I'd like to share some thoughts on the comments about the hospital based LC's who didn't seem to recognize hypertonic babies or provide for followup. This is not to excuse this lapse, but perhaps to try to understand it. I have worked in hospital settings in the past, and know how stressful it can be. Add to this the current "downsizing" and "speedup" phenomena that leave hospital-based nurses and LCs to deal with a huge caseload, with less support and more pressure on them than before. Sometimes a lone hospital-based LC has few peers to share and problem-solve with. A few years ago our local LLL leaders arranged a meeting with the area WIC breastfeeding coordinator, representative public health nurses, and hospital-based OB nurses. I think this helped us all begin to stop blaming the lapses of others and to understand better the limitations of trying to solve all the breastfeeding problems in any one setting. For example, LLL leaders heard from the hospital nurses how difficult it is to evaluate, treat and follow up on breastfeeding problems during a 24 hour hospital stay, when the new mother is on a real high or else exhausted, innundated with visitors, and not especially able to absorb and retain lots of information. So we could better avoid thinking, "Why didn't those hospital nurses teach this mother (whatever)...?" We could hear first hand how the WIC program was trying to work to improve breastfeeding rates, and stop unconsciously thinking of WIC as simply a big buyer and distributor of artificial baby milk. The original meeting led to the formation of our local Breastfeeding Promotion Network, which has been convened by the WIC director for our city ever since, and has fostered dialogue, communal efforts, and networking among people from many disciplines and across varied settings in our joint efforts to promote, support and protect breastfeeding. I am also thinking of a June 15, 1997 NY Times Magazine article, "How Can We Save the Next Victim?" by Lisa Belkin, that talked about some serious errors in hospital care that led to very bad outcomes. Rather than focusing on who was at fault and assigning blame, the hospitals were trying to look at the problems in the system that led to the occurrence of these accidents, and to work together to prevent the possiblity of it ever being able to happen again. I think this would be a helpful approach for all of us, too, as we deal with breastfeeding issues. How can we work better together to build a more supportive system? How can we understand the barriers we each face and support each other, share our knowledge, and reach across our various settings and disciplines? I have also found earlier discussions about background education requirements and experience for LCs to be very interesting. It struck me again as I read about the doctor who spoke in a demeaning way to the LC in the neonatal nursery, in front of a group of residents. Years ago I read a physician's article describing a condition she felt afflicted a number of doctors. She labeled it "generalization of expertise," and described the doctor who stands up in the town meeting and says, "the playground should be built here, because I'm a physician, therefore I'm an authority on this, too." (I'm paraphrasing). Too often, some people generalize their knowledge in one area and come to believe they are an expert in many other areas. This happens a lot with physicians and breastfeeding. I worry most about those with degrees in any field who feel they know a lot by virtue of their education, titles, or positions, speak with great confidence and authority, and have lost the ability to really listen to and learn from others around them. There is something I think is more important than the degrees people list after their names. It is their interest and ability and sense of commitment and responsibility to continue to learn, and to honor and respect others who have experience to share. When I think of how much more we know in the breastfeeding field than we did just 10 years ago, I am really reminded of this. So we all need to be willing to constantly update our knowledge base through reading, attending conferences, and learning from those around us (mothers and babies, and our colleagues from many backgrounds). This is an attitude issue, and it is difficult to control for it in the certification process. I am often awed by the level of knowledge and experience that so many lactnetters have, and I am grateful for their willingness to share with all of us. Each of us has areas in which we are most competent and knowledgeable, and other areas where we need to seek out more expert opinion as we continue to expand our knowledge. Anne Altshuler in Madison, WI