In my new postion I have been visiting moms with Public Health Nurses -
both to help the moms and teach the Public Health Nurses some of the basic
interventions and education they can offer.  In this way we hope to reduce
the need of my seeing every breastfeeding mom (an impossibility) and I also
hope to encourage some to work towards the IBCLC.

One of the questions that has become very "sticky" is the information about
contraception.

I believe in giving the mom a "cafeteria" of choices, informing her of the
alternatives and how each will affect them and their breastfeeding.  for
this reason I start with LAM, explaining the three critical aspects that
must be true in order for it to work (baby under 6 months, uninterrupted
breastfeeding, no menses). I continue on to barrier methods, IUD, Progestin
only and then combination pills explaining the merits and risks of each.  

Some of the staff is questioning this approach because:
1 - Many moms are not careful and may not follow the LAM instructions
        My answer - then these same ones won't use condoms and will
probably forget to take their pills or show up for their 3 month shot... 
We can't avoid giving information because we can't trust women to do what
is best for them.

2 - Many moms are going to lose their medical coverage when the baby is 6
weeks old.
        My answer - so then after the 6 weeks she's still going to have to
pay for her own birth control, lets give her choices.

I could use your input and especially references (especially in relation to
Public Health) to help me in dealing with this.  I am taking the last JHL
and Miriam Labbock's article in Breastfeeding Abstracts to share with them.

Jeanette Panchula, BSW, RN, IBCLC, LLLL
Vacaville, CA
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