I've been quite behind in reading LACTNET, but wanted to respond to
pediatrician Amy who wrote about a mom canceling a prenatal consult with her
because she had decided not to breastfeed her unborn second child after all.
 She wondered how much to pursue the issue with the family and worried that
she risked losing this family from the practice if she pushed too hard.
I, too, have been faced with many similar situations, and the way I deal
with them is still evolving.  I feel very strongly about breastfeeding, and
it is sometimes hard for me to not come across a fanatic.
When I first started in practice, I tried hard to strongly encourage every
pregnant patient I came in contact with to breastfeed.  In an attempt to
encourage, I think I sometimes came across as suggesting that anything short
of what I was promoting was no good at all.  I often put parents on the
defensive, which prevented them from being able to hear me at all.
I try now, to meet folks more where they are at.  And when someone tells me
they have decided not to breastfeed, or to wean early, or whatever, I try to
meet them where they are at, and encourage them to do what they can feel
comfortable with.  I try to present evidence based info, and encourage them
to make their own decisions.  I especially encourage those moms who want to
do only a little breastfeeding, or only pump milk, or only nurse for a short
period of time.  I feel successful if I can encourage a mom to nurse for her
maternity leave only, if she was previously thinking to solely bottle-feed
since she was going back to work.  Sometimes, once these moms start, they
decided that continuing after going back to work will work out after all.
Sometimes they wean early. Same with moms who only want to pump for what
seems to me strange reasons.  I've had a few start off this way, then decide
to put baby to breast.  I've had more pump for a few days, then give up.  I
find if I'm supportive of their decisions to try a little bit, it opens the
door to going further, either with the current babe, or with a subsequent
one.  I find if I'm not as encouraging, or push mom to fully, exclusively
breastfeed, sometimes they think it's not worth trying if they have to do it
some specific way they feel isn't compatible with their lives.  A recent
success story with this is a pregnant mom who could not latch her first baby
due to what she felt were flat nipples.  After seeing her niece successfully
breastfed, she expressed an interest in pumping milk to give her second baby
when.  When she asked if she could just do this and not put the baby to
breast at all, I supported that idea as a possibility, but also mentioned
that maybe there would be some techniques to try to get the new baby to
breast.  She was very frustrated and discouraged the first time around and
was worried about similar feelings this time.  I suggested we try getting
the baby to breast first, maybe try a shield if that didn't work, but keep
the exclusive pumping idea as a backup plan if either the baby wouldn't
latch well, or mom just felt too overwhelmed.  She was relieved to think
there were options.  At her recent birth, she told me she felt no pressure
about being "successful" putting the baby to breast, because she had her own
back-up plans in place.  And lo and behold, the new baby latched happily
with just a few seconds of trying, and nursed like a pro!  Mom's slightly
flat nipples were no problem for this more aggressive baby.  But if the baby
hadn't latched well, mom felt she had support to try what would fit with her
wishes.
I continue to present breastfeeding as the norm, regardless of what choice
the family has made, too.  (For example, when asked when babies should start
solids, I always say "Babies don't need any other food other than
breastmilk, or formula if they are not breastfeeding for the first 6 mos."
even to the formula-feeding parents, so that they hear that breastmilk is a
normal food for infants.  I also use the breastfed infant as the norm when I
talk about infant behavior.  (For example, by encouraging smaller, more
frequent feeds for a bottle-fed newborn, since that is how the breastfed
infant is normally fed.)  I hope that by keeping breastfeeding in the
conversation, it influences folks to view it more normally, and consider it
again with subsequent children.
I try to remember that most women I meet have not had much, or even any,
life experience with normal breastfeeding.  It is almost like suggesting
they learn a foreign language to speak to their children!  If I can make
breastfeeding seem matter of fact, and adaptable to many lifestyles, I have
better luck at encouraging some folks to give it a try at least.  When I
haven't been successful, I try to remember that most likely I am NOT the
most important influence in someone's feeding decisions.  I can only present
the info, and cannot be responsible for what people do with it.  I deal with
it the same way I do any decision a patient makes that I'm not crazy about.
 I don't bring it up every chance I get and browbeat the person, but I do
continue to portray breastfeeding as the norm, and reference it when it is
naturally relevant to the situation.  I have found I have very little
resentment from folks this way, and sometimes even score some converts!
Sorry for the rambling, it's hard to get across what I mean in the e-mail
medium, and I'm also probably too tired to be trying to communicate!
Jennifer Tieman
Family Physician
Mom to 4, including nursling Caroline Rose born 5/31/03

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