First to introduce myself:  I am a nurse (& Army spouse) volunteering for
Army Community Service (ACS) in Yongsan, Korea.  I have 4 children and
successfully breastfeed the last 2.  My youngest is 5yo.  I have taken the
LLLI Breastfeeding Peer Counselor Administrative Training course and help
with our Peer Counselor program here.  I also teach childbirth classes with
another volunteer RN.  She also took the PC Admin training.

Basically there are no IBCLC's here in South Korea that we know of.
Certainly none for our military community.  When Marilyn and I arrived there
*was* no breastfeeding program.  The LC that they had, left as I arrived.
(My husband took over her husband's job and we live in the same quarters and
have the same phone #.)  There was a breastfeeding support group, though.
Now, we have several nurses in our WICU (women, infant, child unit) and the
Peds clinic head nurse who have taken the PC training, as well as several
breastfeeding moms.  Our Peds docs come and go each year.  But basically I
can say that they are overall supportive.  In fact, the docs have asked us
to come in each week and talk with the breastfeeding moms at the 1 week
checkup.  So we end up being another box to check off on their form, so to
speak .  All in all, we are developing a breastfeeding aware community,
slowly but surely.

My question has to do with a family Marilyn and I saw yesterday in the Peds
clinic.  In this family the father is American Caucasian, the mother is
non-English speaking Korean.  According to the father they were given
formula to supplement with in the WICU because the mother "didn't have any
milk".  They had continued to supplement, breastfeeding 5-6 times per day.
They came to us with questions about how to only breastfeed and wondering
why she did not produce "enough" milk.  After a 45 minute visit, observing
and correcting latch and position, extensive education -- they expressed the
desire to "switch" to breastfeeding only.  We counseled them that it might
take 24-48 hours to increase supply to meet demand and told them about the
need to breastfeed as often as possible.  We went over signs of adequate
intake and good feed.

This morning the father called and states that he is worried because the
baby hasn't had a BM since the office visit yesterday afternoon.  5 wet
disposable diapers, but no BM.  He is also worried because the baby nurses
for about a half hour (total) and sleeps for approx. 10 minutes before
crying.  Then they have been nursing again and he sleeps again for 10
minutes.  At the clinic the baby nursed well -- good latch, sucking,
pausing, swallowing.  The father states that the mother is not drinking
"enough", that she won't listen to him, that there is a communication
problem.  He states that he "kicked her mom out" of the house last week
because he was tired of the smell of the seaweed soup that his MIL made for
his wife. (This is a part of the Korean culture for new moms.)  My point in
mentioning this is that there are MANY problems going on here.... not all
breastfeeding problems, but certainly ones that impact the breastfeeding
situation.

The father stated that he called the WICU after he called me this morning
and they told him to just keep monitoring the baby's pees and poops and call
them in the A.M. if no BM by then.  With the father's permission I called
our program director who is Korean and is also a PC Administrator and she
called and talked with the mother.  The mother told her that the baby had a
small BM last night and that she herself was drinking "enough", but she also
didn't feel that the baby was getting "enough".

The father states that he is going to supplement with formula later this
afternoon.  He says they haven't given formula since before the clinic
appointment yesterday.  He is not interested in fingerfeeding or SNS.... he
just wants to give a bottle.  My impression is that he wants a baby that
will eat, sleep for several hours and then eat again and that is what the
baby was doing on formula.  Argghhh!!!   Oh, I forgot to mention that the
dad was worried about the BMs at the clinic appointment and the Ped MD had
the baby x-rayed (no obstruction or stool in intestine, according to what
the dad said today).

So at this point I have to back off and let my program director handle
it.... but we are all still curious... how long can we wait for a BM before
we need to get worried and supplement with formula?  I couldn't find any
time period in the BAB or the "Breastfeeding and Human Lactation" textbook.

Finally, I'd like to emphasize that there are no *experts* here to consult
with.  Marilyn and I are basically it for those with *any* breastfeeding or
counseling experience.  Thanks in advance for any help.

Regards,

Cindi Swisher, RN
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