In the weeks since my return to work I have been waging war on those who
aren't supportive of breastfeeding. A couple of docs wanted to put the blame
on me and my department because we aren't there 24 hours a day. But as we all
know this is multifaceted-- the problem is like a cancer, spreading from the
clinics to childbirth classes to labor and delivery, post partum and beyond.
The whole body is sick. And there were a lot of days when I felt like the
lone crusader tilting at windmills.

     Then I was called to attend a collaborative practive (all the perinatal
services were represented) meeting last Friday and I was really dreading it.
To my surprize it was a very fruitful meeting. Although pediatrics is planing
to to the 3 day post discharge follow-up for babies who are discharged before
24 hours of age, I was assured that any breastfeeding problems would be
directed to the clinic before formula would be suggested. Score one for our
side.
     The head of the pharmacy Bob Batman (yes that's his real name!) was also
there and he literally hit the roof when he found out that the ABM reps had
free access to the postpartum units and the clinc. (All other drug reps are
not allowed direct contact with the staff) He hates drug reps and the formula
guys fall under his juristriction (One rep is planting his "W------
A---------" stuff all over the place-- parents sign up for this club and are
bombarded with ABM literature sent to their homes and they even receive a
case of ABM prior to delivery ). Anyway he's going to restrict them the same
way as other drug co. reps. No more reps going up to the units ans smoozing
with the doctors and nurses "We won't be doing their advertizing for them."
 Score: LC two:ABM Zero.
     Also I am very greatful to Katherine Dettwyler for allowing me to use
some of her material from the Lactnet and Parent-L on the hazzards of formula
use. I came up with a piece entitled "Parents and physicians remain
uninformed about the risks in formula use." And included a slew of
references. Two of the pediatricians insisted that I get copies of the
material to them as soon as possible so they can get the word out to all the
other peds, ob's and staff nurses. Score: LC three:ABM Zero.

     The highlight of the entire meeting was when one of the peds stood up
and said "Stop worrying if the baby won't eat in the first 24 hours-- and
unless it's medically indicated baby's don't need formula or water. If you
think the blood sugar is low, test first then have mom breastfeed, if it
still doesn't come up, call the ped on duty before you give that baby
anything other than the breast." Score: LC four:ABM Zero
     The one of the peds stayed after the meeting to ask me privately how the
LC's thought the ped dept was doing supporting Br Fing "Lousy" I said and
began giving him a list of problems. He listened patiently and said. "I'm
sorry but I am guilty of one of those" Which one? I asked. "Insisting that
the babies are weaned by a year." Instead of saying shame on you, (which was
the first thing that came to mind) I told him there is no reason to wean at
one, two, three or four years both mom and baby physically benefit as long as
they are breastfeeding. "But how do you do it, that loooong? Are they still
nursing ten times a day?" So I educated him about nursing toddlers. When all
was said and done he nodded his head and told me "I never learned anything
about breastfeeding in medical school, most of this I've picked up on my own.
I guess I'm going to have do some more reading." Score: LC four:ABM Zero (Or
should I say breastfeeding four: Formula zero?)

I feel lucky in some ways. The HMO I work for, insists all the departments to
get together and work on problems in collaborative practice meetings. They
really want to present a united front. I know this meeting will bring forth
fruit.
 It isn't that way in my private practice. I have little or no input with the
physicians or the hospitals. I take mostly difficult cases from other LC's
now and the battle is concentrated on fixing the screwups if they happen to
make it to my office. Maybe you all can take on that battle.
Marie Davis