Given the variability in response of women BFAR (and adoptive breastfeeding)
I don't understand the need to give an opinion on a particular mother's
likely outcome and  I have found that beng "realistic" is often an euphemism
for being negative. My preference is to tell women that there is an enormous
variability- no way of telling that they will or will not produce all the
milk their child needs (to start with at least. I also say that all they
need to do is breastfeed for long enough and if their babies demand and
their supply does not match up to start with it will eventually!) but this
is what they can do to give themselves the best chance. Of course you can
add in "this is what we need to do to make sure that your child is OK"
I find that I need to warn adoptive mothers about the negative information
they are likely to come across in books and from others. It's almost as if
the repetition of the 'fact' (ie in this case something not based in
evidence) that producing a full milk supply is rare is  repeated often
enough it will become a reality. I think BFAR mother suffer from a similar
sort of response- almost a form of prejudice.
I'm just about to head away for a week so I'll be interested to hear the
rest of the discussion when I get home.
Karleen Gribble
Australia

  However, I do feel very badly
> indeed when I err in the other direction and a baby ends up in trouble
> because I've been overly optimistic.  It is really, really hard to know
what
> a surgically affected breast is going to do. ...We take our best shots at
trying to be of service in these situations, and
> all of us who have worked with lots of BFAR moms have seen many of them
with
> severe lactational impairment.  So there is a lot of guess work.  I side
> with Diana on the being realistic part, but always try to balance that
with
> encouragement.  And when I'm wrong, I'm glad.

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