Dear Teresa:
I think all of us face two very important problems:
1) Overreactions:  of the type you mention.  I can't tell you how many mothers I see who are told they MUST (no informed consent involved) supplement their baby for some parameter such as a 7% weight loss or even worse -- the much discussed 5% weight loss with no attempt whatsoever to either improve the frequency of feedings, efficacy of feedings or express milk. Clearly, this is NOT evidence based practice.

For this reason, the data by Neifert does not distinguish between iatrogenically-induced low supply and physiologicallyinduced low supply.  And until such time that a significant proportion of hospitals eliminate baby unfriendly practices, I think it is impossible to gather such data. 

2) Negligence:  I also see this just as frequently among the clients I see (particularly with the aggressive sleep training tactics adopted by one "guru" pediatrician who insists all his practitioners adopt even more restrictive practices than Ezzo) whereby they are told that their babies are just fine when the signs of excessive weight loss and poor gain are readily evident.  This does every bit as much damage to the breastfeeding relationship as the former and, I truly believe, leads to more "angry formula feeders". This later type of negligence is RAMPANT in the online chat rooms.  

To be honest, I am tired of hearing that a mother's concerns are all in her head.  Too many times I've seen mothers who were told that their baby is just fine by people who have never seen the baby feed (and I just had one recently whose baby had been feeding once an hour around the clock for two weeks straight and was told that it was perfectly normal).

This is where we much demand THOROUGH evaluation and customized interventions that are appropriate.

Best regards, Susan Burger

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