Dear all:

I think an important difference in telling women about risk, is to arm them with 
information to do something to either prevent or mitigate the risk.  If they know that they 
are not powerless, it can be very very helpful.  

I always warn mothers about head ramming nurses in the hospitals, explaining that those 
nurses who know the new techniques will not smash their baby's nose into the breast --- 
and that they should seek out those who help them diminish any discomfort they may feel 
rather than platitudes such as "its supposed to hurt".  In this way they may gravitate to 
those health care practitioners in the hospital have that appropriate touch to really get a 
good attachment rather than suffering through with those who have not had adequate 
training.

I cannot tell you how many times I have had to patch up a mother's confidence after 
months of false reassurances from unknowledgeable health care practitioners who kept 
telling her she wasn't doing enough and if she just BELIEVED her milk supply would be 
greater it would be so --- even if she never touched a pump, never took an appropriate 
galactagogue and had a baby completely incapable of swallowing.  Ditto with the 
developmental delays for babies that were borderline gainers.  These are all 
PREVENTABLE conditions if you listen well to moms.

Every single one of the mothers I saw who had insufficient glandular tissue were really 
pissed off at other health care practitioners who didn't tell them straight up what was 
going on.  Some of them struggled for months thinking they were not doing enough while 
they were doing triple duty with tubes, pumping, feeding every 1-1/2 to 2 hours.... 
thinking some magic would occur if they were only more relaxed, more diligent, more 
something....

AND they were incredibly relieved when they were told that they had an anatomical or 
endocrinological condition that they were not at fault for having.  Then we could move on 
to a more sensible plan that took into account their own particular situation instead of 
feeling completely inadequate. 

And yes, I do modulate my treatment when I see a woman has particular conditions that 
may limit supply.  I find that really listening to moms prevents what I call the syndrome, 
"if it's not perfect, I'm giving up".  And more than anyone, women who have some 
conditions that prevents a 100% supply need empathy to help them mourn the loss of 
perfect.  I actually think that NOT listening to mothers about their perceptions of supply is 
what kills breastfeeding.  Listening empathetically to the perceived and/or real barriers 
and removing the obstructions in an empathetic manner keeps them going longer.

I've clearly had to mop up after too many of these situations.  It is heartbreaking to me 
that they could have been at a more optimal supply or a more optimal emotional state 
had someone recognized their conditions far sooner in the process.

Best, Susan

PS, I really HATE pracitioners who don't tell me full information myself.  I remember 
every single incident with a health care practitioner that withheld information from me, 
including the breast surgeon who didn't give me the choice of whether my fibroadenoma 
would be biopsied with a simple incision at the cite or a so-called more aethetic 
periaerolar incision.  I had one health care practitioner turn purple in the face when I 
asked him for real scientific information about malarial prophylaxis instead of his 
"opinion-based" letter to the editor of the NY Times on the topic.  The medication he 
wanted to withhold from me based solely on his opinion, not any hard-core research, 
actually was a better prophylaxis for me in the country I was visiting.  But, I was merely 
a patient who couldn't be trusted with scientific information.  He was horrified that I 
asked for a peer-reviewed paper on the topic.

             ***********************************************

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