>4. Questions for discussion
>What "safety net" is in place in your community to identify and assist
mothers who are at risk >for inadequate milk production?  Or, how will your
clinical or community practice change in
>light of this study?

Wonderful article!  Great photos!  The term "safety net" got me to thinking
about how many safety nets are required here.  We need a safety net for the
baby, one for the mother, and one for breastfeeding in general.  If I were
to share this article with most of the medical community in my area, I'd be
punching a hole in the safety net for breastfeeding in general.
Practitioners are eager for "markers", for black and white, for protocols,
for easy knowledge.  And I could see OBs smugly pronouncing to an expectant
mother that she "probably won't be able to" nurse her baby and discouraging
her from starting.  Babies would all be adequately fed.  But breastfeeding
rates would drop.  I think our medical community would *love* to have some
guidelines as to who's going to produce milk and who isn't... and so I'm not
sure they should have them.  Our breastfeeding safety net is only fair as it
is.

Here in my town, babies are currently pretty well supported.  I do see
babies at 6 weeks who are still at their birthweight (they sure could be
getting to me faster!) but very, very rarely have I seen a baby in imminent
danger of dehydration or starvation.  So I'm disinclined to tamper with the
baby safety net.   It's not perfect, but it will take long years to improve
it, and putting this article into unskilled and unsupportive hands could
cause the majority to suffer greatly for a minor improvement in the very
few.

The mothers also need a safety net - the kind of gentle, informed, watchful
support that Kathleen Huggins and Barbara Wilson-Clay obviously provide.
LCs like them understand how to support a mother in breastfeeding *to the
best of her ability.*  They understand the gray area.  As to our community's
typical OBs and pediatricians:  I shudder to think of the kind of support
they'd offer a "marked" woman.

I once taught at a nature center.  I was slated to teach environmental
interrelationships to a middle school group, but when they came, their
teacher looked thoughtfully at our great horned owl and asked me, "Now, is
an owl a bird?  Or is it an animal?"  I scrapped the high-falutin' talk and
we spent the morning talking about animal groups and their characteristics.
Maybe as a result of that day, when our sons were little, I'd point out owl
birds and duck birds and cardinal birds, helping them understand the gross
category of bird and what all birds have in common before I paid too much
attention to individual species.  Walk before you run.

I feel sort of that way about this article.  I'll share it with the other LC
and the experienced LLL Leaders in town; it's good information for us
(though I will still consider a mom's potential to be normal until proven
otherwise, and try very hard not to let myself prejudge).  But I think the
article's content is higher-level knowledge that's inappropriate for most
health care providers around here until they're good at providing sensible,
enthusiastic breastfeeding support across the board.  I think they need to
understand down to their toes that any woman with a breast *can*, provided
one includes gray areas under the word "can", that's it's an issue of
lifelong physical and psychological importance to mother and baby,  and that
there's knowledgeable help available when something seems amiss.  Otherwise
- at least in this corner of the world - any of the three safety nets can
suffer bigger holes than they already have.

Diane Wiessinger, MS, IBCLC  Ithaca, NY

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