Barbara, 
I well recognize that my experience is not enough to consider it "evidence
based practice", and that it should be shared and then tested by others to
either refute or confirm it.

However, in our practice, as in many psychosocial and physiological
situations, we need to understand that the variabilities we see include
such aspects as:
 -  Mom's tissue - is it more or less taut (so that when one mom inverts a
nipple shield, the tissue goes into it as I think it should, whereas
another mom's nipple just stays at the base of the nipple shield - and it
becomes an ineffective and even a damaging tool).  
  -  Mom's persistence  - even with the best instructions, some moms tell
us they are doing.... when in fact we much later find out she is doing
something completely different.  
  -  Baby's personality as well as physiology and past experiences which we
have no way of knowing (deep suctioning, sore throat due to thrush no one
identified for weeks, one baby is quickly habituated to the family noises,
another cannot breastfeed well except in a quiet, dimmed room).

So that when one of the LC's reports xxx or YYY experience, instead of
saying "no, that's not so", all research and evidence shows ...... we can
more correctly say "boy, that's a new one!  thanks for sharing it!  In my
experience......."  This allows us to share, to hear other points of view,
to consider alternatives - without fearing "trashing" of our information,
decisions and the alternatives we took given the situation we had before
us.  

How many moms I have "allowed" to bottle feed - because I knew they could
only cope with pumping and bottle feeding.  If I said pump and
cup/spoon/finger feed, baby would have gotten no mother's milk at all. 
Maybe another LC could have done things differently and gotten her to do it
"the best way".  But if I brought up these cases in Lactnet (as we try to
keep our notes brief) and I don't go through all my reasoning and the whole
picture - the answers are often unkind or even downright nasty.

In order for Lactnet to provide us with a forum for exchange of ideas, we
need to be able to freely express ideas and experiences (like a meeting
that is held to brainstorm, where all ideas are brought up and then
discussed, no matter how unusual they may be).  The brainstormers need to
feel they can bring things up safely - then we can discuss and consider
them.  

Once my son thought up how he thought breast milk was made in the breast. 
As a young child, he had a sort of "factory production line" view of it. 
But I respected his ideas and we talked it through.  He's a physicist now -
probably never going to do research in breast milk production.  But he is
willing to try "crazy" things and who knows what he will come up with?

Jeanette Panchula, BSW, RN, IBCLC
Vacaville, CA
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