Kathy D.  I agree in principle with your rant.  I, too, feel as if
breastfeeding has such importance to the child and the mother that all care
should be taken by all parties to protect it.  This why I still maintain a
private practice.  I see a small sub-set of women who are seriously
challenged to breastfeed, sometimes for reasons that aren't always exactly
clear.  What you say about infertility is prob. true.  But,  the infertility
pts that I see are having trouble with bfg, so it stands to reason they are
skewed in favor of belonging to the hormonally challenged.

 It's not always hormones related specifically to infertility.  I saw TWO
women today with Pregnancy Induced Hypertension --  a condition that often
(in my experience) produces delays in the onset of copious production.  I
photographed one's ankles because they were so strikingly swollen.  One
mother was Day 5, one on Day 6 pp. neither with any milk.  One mom had, in
addition to the  PIH, gest. diabetes, a hx of low thyroid, and really
unusual looking breasts.  Both moms had the wide span between breasts and
the hypoplastic, soft tissue that often accompanies low lactation
performance.  Neither had fertility probs. I  immed. instituted measures to
protect their maximum performance, but had to make some difficult
suggestions about feeding the babies in the meantime until the milk shows
up.  The one with the PIH diabetes and thyroid has a baby down 12.5% of
birth weight on Day 5 with no output in 24 hrs.  We got  less than 1 ml from
pump and nothing from hand expression.  I finger fed 1 oz and then put
formula in an SNS and we delivered it at breast. Baby took a little more and
checked out.  I'm hoping we can bring the milk in. But what I WANT and what
there IS to work with often are pretty far apart in these cases.  With luck
and persistence, often things turn out well, but "well" can be a relative
term.

When talking with the sicker of the two moms, she asked if I thought she
would be able to fully produce for her baby.  I told her I hoped so, and
that that was the end toward which I'd apply my best efforts, along with
hers.
She told me she knew a partial exper. would be beneficial, but she could see
why people were tempted to give up, because the partial breastfeeding would
be a constant reminder that it didn't work out as planned.  I pointed out
that by this reasoning you'd be forced to eat fast food every meal forever
if you were only able to home cook 2 meals a day.  A sane person realizes
keeping those two home cooked meals in the diet is great!  But new moms are
so emotional, and the disappointment of having bfg turn out to be difficult
and scary and not to work just makes a lot of them crazy.  The counseling is
why LC work is so time consuming.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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