I don't mean to be a devil's advocate here, and I may have a different take on some of this because I mainly deal with mothers of multiples, many/most of whom experience glitches in initiation and many of whom complement or supplement BF initially or later because of such. If the MOT/MOM is in contact with an understanding BF resource post-discharge, I see a tremendous number (most) do really well combining breast and bottle. In fact, if duration depended on initiation, I'd rarely know a MOT/MOM who BF for any length of time. The number of employed mothers who continue to BF although babies get bottles when mom is gone is another example. ("Bottle" to me doesn't equate to AIM/ABM or whatever term is currently used. It often refers to human-milk-fed via bottle, so I tend to distinguish human-milk-fed and formula-fed vs. bottle fed.)

When I was a hospital LC, I couldn't force a mother's level of commitment or make her create a post-discharge BF resource system for herself, but I could highly encourage it by singling out the list of resources from the rest of the pile of junk she was about to take home from the hospital and ensuring she understood what the list represented. (The amount of info/junk sent home with already overwhelmed new mothers who often cannot figure out what is important for the next few days vs. what can wait is a whole other topic!) As a community LC I can't force someone who contacts me to fully BF, which research indicates is associated with longer duration. But if a mother plans to combine breast and bottle (with EBM or AIM), I can help the mother intro bottle-feeding behaviors that are more compatible with maintaining lactation and long-term BF.

I wish all mothers who initiate BF planned and achieved full/exclusive BF, and it's definitely something I advocate, but I think we let a significant number of mothers (and then babies) down when we don't provide the tools needed to do both when mothers send clear messages that this is the option they plan to implement--whether their particular plan is realistic for maintaining lactation/BF or not. Too often I hear from mothers who have gotten the idea that BF is always "all or nothing." Personally, I'm for "something is better than nothing --if you're about to choose nothing" and I'm comfortable now with related tools, techniques, whatever.

(Hope the above makes sense and isn't misinterpreted...)

Karen

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