dear all,

as a paraprofessional lactation counselor for a volunteer breastfeeding
advocacy group (and believe me i have good reasons for being slightly vague),
i have had two cases this week that have made me curious about the
information included in the preparation for being an IBCLC LC. i find that a
fairly large and consistent number of mothers who call me have a baby
displaying the symptoms of hypertonicity, or as it is called in the BAB, the
arching baby. the BAB gives an excellent description or this problem, it has
great tips that i find generally work deal with these situations, and it was
only this week that i felt that the baby in question might not be able to
nurse at all, and would some very advanced assistance (an OT, for example, or
an LC with lots of experience in dealing with this).

what i have found quite disturbing about this week's two cases, and have
heard many, many times before, is that both of these mothers were referred to
LCs at the hospitals where they delivered (two separate ones), and both LCs
saw the mother/baby dyad and interviewed them at length and never asked any
questions or interpreted the mother's information as even hinting at this
problem. in the first case, the mother was told by the nursery staff that her
baby was "aggressive," which she felt was derogatory and negative. the lc
that this woman consulted promptly rented her a pump, and asked, and this is
a direct quote from the mother (all right, i know this is hearsay, but . . .)
"would you be satisfied just pumping your milk and giving it to the baby in a
bottle?"

the second mother was also immediately rented a pump, a necessity in this
case, but was not given the larger cups that seemed obviously needed due to
her large breast size. although this baby was considered to be in a serious
decline, and the mother's milk supply had already decreased, there was no
followup at all by the lc, although the mother felt concerned enough by the
situation to make a call to my group.

my point in sharing this rant is NOT to criticize LCs as a group; i have
consulted with two others locally about the second case and was impressed as
usual with their knowledge and concern. i can tell by what i read on lactnet
that so many of the LCs who take the time to post here are doing HEROIC jobs
dealing with many mothers and babies, educating every medical professional
and lay person in a hundred mile, radius, and generally possessing more
knowledge and experience than i could gain in years.

BUT i am wondering why there is such a large gap in knowledge; is the
hypertonic baby and hypertonic bite reflex problem so minor that it isn't
covered very thoroughly in the training others (such as LCs, etc) receive? is
this possibly something that some HCPs don't "believe in" as i have heard
that some HCPs don't believe in nipple confusion? Thinking back to the recent
thread about the inherent conflict of interest problem in LCs renting and
selling pumps and related equipment, my experiences this week have cast a
rather negative light on this practice. and in my humble experience (hey, a
new acronym, IMHE), this is a common reason for problems.

i am happy to add that the more serious case, a two week old baby with severe
difficulty breastfeeding, has made a personal appearance at my house, looked
to be in excellent  condition (due to the EBM), and had made a terrific
comeback by nursing in the morning at home, and then nursing quite well at my
house. all due to the gentle persistence and dogged determination of the
mother, i might add.

please do not interpret my musings about this to be derogatory, i would like
to use these examples as an opportunity to understand what seems to me to be
the parallel universe of those who are truly the professionals at this.

carol brussel