Rachel and anyone else in a developed country with very high breastfeeding
rates--I have a question for you.
Background: In our hospital initiation is 83-85% (and we are proud of
that!) but even pro-breastfeeding people sometimes comment on that by
saying "it's almost as if you don't even give them a choice!".  The nurses
are very worried about not "pressuring" mothers, and about "empowering"
them.  The  head of nursing has just said we're going to try for
Baby-Friendly, and I have two main challenges to overcome: getting the
required education hours for all relevant staff, and overcoming the worries
of some of the nurses.  One or two have worked in hospitals that went for
BFHI and were very put off by what they perceived as an atmosphere of
righteousness and pressuring mothers.  It sounds as if the LCs there may
have been trying to convert mothers during their stay in the hospital, and
arguing with them, and were trying to get the nurses to do some of this
work as well.  (Of course I've only heard one side, but if that's how the
nurses felt it was a problem.)  So I am trying very hard to work out ways
to reassure the nurses that we can maintain and even improve our
breastfeeding initiation and duration rates without alienating mothers.
People probably commented (I was nomail at the time) on the NYTimes article
about Norwegian breastfeeding rates which quite strongly implied that these
figures are both unrealistic in the US where mothers are more likely to go
back to work in the first couple-three months, *and* somehow a bit fascist
-- as if bf initiation rates of 99% are unnatural, and if mothers were
really given a choice, the numbers would be lower.  Ugh.
Now, I can of course go on more or less indefinitely about the pressure
mothers get *not* to breastfeed, and about how "empowering" them to choose
formula if they want to is a lot like the old "you've come a long way,
baby" Virginia Slims ads, and about how in all this concern about not
making women feel bad if they choose formula we are kind of forgetting the
grief and anger of all the women who would have breastfed if they'd been
properly informed and supported.  But what I need is some concrete ideas
from a place where breastfeeding rates are very very high.
For example, if 1% of mothers are not starting breastfeeding in the
hospital, is it because they wanted to but couldn't, or are there some who
don't want to even in (say) Norway?  What happens in the hospital if a
mother says she doesn't want to nurse the baby?  How do hospitals and LCs
work outside the hospital to educate women in such ways that they come into
the hospital already wanting to nurse their babies?

Basically the concerns about not "pressuring" women are based on a
perception that wanting to breastfeed is not a very universal trait.  I
operate from an assumption that on the contrary it's completely normal and
usual to want to breastfeed and that rates will be higher if you enable
people, remove obstacles etc. -- there's no real *need* to shove them.  But
I need evidence that these high rates can in fact be achieved w/o
dragooning the moms.  (Wasn't it Jordan where they decided all mothers
would *have* to breastfeed for their (long) hospital stay, no choice given?)

Elise

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