This is a many-faceted problem. I have a few comments.

I don't teach bottle feeding or pumping in my antenatal bf class. Because
my population has about a 50% initiation rate (any bf), most of these do
partial bf, many of these abandon bf in hospital or shortly thereafter.
Therefore my focus in class is on the early days of breastfeeding,
exclusive bf, how to get help, biological nurturing video.

If a mother asks a question about pumps or pumping, I will answer it
briefly and ask her to contact our BF Center again when she gets closer to
the point of needing to pump. I have some resources she can refer to.  I
don't think I've ever gotten a question about how to bottle feed but rather
what is the best bottle. Again I would answer that briefly (I don't believe
there is one best bottle, of course), give resources, and again we can help
her with that as time for work gets nearer.

As for teaching formula feeding properly, there is a huge need for this, in
my opinion. I just saw a young lady for a followup bf visit. This was an 18
yr old mother who had abandoned bf (temporarily I hope) but was pumping
occasionally (very small baby was losing weight) and said the baby was
rejecting the ebm but taking the formula. In my office she repeatedly
refused to allow me to see her breasts (possibly low supply) or help her
bf, and she fixed the baby a bottle by scooping some formula powder rather
haphazardly out of the tin, and dumping it into a baby bottle of water she
had in her purse, and shaking it up and feeding it to baby. She believed
she was measuring it. As you can see this was a mother who needed much
empathy, support, information, and more followup. (Myself and the WIC bf
specialist were following her already). Of course I instructed her on the
proper way of preparing and storing the formula.
By the way, I have seen many many mothers out and about who prepare a
feeding bottle this way.

In the hospital, ready to feed bottles are used. Then a tin of powdered
formula is sent home but no teaching is done that I am aware of. Even
though I am the bf specialist, I have brought this problem up to the mgmt
and nsy staff several times. There is a section in the baby care book that
mothers are given about formula prep.

 I know that WIC requires certain classes or educational sessions of its
clients. I fear many of these are cursory. I am sure there are some
trainers doing an outstanding job but I fear there are many just giving it
lip service. WIC (Women, Infants, Children) is a federal nutrition program
for low income families in USA.

I don't have the answers but the debate should continue.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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