I think it's great that there are so many new "political pressures" on maternity hospitals and employers and other entities to change conditions to further support successful breastfeeding.

However, there is another side to the same coin still requiring much more focus and effort, at least in the USA. In my contact with WIC mothers, I continue to see the strong drop-off of exclusive breastfeeding by the end of the first two weeks that so often reduces rates of breastfeeding continuation. This is certainly not all due to easy availability of formula. Perinatal breast edema continues to be a huge elephant in that living room. Both the effects of copious intravenous fluids and injudicious pumping on intrapartum nipple-areolar edema need to be explored more fully.

These iatrogenic problems still need much further recognition by the caregivers who contribute to them, and the caregivers who contend with the resulting effect on infants and mothers. I want to encourage further research to engage the attention of physicians, nurses, LC's and others caring for mothers in the intrapartum and postpartum periods. So I recently wrote a letter to the editor of Pediatrics.

  http://pediatrics.aappublications.org/content/127/6/1177/reply

I still sometimes feel like the little kid in the fairy tale who cried out "But the emperor has no clothes!"

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH

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