This is perhaps more of a philosophical question than one about a specific
case, although a recent case brought the issue to mind.

I have been following a lovely little girl who is now 2 mos old.  She was
born at 37 weeks (mom went into labor spontaneously) by normal vaginal
delivery, there were no interventions other than IV antibiotics for group B
strep prophylaxis (no pitocin, no pain medication, unassisted vaginal
birth.)  Baby was decent size for her gestation (3150 gms) and seemed to
feed well from birth.  The mom was on the fence about exclusive
breastfeeding from the start.  By her choice, she started supplementing with
1 4 oz bottle of AIM most days of the week by about 2-3 weeks of age.  At
about 4 weeks of age, the baby stopped having daily stools, and since then
has gone as much as 1 week between stools.  She is otherwise happy and
content and does not appear fussy.  In preparation for returning to work in
2 weeks, mom is now giving 2 4 oz bottles of AIM a day and pumping and
storing her milk at those feeding times (she didn't get this idea from me -
I have encouraged and encouraged her to feed the baby directly while she is
home and able, but she feels better getting baby "used to a schedule" before
she goes back to work)  This baby has always been a slow gainer, at 2 mos,
she weighs about 4350 gms, for an average weight gain of just under 20 gms a
day.  She is otherwise healthy, happy, meeting developmental milestones, and
does not appear thin.  Frankly, there is probably nothing wrong with this
baby at all, other than her petite nature (her mom is also quite petite.)
In counseling this mom, though, I have repeatedly run up against this
reluctance to offer to feed the baby unless she is sure the baby is hungry.
 In keeping a diary for me, I found that she is averaging 7-8 feeds in 24
hours, and she isn't generally sticking to a set schedule, but she talks
about how the baby will frequently fuss an hour after a feeding, but if she
walks or bounces the baby she will go to sleep.  I ask if baby will nurse at
those times if offered, and mom says she will, but often goes to sleep after
just a few minutes.  I suggeted she offer to nurse her at those times a s a
way to boost her intake since the mom is concerned about her slow growth,
but the mom is worried about offering to feed her if she isn't really hungry.  

I think she is going to try this anyway, but the whole situation got me
thinking.  This mom has the perception that breastfeeding is about FOOD. 
And that baby should be offered FOOD when she is hungry, and OTHER THINGS
when she is not.  The perception is sort of foreign to me as I have thought
of breastfeeding my own children as a way of mothering them, and would offer
to nurse in the early months for basically everything (except poopy diapers)
that might be causing my babies to fuss.  I couldn't have told someone how
often my babies nursed, or at what times, because I really had no idea. 
Sometimes they probably nursed 20 or more times in 24 hours.  Once, out of
curiousity when my last babe was about 2 mos, I tried to keep track - but I
couldn't even make myself remember to look at the clock.  This little one is
still happily nursing at almost 3, despite my crazy job and frequent
separations.  Her beloved "nursie" is still her favorite comfort and clearly
provides such a nice way to center herself and then go back to being a
confident and competent big girl when she is feeling little and needy.

I find that frequently moms who have the attitude that breastfeeding is only
about food have a harder time continuing long term, and struggle more with
supply.  Yet, I have a hard time communicating to moms how to go about using
breastfeeding as a mothering technique, or why it might be desirable.

Reading Esther's description of the babies she sees who are separated from
mom after birth and given AIM due to not breastfeeding well was a "light
bulb" type of moment for me.  What a wonderful description and
interpretation of babies' message to us.  I'm hoping using her description
will help me in informing parents and provide similar light bulb moments for
them.  I'm wondering if any has a "light bulb" description or even a handout
or something to help me with communicating this to moms and families.

Jennifer Tieman
Family Physician
Mom to 4, including my nursling Caroline Rose, age 32 mos.

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