Dear Dr. Karp,

I find it so flattering that you have taken the time and energy to address concerns presented by my colleagues in such a caring and thorough manner. It is great to know that there are positive books coming onto the market to negate the very often dangerous information emanated to the public.
You also took quite a risk opening these issues up on a forum such as Lactnet!!!

Having produced a booklet for public consumption - for moms, I can appreciate that often what comes out in print isn't always what we intended to portray. And also, that by the time a book gets born, which is probably longer than the gestation period of a human baby, findings and recommendations can change. 

I haven't had the opportunity to see your book, living in the Middle East, but I do have two comments or maybe suggestions for future print.

In your communication you wrote that you begin by stating that the breast is and always has been the #1 pacifier YET, you list a pacifier as number 1 in ways to satisfy baby's sucking needs. When you suggest using "You as a pacifier", this gives the impression once again, that a pacifier is a necessity and is the norm when in fact, pacifiers like bottles are a replacement for Mom. The sucking reflex was created in babies so that they will be able to and want to breastfeed. When mothers chose or failed to breastfeed, there had to be an artificial method to feed babies (bottles and formula instead of breast and breastmilk) and to answer the sucking need (rubber pacifier instead of breast because the bottle does not answer that need). As we are trying to get Moms back to basics in order to succeed to breastfeed, I feel that we also have to try to educate them to understand the physiology and needs of the newborn - which IMHO does not include pacifiers, at least not during the early period of establishing of a successful breastfeeding relationship. The commercial interests have worked over the years to convince moms that pacifiers are part of the facial ornaments,  which a baby (or the parents) cannot live without. Maybe it would read better: 1) the breast and 2) "A pacifier instead of YOU."
 
Regarding bottles: A baby's refusal at anytime, of a bottle, is highly individualized.  Most babies might not encounter any difficulty in combining the two methods - breast and bottle.  However, it isn't always the time factor that determines the babies readiness or willingness to accept a foreign body in its mouth, as in my nearly 20 years of practice I have seen cases where in the early weeks the baby didn't mind, but later on they refused. 

I think I can safely speak for many Consultants who deal with serious problem solving and disasters, that at two weeks or any age before breastfeeding is well established, some babies unequivocally refuse the breast after one solitary bottle.  Once they are fighting the breast, then of course, the SNS at the breast, would not be the remedy of choice as it will most likely fail or cause even more stress at the breast.

Thanks so much for taking the time to include us all.
And thanks so much for investing the time to get some good information out there. I look forward to reading the book soon.

Sincerely,

Ellen Shein, IBCLC,
Tel Aviv, Israel

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