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From:
Diana West <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 22 Apr 2002 09:25:02 -0400
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>I've observed, but don't know if there is research to support that mothers
>who heavily focus on increasing production do not do as well as mothers who
>focus on the enjoyment they get from breastfeeding and set shorter term
>goals towards the eventual goal of minimizing supplement use.

This has been my finding, as well, in my work with the mothers on the BFAR
(breastfeeding after reduction) email lists and in my empirical research
for writing the LLLI book on BFAR.  It was for this reason that I placed
such a strong emphasis in the book on educated, realistic expectations
combined with a deliberately positive attitude of appreciation of any milk
production that occurred.  It was also the reason behind my choice of the
book's title.  I believe that when mothers create their own definition of
breastfeeding success that is relative to their particular circumstances,
they empower themselves with a positive perspective that dissolves many
psychological barriers and significantly increases their perception of
breastfeeding satisfaction and often their milk supplies, as well.  My
experience has been that setting short-term goals greatly facilitates these
objectives.

The issue of educating mothers about probably BFAR outcomes so that they
have realistic expectations has turned out to be somewhat controversial,
however.  Several BFAR mothers have recently confided to me that the reason
they persevered was because no one told them that BFAR isn't always
successful.  One mother in particular told me that her LC deliberately
refrained from telling her that many BFAR mothers must supplement in order
to preserve that mothers' motivation and focus on exclusive
breastfeeding.  She felt it was an excellent strategy and recommended it
for other BFAR mothers.  I gently and respectfully disagreed with her.  I
responded that while I do firmly believe that a BFAR mothers' attitude
greatly affects both her milk supply and her perception of the experience,
because so many BFAR mothers have such significantly deficit milk supplies,
which puts their babies at serious risk, I feel it is important to be clear
in discussions with mothers, as it is in my book, that it is very likely
they will not have a full milk supply. This is not done to be pessimistic
or to sabotage their outcomes, but rather from the premise that when BFAR
mothers are well-educated about both the probable outcome and methods of
maximizing their lactation capability, they will have the greatest
opportunity of producing as much milk as possible.

>Instead of creating reliance on a lactation consultant for what might turn
>out to be long term supplementation, it seems to me that a more powerful
>approach would be to empower women to observe their infant to determine
>when and how to use the SNS at any particular feeding.

I strongly agree.  In my book, I attempted to convey the importance of this
strategy as the means to gauging when supplementation is, and is not,
necessary, so that supplementation can be minimized.

>Helping a mother to observe her own infant's behavior avoids the problem of
>basing the amount of supplement on theoretical calculations extrapolated
>from one test weighing that may not reflect the infant's average intake at
>every feeding.

 From my background as an LLLL,

>While some infants do take in a similar amount at every
>feeding throughout the day, many others do not.  Moreover, research shows
>that infants' growth varies considerably from one day to the next (day to
>day measurements are not like that nice smoothed curve on the charts, these
>are sharp peaks and troughs) and hence their needs may vary from one day to
>the next as well.
>
>We do follow up with weekly weight checks. Usually mothers who rent an
>infant weighing scale become extremely anxious because the temptation to
>weigh their infants frequently is too great and they go through frequent
>moments of elation and despair.
>
>Most often, when an infant is not growing well, we find that the mother has
>tried to challenge the infant a little too quickly and has been leaving her
>infant on the breast for extended periods of time when the breast has been
>already drained.  Mothers often feel that if they just make the infant work
>harder, the infant drain the breast better.  We find that an infant that
>isn't ready for that challenge just gets tired and will either start crying
>a lot or sleep longer.
>
>Similarly, we find that if an infant is ready for a greater challenge and
>the extra support isn't withdrawn, they will often develop compensatory
>behaviors that lead to setbacks.  For instance, if the flow is too fast,
>they may start retracting their tongue to reduce the flow.
>
>Finally, as I've posted before, my supervisors modified the tube placement
>and use of venting - modifications which I'm hoping to study in a formal
>research study at some point when my son is going to nursery school 5 days
>a week instead of the current 2 days a week.

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