Lisa, the mothers should be given their options and asked what they want 
to do. For those mothers who would like to pump their milk, a good 
manual pump like the Ameda one hand or the Medela Harmony (kind of 
complicated for some WIC participants to put together), would be 
helpful. I don't see why they could not wear a loose shirt and pump a 
few times a day under it -- if the mothers want to. The old Medela stick 
style manual can not be used under a loose shirt like the other ones 
can. It is not up to the WIC employees to decide what is best for mom, 
nor is it up to us to push mom to try pumping if she has no cooler or 
way to store her milk or way to clean the pump out in the fields. Mom 
might want to continue nursing before and after work and pump and dump 
in the day if she has no refrigeration. From what I understand, field 
workers work long days and this type of schedule might interfere.

The best thing might be to encourage nursing breaks, but again this 
might not work. I once saw a special on PBS where the Chinese farmer 
women would nurse in the morning, then bundle the babies up in bags with 
sand to catch the urine and feces and leave them all together (and 
alone) in one house. They came back at noon and nursed, then back to the 
fields with the babies bundled in the bags and left alone. These babies 
were behind in crawling, speaking, etc. from being bundled and not 
allowed to move all day long. But with no one to watch the babies, this 
is what the people devised to keep the babies safe.

One problem with WIC is that some staff feel that if they give less than 
a full package of formula, the moms will be back in a few weeks for more 
formula and thus make the clinic busier. So the attitude is give a whole 
package and have less work in the long run. If you are finding this 
attitude, it is hard to change without management or administration 
stepping in and rewarding the nutritionists who give less formula. I 
find that there is only pressure on the BF Peer Counselors to increase 
rates but they can not change the nutritionists attitude about giving a 
full package to keep the client load slower.

Kathy Eng, BSW, IBCLC -- WIC LC

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