Morning all,

This post is finally provoked in response to Kathleen's post about the twin 
mom and the difficulty she is having in building up her milk supply to meet 
the needs of two babies.  Kathleen wrote, ". It's a balance between sleep, 
enjoying her babies, and trying to build supply. She doesn't have a lot 
left to do more...."  But it's really only an extension of recent posts 
outlining some of the frustrations of LC practice, culminating in the wise 
response that we probably need to take with a small pinch of salt some of 
the things that mothers tell us about the advice they have previously 
received from other LCs, nurses, doctors, etc.  So I'm connecting a few 
dots this morning to find a common theme.

It struck me that the central frustration of lactation consulting that we 
struggle with day after day (whether we're helping a mom with sore nipples 
or not enough milk or returning to work or whatever), is the priority which 
the mother places on her baby's need for her milk.  And from there, the 
effort she needs to make to work around the difficulties to keep 
breastfeeding.  When a baby's need for breastmilk is presented as being in 
competition with a mother's need for sleep, or a mother's need for freedom 
from pain, or any other reason, but especially when it is portrayed as a 
competing need for her enjoyment of the baby (ie if she breastfeeds less, 
or not at all, she will be able to enjoy her baby more) I wonder how we, as 
LCs, can possibly "support" the mother *and*, at the same time, protect the 
baby?

What frustrates me is the obligation we seem to have to endorse ("accept") 
that somehow the *other* priority should always be placed first.   I'm not 
saying that mothers with sore nipples should be forced to breastfeed.  But 
it is almost always possible for the baby to keep receiving breastmilk even 
if a) there is a physical reason why the baby cannot breastfeed, or b) the 
mother cannot put the baby to the breast, for whatever reason (physical or 
mental pain, separation, inverted nipples etc).  There are breast pumps, 
and when they fail there is hand-expression.  With the exception of mothers 
who deliver but simply don't lactate (1 in 1000 in my experience) there is 
*always* a way for the baby to receive the breastmilk - preferably at 
breast, but when that is not possible, a way can be found!

What I'm wondering is how we, as LCs, help mothers to set priorities.  Do 
we "meet the mother where she's at", sympathise with her lack of sleep/time 
for herself/her husband/you name it, and "support" her to go on feeding her 
babies formula because providing them with breastmilk seems too hard?  Or 
do we focus on the baby's vulnerability and real need for her milk and 
outline clearly whatever effort she needs to make to provide it?  I'd 
really like to know how others handle this.  I think this is at the core of 
LC practice.  And I think it creates a conflict of interest for us, as 
LCs.  When we are too afraid of alienating the mother (or our colleagues) 
to be able to speak for the baby, then we cannot be very effective. This is 
not a criticism, I've recently "supported" a mother in just this way - my 
only consolation being that the baby has probably had a few weeks more 
breastfeeding than he would have had, I have *not* alienated the mother and 
she's already talking about trying "harder" when she has her next baby, but 
I am left feeling that *this* baby has been failed, by his mother, by me, 
and by society at large.  This is a clear situation of competing 
needs.  The breast/bottle controversy is alive and well.  For so long as 
breastmilk is not really valued in our society, then our profession 
(helping more mothers get more of their milk into more of their babies) 
will continue to be unacknowledged and under-valued too.  If the #1 health 
priority was to help each mother breastfeed each baby, then it *would* 
happen.  Thoughts, anyone??

Pamela Morrison IBCLC
Rustington, UK
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