This discussion has reinforced for me two big principles.

First is, that when we are talking to new parents we need, as Cathy Bargar
has often written here, to meet them where they are.  For many young
Americans, at least, that means that this is their first introduction to the
idea that bottles aren't really the ONLY normal way to feed a baby.   So just
normalizing bf as if it were *equal* to bottles can be, *for these parents,*
a huge, huge, step, and if you can get them in your prenatal classes to take
it you have made a huge difference in the world.  Obviously this is not true
of all new parents, thank god, and it is important not to set a lower
standard than the traffic can bear -- but it is true of some, and you have to
be realistic about your audience.

Second, however, is that what we expect of trained and principled health care
professionals should not be the same as what we expect from the least
knowledgeable new parents!   It is not inconsistent to tell some parents, on
the one hand, that an occasional bottle is not the end of the world, and yet
still to tell hospital nurses that there is NO reason for them EVER to
suggest a bottle for the healthy term newborn of a healthy new mother.

This difference in standards is true for two reasons.

First of all, a parent's job is to do the best she can overall to raise a
happy, healthy child, and that truly does include an element of not pushing
herself beyond a point that she feels she can handle in the larger context of
her life.  But a doctor or nurse's job is to promote health, period.

And second, a very big part of what gives parents the cultural message that
bf is less, equally, or more normal than bottlefeeding is the behavior of
their health care providers.   If you want a new mom to get the idea that you
think bottles are to be minimized as much as she possibly can, DON'T SUGGEST
ANY FROM YOU.

That soft-sell class for new mothers can say something like, "In the hospital
we will almost never give a baby a bottle.  There really are times when in
the first few weeks it can contribute to nursing difficulty, and our job is
to make nursing as easy and trouble free for you and your baby as possible.
That means we will help you bf at night when you are tired, and help you get
the baby on as often as she needs to be fed so neither she nor you gets
crabby or uncomfortable from not feeding often enough.   That way you'll have
the best shot at having bf really well established when you get home, and
then if in the coming weeks you feel that you need to give your baby your
milk in a bottle for any kind of reason, you'll have the least likelihood of
any kind of nipple confusion or trouble from it."

That way the message you give moms about bottles is:  You may need to make
compromises in  your life for one reason or another, and that's OK, as long
as you understand that they ARE compromises -- and I my job isn't to
compromise too early, but rather to help as best I can to keep you out of
trouble from any compromises that may be reasonable in your life.

And of course we all know how much more and more quickly those same babies
are going to be on bottles if they really did get bottles in the hospital.
And I personally believe that, real as nipple preference in the baby is, it
is much, much, less of a factor here than the hcp's example to the parents.

Elisheva Urbas
lay bf agitator in New York City

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