nurses, and
hospital-based OB nurses.  I think this helped us all begin to stop blaming
the lapses of others and to understand better the limitations of trying to
solve all the breastfeeding problems in any one setting.  For example, LLL
leaders heard from the hospital nurses how difficult it is to evaluate,
treat and follow up on breastfeeding problems during a 24 hour hospital
stay, when the new mother is on a real high or else exhausted, innundated
with visitors, and not especially able to absorb and retain lots of
information.  So we could better avoid thinking, "Why didn't those hospital
nurses teach this mother (whatever)...?"  We could hear first hand how the
WIC program was trying to work to improve breastfeeding rates, and stop
unconsciously thinking of WIC as simply a big buyer and distributor of
artificial baby milk.  The original meeting led to the formation of our
local Breastfeeding Promotion Network, which has been convened by the WIC
director for our city ever since, and has fostered dialogue, communal
efforts, and networking among people from many disciplines and across
varied settings in our joint efforts to promote, support and protect
breastfeeding.

I am also thinking of a June 15, 1997 NY Times Magazine article, "How Can
We Save the Next Victim?" by Lisa Belkin, that talked about some serious
errors in hospital care that led to very bad outcomes.  Rather than
focusing on who was at fault and assigning blame, the hospitals were trying
to look at the problems in the system that led to the occurrence of these
accidents, and to work together to prevent the possiblity of it ever being
able to happen again.  I think this would be a helpful approach for all of
us, too, as we deal with breastfeeding issues.  How can we work better
together to build a more supportive system?  How can we understand the
barriers we each face and support each other, share our knowledge, and
reach across our various settings and disciplines?

I have also found earlier discussions about background education
requirements and experience for LCs to be very interesting. It struck me
again as I read about the doctor who spoke in a demeaning way to the LC in
the neonatal nursery, in front of a group of residents.  Years ago I read a
physician's article describing a condition she felt afflicted a number of
doctors.  She labeled it "generalization of expertise," and described the
doctor who stands up in the town meeting and says, "the playground should
be built here, because I'm a physician, therefore I'm an authority on this,
too."  (I'm paraphrasing). Too often, some people generalize their
knowledge in one area and come to believe they are an expert in many other
areas.  This happens a lot with physicians and breastfeeding.  I worry most
about those with degrees in any field who feel they know a lot by virtue of
their education, titles, or positions, speak with great confidence and
authority, and have lost the ability to really listen to and learn from
others around them.

There is something I think is more important than the degrees people list
after their names.  It is their interest and ability and sense of
commitment and responsibility to continue to learn, and to honor and
respect others who have experience to share.  When I think of how much more
we know in the breastfeeding field than we did just 10 years ago, I am
really reminded of this.  So we all need to be willing to constantly update
our knowledge base through reading, attending conferences, and learning
from those around us (mothers and babies, and our colleagues from many
backgrounds).  This is an attitude issue, and it is difficult to control
for it in the certification process.

I am often awed by the level of knowledge and experience that so many
lactnetters have, and I am grateful for their willingness to share with all
of us.  Each of us has areas in which we are most competent and
knowledgeable, and other areas where we need to seek out more expert
opinion as we continue to expand our knowledge.

Anne Altshuler in Madison, WI