In a message dated 2/19/2004 8:10:14 AM Eastern Standard Time, [log in to unmask] writes:

> Because nursing is more than the milk.  The focus for some mothers is not the
> amount of milk produced but the intimacy of the breastfeeding itself.  How
> many mothers have we worked with who will not make milk, but nurse after every
> bottle or nurse with a sns/lactaid because it is the 
> nursing that matters to
> them.  


This discussion seems to have deviated and become a comparing of apples and oranges. When I suggested "why continue for an hour," the context was in reference to the baby who was ineffectively BF and therefore unable to remove milk well enough, so production was being negatively affected. Then the choice for the mother became one re: developing a " care plan" (or anything anyone wants to call it) that would increase production so baby/babies received more or all EBM vs. ABM while baby/babies learned to effectively BF or spend lots of "ineffective BF" time at breast, let production drop (or not increase) and offer more ABM. "Practice" BF may be brief or longer depending on baby's/babies' progress or other needs, including pumping. And the plan would encourage kangarooing as possible. 

I'm certainly not in disagreement re: BF as more than food and also a part of parenting. One of the benefits I've seen with what I wrote earlier is that more mothers seem to stick with it, so BF in all its contexts seems to last longer and baby/babies enjoy its nutritive and parenting aspects longer.

I was not trying to suggest a "one size fits all." There are all kinds of roads to get where a mom (and baby/babies) want to go, but getting there with more EBM vs. more ABM complement/supplement is often the mother's big choice. If after reviewing possible options, a mother said she preferred to stick to more "at breast," even if BF was still ineffective at some level, I'd briefly review benefit-risk re: production, ABM supplement and say go for it. If she said she'd rather make more milk, we'd try to develop a plan together that she believes can preserve her sanity while pumping, doing "practice" BF, and kangarooing -- revising as baby/babies progress and/or her body responds (or doesn't) to pumping. Exploring options for some household help would also be part of the dialogue. 

No argument from me re: any BF dyad, triad, quadrad, etc. situation requires assessment of the individuals within it. Any care planning requires discussing all options that may work for a given mother and her baby/babies before arriving at a plan that is developed mutually and that the mother believes she can stick to for at least a few days before reassessing. (And if she finds she can't stick to it earlier, that's OK too and revision is done earlier.) 

I passionately believe in solution-oriented techniques. Among these are the concepts that care plan choices are always the mother's (client's) to make, and if a LC or other BF support person insists on something that doesn't fit a mother's life (after possible explaining rationale, reframing, clarifying, etc.) she'll start telling us only what we want to hear, quit contacting us, give up without getting in touch, or keep trying to find someone who will work with her to develop a doable plan. As a LC or LLLL, I simply offer an understanding of the anatomy and physiology of BF, options that may "fit" her situation (with thorough rationale provided for informed decision making), and a depth re: implications of various options -- both the ones we suggest and her own (again with thorough rationale). And I try to keep learning and working on evidence-based practice that lets go of "but I've always done it this way."

I'm deeply sorry if in trying to be concise in previous related posts, I gave an impression that I believe otherwise.

Karen G.