Dear Kathleen:

Look out, I'm mounting my soapbox -- Harumpffff.

I would probably start first with the ADA position paper on Breastfeeding
that was in the April 1993 ADA Journal. It is quite good and well-documented.
  Then there is the AAP position paper on Breastfeeding, Marsha Walker's
Fresh Look at the Hazards of Formula Feeding  (the actual title may be a
little different) and the Institute of Medicine's Nutrition in Pregnancy and
Lactation.

Dietitians are supposed to base their practice on research.  I would ask her
to provide the research that backs up her position.  Do you have Maureen
Minchen's article on Formula Feeding: a Mass Uncontrolled Experiment (I think
it was from Brith).  The Allan Cunningham Bibliographies (I think they are
available form ILCA) are also a good source (He also published an article in
Pediatrics about 2-3 years ago on epidemiology & BF).

You might ask her under which circumstances she recommends processed foods
 as identical replacements for whole, natural foods (why or why not) to her
other patients.   I also would ask her for studies to show that lack of DHA
in formula  is of no consequence (there have been several articles in the ADA
journal and others about the importance of DHA on brain development--I think
Wyeth did a whole supplement to one of the Pediatrics journals on it).  There
is no formula right now that provides DHA.  (DHA is a long chain
polyunsaturated omega-3 fatty acid).

I happen to think that Teenagers should not get pregnant if they are not
planning to eat a nutritious diet.  I do not advocate they terminate the
pregnancy if they do not eat well......., I try to teach good eating habits
and often they are receptive.  Personally I am not in favor of sacrificing
either the mother's health OR that of the baby.  In my experience, if a teen
mother wants to breastfeed, she is more likely to be open to eating better,
especially if you tell it what is in it for HER (nice skin, pretty hair,
healthy baby, flatter tummy, decreased risk of pre-menopausal breast cancer,
less butt fat,  fewer dishes to do, etc.)

In defense of dietitians, many receive the same educational message as the
one you wrote about.  I did too.  Many educational programs use formula
company freebies to teach infant nutrition (who is surprised????), so the
message given is muddled.  It would be great if each of us could educate all
the different allied health professionals about breastfeeding.  What a
difference we could all make.

Perhaps your RD needs to belong to the Perinatal Nutrition Dietetic Practice
Group.  It is a young practice group (the newsletter editor belongs to
LactNet!!--I'll let her respond on her own).  I submitted (and understand it
will be published in the fall) an article to the Nutrition Education for the
Public Practic Group on Breastfeeding education tips (for parent classes), so
she might get that, if she belongs.  (Maybe she does not belong to ADA.)  A
lot of dietitians who are breastfeeding advocates do NOT belong to ADA.)

You also might want to enlist the aid of WIC dietitians in your area.  If
they are telling the mothers one thing and she is saying something else, the
patient will be confused.  She might be more inclined to  listen to other
dietitians.

Sounds like she perceives breastfeeding as a WIN-LOSE proposition--the baby
wins at the expense of the mother OR the mother "wins" by formula feeding and
the baby "loses" the benefits.  The obvious solution is to think of BF as
WIN-WIN.  It is an opportunity to educate mother who may be in a much more
receptive frame of mind (but this does not make it OK to lie to her by saying
her milk won't be good unless she eats thus and such....) and, of course,
baby gets all the benefits of breastfeeding.  With all the running around
these mothers do, their babies will be exposed to a lot of children and germs
(I call it the "disease of the week club".)  Healthier babies mean fewer
sleepless nights.

Good luck!!  I spoke to our local dietetic group about "Breastfeeding in a
bottle feeding world" and opened a lot of eyes (especially with that Indian
mother slide).

Air....Air...  the air is thin up on this soapbox in particular--or maybe it
is my new advanced age as of Midnight - YIKES.

Queen Martha (See--I told you there was a dreadful case of factophobia going
around.... but actually it is probably a case of psychosclerosis--hardening
of the attitudes)