I whole heartedly agree that the trend toward gagetry has gotten way out of
hand. I repeatedly tell moms that they don't have to buy anything to
breastfeed. They have been told they need everything from lanolin to
breastpumps, nursing bras , pillows, stools the list grows longer daily.  Many
are surprised that they don't need these things.  One local hospital sells the
PNS at their maternity teas. Most of those mother's don't know that they have
other options.
I am sick because mothers who need pumps for ill babies can't afford them and
they aren't poor enough for public assistance. I am sick of how much
breastfeeding speciality items cost. I am sick of how much it keeps going up
every  year.  Don't we have some power to stop this? The few profit hungry
manufacturers of these items will continue this upward spiral as long as the
market remains unchecked by competition and education. (Use any other medical
supply manufacturer as an example. If it says medical on the label it's worth
its weight in gold.)

Working and nursing is a trigger for our own feelings. I think our teaching
priorities are different depending on our client population. Women in my area
truly WORRY about that return to work. It is unrealistic for many of them to
discuss NOT going back to work. For others, it is obvious that staying home
would be more financially and personally gratifying. Many of the women I see
make more money than their spouses or it is their job that provides the
medical insurance. We shouldn't be the ones to make the judgement as to wether
they can stay home and may alienate them if we appear to do so.
For example: I had a call the other day from a mom who wanted to rent a pump,
as always I asked her why she need the pump.  When I told her that I could
help her with what sounded like a simple  problem she angrily said "It sounds
to me as if ALL you lactation consultants want to interfere with what I want
to do" and she hung up. I agonized over this call for several days. How many
do we loose because we are perceived as interfering or dictating?

In our prenatal breastfeeding classes the segment on expressing milk, pumps
and returning to work is at the end class. After we cover the WHY and the HOW
then we address concerns. Our written department policy states that all women
will be taught how to manually express. That doesn't mean we don't educate
about the alternatives.
May I suggest that you try this method of surveying your classes and
population.
At the beginning of class I hand out a 3X5 card to each person and ask them to
complete the following statements:
On the front: The one thing I need to learn from this class is....
On the back: The one thing that frightens me about breastfeeding is...

I go over the cards at the class break. Almost all of the questions have been
answered or will be in the second half of class. Only occasionally have I had
a question relating to something too personal to discuss (although no subject
is taboo). I ask them to come see me after class.
The responses have given me great insight into the minds of those that attend
classes.
What do I see most often?
1. The one thing I need to learn from this class is --how do I know if the
baby is getting enough
and
2. The one thing that frightens me about breastfeeding is -- going back to
work and keeping my milk.

If I were to not mention expression and storage of milk, I would not put their
fears to rest. Nor would I appear to be supportive of their needs. And I would
be doing a great disservice.
We may not like their reasons, we may not even know the real reason. However,
it is the needs of the mother and baby and maintaining the breastfeeding
relationship that must come first. Our own opinions on their choices matter
very little. What matters is that is THEIR choice.

Just My Humble Opinion
Off the soap box now, next ;-)
Marie Davis RN, IBCLC

"There are two types of people in the game of life, those that take the cards
they are dealt and use them and those that fold and complain because they
didn't win." Annon.