This does not yet seem to me a prolonged nursing strike.  Four weeks, 
that's a prolonged nursing strike.  The striking feature (ha ha) of a 
nursing strike is that though the mothers say that the baby no longer 
nurses, he will often nurse at night or when half asleep.  

The mother should not try to feed this baby when he does not want to.  
Even a few feedings a day will keep things going.  She should not 
succumb to giving bottles and she can feed the baby off a spoon 
(solids ± liquids) if she is worried.  She can try putting the baby to 
the breast when he is half asleep, at night (in bed together, skin to 
skin) or the mother can walk him around and try putting him to the 
breast while he is settling in her arms.  It is better to let him suck 
his hand rather than try to force him to the breast, which will not 
work in any case.

This also sounds like a situation where domperidone will also be very 
helpful.

This is also getting bloody embarrassing that everyone is posting 
about problems in Toronto and area, where we have at least 12 hospital 
based breastfeeding clinic, where we have terrific LC's around and so 
on.  How come these mothers know to e-mail to the UK and Louisiana and 
who knows where else, and can't find help locally?

No comment on having to wean before the operation.  Some doctors are 
incapable of learning or understanding, especially surgeons.

Jack Newman, MD, FRCPC