Jennifer, it sounds to me as if you are doing a wonderful job promoting
breastfeeding in your practice. The identified barriers to continuation of
breastfeeding include things like painful experiences, fears about milk
supply, the perception that work or school are not compatible with
breastfeeding. So bringing the babies back at 4-5 days postpartum and
including a nipple exam, or asking an educated office staff person  to help
with positioning and latch, engorgement management, etc might help.  There
are good handouts about combining working and bfg.

Your point about the culture where you live is well taken.  If mothers go
home to a bottle feeding culture, it is hard to overcome the pressure to
reach for formula.  Some studies have identified other family members as key
here:  husbands, grandparents, etc.  While there is only so much you can do,
you might consider requesting that dads be part of some of the first
postpartum contacts and reinforce to them that you really want this baby to
have the health benefits of bfg and that you hope you can count on dad (or
grandma) to support you in this.  It has been borne out that the opinion of
the physician does matter, and I compliment you for your diligence and urge
you to just keep on keeping on.  These changes don't happen over night.
Over time though, each mother who persists becomes an influence in her
circle, and the change does begin to occur in communities.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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