Some thoughts about Amy Kotler's case and the exchange between Amy and Cathy
Genna.

1. Jane Heinig gave a presentation at ILCA about recent research at UC Davis
that has got me thinking. In focus groups with WIC moms, both
English-speaking and Spanish-speaking, they learned that the baby's behavior
was the main criterion that the mothers used for determining whether their
babies were "getting enough." (These mothers had all planned originally on
breastfeeding but ended up using more formula than they planned or even
switching entirely to formula.) If the baby did not seem "full," then they
gave more food. The standard ways that WIC was teaching moms to monitor the
breastfed baby's intake--looking at weight gain, number of feedings per day,
or diaper count--did nothing to convince the moms. If the baby did not
settle down and seem satisfied, then they gave more food.

In fact, Jane described a kind of continuum of feeding decisions. If a
breastfed baby doesn't seem full, you give formula. If a formula fed baby
doesn't seem full, you give cereal. If a baby on formula and cereal doesn't
seem full, you give other solids. [...And we wonder why we have a nation of
fat people!]

So what we are dealing with may be a lack of basic mothering/parenting
information about how normally-fed babies (breastfed babies) normally
behave. If people believe that babies should just eat and sleep (in their
beds alone), then many very well-breastfed babies who need more intensive
mothering are going to be given formula...and that, of course, does make the
baby sleep longer and does make the mother's milk supply decrease. So we're
in a bind.

As I see it, a mother doesn't make ONE decision about how she will feed her
baby. She makes a few hundred decisions every day--each time the baby
signals a need, she decides whether and how she will answer that signal.
What we should teach breastfeeding mothers is that offering the breast is a
good way to answer signals that indicate a need for food, drink, and sucking
(promote relaxation, induce sleep, stimulate perstalsis, give reassurance
and comfort). Mothers need to develop a range of other mothering techniques,
too--pick baby up, change baby's position, burp baby, clean up messes,
bathe, adjust clothing for comfort, carry baby around, give baby something
interesting to touch, look at or listen to, hand baby to a new person for
awhile, etc. I learned these techniques from hanging around with other
mothers at La Leche League. How are people supposed to learn these
techniques when one so seldom sees them being used in public places like a
WIC waiting room or a shopping mall? The family should be teaching them to
new parents...but how many family members know them? 

2. Amy, I wondered about the relation of weight gain and non-stooling. If
the baby is gaining an ounce a day and not stooling, isn't the weight gain
partly poop, not baby flesh? I mean, a pre- and post- feed weight will show
us how much milk a baby takes. Theoretically, a pre- and post- poop weight
would show us how much poop the baby gives---but we don't do this because we
could just weigh the poopy diaper if we wanted to know that. So a baby who
is not stooling presents a couple of puzzles: a) why isn't he stooling? b)
how much is he actually growing?

3. I agree that the 3-step counseling technique is a great way to go. Nurses
and doctors have a lot of difficulty with the second step--validate the
mothers concerns--because we want to jump ahead to step three--educate--but
it is possible to teach ourselves to do it. 

Chris Mulford, RN, IBCLC
LLL Leader Reserve
working for WIC in South Jersey (Eastern USA)
Co-coordinator, Women & Work Task Force, WABA
 

 

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html