It is hard not to become impatient when we hear uninformed beliefs presented
as opinion from individuals whom the public views as authorities.  It is
tempting to take strictly an adversarial approach to countering this.  While
we do need to stand up with the facts, and write those letters to the
editors, as Jack suggests,  we also have to understand that the slow,
steady, discipline of remaining at our posts in our communities DOES make a
difference.

 Every report I write (and I write one for EVERY baby I see) is faxed to the
OB/midwife and the baby's doctor.  In a brief and friendly tone, I
communicate what I think is wrong, what I have suggested as a plan to help
breastfeeding succeed, and my thoughts on what the doctor could do to
assist.  This last bit is always delicately framed in terms such as: " Mrs.
D. was directed back to you for discussion of the use of metaclopramide"  or
"It might be prudent for the baby to receive frequent weight checks at your
office until lactation stabilizes"  or "While good lactation management
should help, I am concerned that we rule out a breast infection, and I have
urged Mrs. D to come to see you as soon as possible to discuss her symptoms
and to allow you to directly visualize her breast."  This way I don't tell
him or her to do anything, I merely describe.  Therefore, I acknowledge my
role as detective and front-line worker, and his/her as supervisor of the
medical aspects.  This makes us colleagues working for the same goal:
resolution of a problem that may undermine breastfeeding.  When we succeed,
the mother views us both as having helped her, and that makes us feel good
about our working relationship.  It makes the doctor feel safe about
trusting me, and it helps me when I am trying to advocate for this and for
future mothers.  If the doctor seems misinformed about something that the
evidence supports, I can fax or mail over an article with a note saying:
"This reminds me of Mrs. S's situation.  What do you think?"

Many times the doctor's nurse is the one telling mothers what to do over the
phone, and the doctor never gets to see the consequences of bad lactation
management (either from the hospt. exper. into early pp, or later when
problems come up).  By taking the time to communicate, and by keeping these
notes short (one-two paragraphs max)  I now find that many of the doctors in
our city are much better educated than previously. Many of them are
adequately managing some types of cases they never used to handle on their
own.  While this may be losing me some business, think of how many more
women this positively impacts?

In Austin, we see tongue-tied babies getting cared for in a routine manner,
galactagogues are easily obtained, mastitis and candidosis are more
appropriately managed, and there is much more trust in using pumped milk
rather than formula as a solution to poor weight gain.  There is also
greater reliance and more trust in LCs.

I wish there was a quick fix, too, and being a bossy woman, I want to go
right in there and shake my finger under people's noses and tell them to
shape up.  But no one has ever thanked me for telling them they were idiots.
What I have learned through sometimes painful experience is that I get a
more positive reception for my information if I take the time to teach a
better way of doing things.  I still believe that most of the bad management
is just because people don't know how to do it right, not because they are
malicious or our enemies. (P.S.  This doesn't include the formula companies.
They really ARE our adveraries.)


Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.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