Barbara is right. Increasing Initiation rates is only half the battle. We
need to work on bf duration, and of course, exclusive bf. I am pretty
accurate at predicting which moms will d/c bf early, some even before they
ever leave the hospital. I think most LCs who have been practicing awhile
can do this. This would be a hypothesis I guess. I think High risk moms are
"c/s moms" who rarely, if ever, bf in the delivery or recovery room, and
usually do not bf the first evening/nite. Also mothers who have (what to us
would be) minor bf challenges, but who have formula fed previous babies.
Mothers who ask me "what if I just don't like it, how do I dry up the milk?"
after the first feeding. Mothers who consistently give supplemental bottles
even after good feeds with info/support to exclusively bf. This sounds like
I'm being judgemental but most of these situations have a lot to do with
institutional barriers. My quandary is that even though I can identify that
these moms are high risk for weaning, how exactly do I intervene to prevent
this? Obviously I am constantly trying to change the hospital culture to be
baby friendly and to refer to LLL (the population of moms I work with and
the docs and nurses are resistant to this). But until that happens, what can
we do for the moms to keep them going?

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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