very good question re alternate feeding: is bottle feeding going to preserve bf better or will it be the end of bf sooner due to bottles being seen as more normative and able to be continued? this is a question every lc must struggle with i think. i agree that the best tactic is to present the options to the parents. i think, too, that if a very short term alternate fdg is needed, like in hospital with a sleepy or jaundiced baby, then syringe, spoon, etc would work well. if a long term non-bfer is expected, like the case with the large nipples and small baby, then bottle feeding may work better. i think one of the big issues that i am really seeing is motivation to bf or committment to bf. i think somewhere i saw a pyramid, similar to the food pyramid, with factors influencing bf. the bottom or base of the pyramid was motivation (or committment). without this, the mother will not persist, regardless of alternate fdg method chosen. of course, having the healthcare system, friends, family, and culture supporting bf would help. i know her committment is influenced by all the above, but ultimately it is the mom who chooses. this may seem callous, but i am seeing this more and more as a factor. if i am the one coming back again and again into her room and she is saying, oh i gave him a bottle due to having visitors (for example), or if i'm making all the f/u calls and the mom is really not seeking out help or going to pick up the pump that i've arranged for her via the wic program or the one she says yes she is going to rent, then she is really not motivated to continue. Laurie Wheeler, IBCLC, MN, RN New Orleans Louisiana, s.e. USA _________________________________________________________________ Join the world’s largest e-mail service with MSN Hotmail. http://www.hotmail.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html