Much of the so-called discussion that has been going on re: Code and related
violations, advertising, updating, etc. exemplifies the reasons I rarely
choose to post on this forum any more. A lack of respect for others (much
less for other points of view) and their level of intelligence, the use of
patronizing to snide to judging tones in some posts, the taking of info out
of context, the turning of apples into oranges, the trivializing of
another's experiences, etc. seems to be contradictory to a true learning
and/or empowering environment. (And, yes, I understand that this forum
allows only for written/verbal communication, which means that the most
important, the nonverbal, aspects are missing.)
We all bring different personal gifts, education and experiences to this and
any other forum. We all are at a different point on the learning continuum
-- and there is always more to learn. While some seem able to view
certain/some/all issues in a "black vs. white" sort of way, others see
shades of gray even when they'd like to be able to categorize. If we can't
accept each other's differences or where each of us is on that continuum at
this moment in time or if we become smug/stuck in our positions, I wonder
just how accepting we appear to be to the mothers and babies we're supposed
to be helping with breastfeeding and lactation-related issues or problems.
Many of us are working with breastfeeding dyads who are NOT the norm -- baby
has a transient or an ongoing feeding difficulty for one or more reasons,
mom has a physical or emotional-behavioral condition that interferes with
lactation, both may be dealing with cultural issues that leave them
(currently) in the a different place than others -- and the Code doesn't
cover those. Personally, I want all babies to have as much breastfeeding as
the particular mom and baby can do together because process (how fed)
matters as much or more than product (what fed). Barring less than exclusive
BF, I want babies to have their moms' own milk as much as possible.  No
matter how fed, I believe all infants deserve airway protection during
feeding, which is more likely to be compromised with bottle-feeding (even if
EBM) but doesn't have to be...

Not all mothers choose what I would choose (or think I would choose) if in
their situations, including alternative feeding method(s). Not all/many get
the support they need during a period of extreme stress from other health
professionals, family, friends, etc. to choose something I might choose.
And, many of the alternative feeding device options I think I would choose
are not really evidence-based options in terms of long-term breastfeeding
outcomes -- or the evidence indicates they have as many disadvantages as
advantages. (And often I learn there is so much more to a mother's story
than the bit I've been aware of -- and I'm so often in awe of today's
mothers and what they will go through to do their best by their babies.) So
if it currently isn't possible for a baby to transfer enough milk at breast
or mother isn't producing enough milk -- for whatever reasons -- another
feeding method is going to be part of the mix and for many that is
bottle-feeding whether I like it or not. Often to preserve the possibility
of breastfeeding now or in the future -- whether I think the reason is/is
not valid, I find I need to accept short- or longer-term/a little to a lot
of bottle-feeding as part of this dyad's breastfeeding experience.

Because of this I need to know more about bottle-feeding and the effect of
different kinds or types of related equipment if I am to help preserve (or
preserve the potential for) a long-term breastfeeding relationship. Are some
brands better at preserving BF; do some allow for oral behaviors more
compatible with the transition to or the going back-and-forth with
breastfeeding? Would manufacturers of such products be interested in
developing a product that allows for these oral behaviors -- or are they
only interested in products that force maladaptive oral behaviors (by
threatening the infant airway/breathing) because such behaviors conflict
with those of breastfeeding so they'd sell less product? Maybe you don't
need this info where you are or with whom you work, but I do, at least as of
now, related to where I am (on my continuum) and with whom I work.

I realize the Code is about the normal newborn and infant, but Code
discussion has created an environment that makes it difficult to have a
dialogue with one another about those dyads that are outside the norm as
well as those who have chosen some "relief" (hate that term) or
supplementary feedings for other reasons (that are not mine to judge) and in
spite of informed consent about risks. It has created an environment that
makes me hesitant about seeking information about bottle-feeding products
directly from the source/manufacturers -- and it has made me hesitant to
share what I've learned about feeding-bottle flow rate with such companies
in spite of believing babies deserve better (airway-protecting)
bottle-feeding products. This has become a highly charged issue that seems
to provoke judgements.

If I am to be an advocate for both preserving and increasing the amount of
breastfeeding (up to exclusive ASAP) for the non-norm dyads, I need to know
more about all kinds of devices for professional practices vs. personal
interest or use. It means I have to leave personal prejudices, biases,
preferences, etc. about all types of alternative feeding devices out of the
equation and seek evidence. It means I'd like to talk to these companies,
perhaps at conferences or wherever -- not necessarily as exhibitors who are
marketing their products -- but in a venue that allows for info sharing on
all sides. At least I could expect the support of colleagues who realize I'm
doing my best in a "gray" situation, although I may apply the info to
situations when it seems less gray yet a mother makes a choice different
than my own and I believe I'm sharing info more likely to preserve as much
BF for this baby (and mother) under the circumstances.

I want every mother (or all those capable) to choose exclusive and direct
breastfeeding for at least the first six months with continued breastfeeding
with child-led weaning. When that is not going to happen, I want every baby
to get as much direct breastfeeding, followed by as much mother's own milk,
as possible for as long as possible. Sometimes I feel a pull between my head
and my heart re: exclusive breastfeeding with the notion that many seem to
have explicitly or implicitly given or received re: breastfeeding as
something that is "all or nothing" vs. the notion that some breastfeeding
and/or some mother's milk sure beats no breastfeeding and/or no mother's
milk. I'm often very confused re: how this fits with the Code in a
meaningful way. Just as I am getting exhausted by proponents of the "one
size fits all" messages about where young infants should sleep (in spite of
evidence) because it insults women/mothers in all populations and their
ability to weigh info and make good decisions, I'm becoming exhausted by
those who seem to be proponents of a "one size fits all" re: Code issues.

Maybe I just don't get it, but please don't insult, patronize, show
disrespect, misinterpret my meaning here, etc. That really won't help me
learn...

Thanks.

Karen Gromada

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