>I stand by my belief that a lot of early instruction for bfg. is not geared
toward where mothers are physiologically or psychologically.  I think just
brief sound bites of praise and encouragement from everybody from the doctor
down to the janitor would be useful, and each nurse should know asymmetric
latch and just help gently.  It would be wonderful if there could be some
community based support so that when moms suddenly come to (on the day they
get engorged and are hitting peak nipple sensitivity) they could get some
skilled help in their homes or a near-by clinic.<

I totally agree Barbara about the length and content of intervention
sounding like too much.  I just worry that this study is going to do serious
damage to our messages.  I guess what we need are other studies of a
positioning and attachment intervention -- only one I know of is Righarde
and Alade (also full of questions for me).

On your last point -- sadly here in the UK we *have* a system of home
visiting by community midwives until day 10 (ish) and community baby clinics
with universal allocation to a health visitor -- but this does not mean mums
aget skilled help.  Indeed, it means that we are always saying 'we need to
improve HV eduation on bf' without stopping to think whether HVs, with their
history in public health and surveillance and hands off (they are nurses but
don't touch anything) are really the people to go to......it sounds as if
you could teach them hands off bf support, but I am coming to the conclusion
that they really cannot take bf on board in their professional repertoire.
There is an interesting study from Sweden on health visitors there -- and
remember official stats of ebf over 90% at 2 months -- saying health
visitors are poorly equipped to support bf........

Magda Sachs
Breastfeeding Supporter, BfN, UK

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