Lynn Shea said:  "Of course it is hard.   Obviously I 'hear' what your
saying   but I'm sure that is what Bobbie Phillips and Anne Merewood felt
when they initiated the changes in the breastfeeding climate at Boston
Medical Center . However, These changes are the only thing that can explain
their huge increase in breastfeeding with the same population that you
describe. Breastfeeding became the *norm* at that hospital. I know that
pedi HCPs are worried about alienating patients but until *you do what they
do* (at BMC) and create a climate that shouts "we promote breastfeeding
here!" and not "we try to walk the fence " (and yes that ould include
posters etc!~) can you truly know how much of a factor you are"

I think you misunderstand my point.  I'm not walking any fence in my
practice.  It's just that it's not enough to say to a mom "You should
breastfeed" and then feel guilty when they don't.  Simple medical
information is often not enough.  Providing cultural change is what we
need.  Another example would be the Mother's Milk Club at Rush in Chicago,
where there was comprehensive support.
When I conducted the survey, it wasn't so I could then say "Look, it isn't
my fault or my responsibility" but so I could know what type of support
might be needed.  We went on to start a breastfeeding mom's support group,
and had several of our clinic patients train as breastfeeding peer
counselors.  Unfortunately, I think this languished after Mary Kay and I
left, but I have taken with me the understanding that it's often not enough
for me to be the sole voice in a woman's life supporting breastfeeding.  I
certainly do not dilute the truth when I counsel women or even when they
have have weaned or never started breastfeeding, but I know that I'm only a
small part of a woman's life.
Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose

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