Hi All
  Anita, I think sabotage is a great topic. For an interesting look at
the subtle nature of HCP comments and routines, Gabrielle Palmer's book
"The Politics of Breastfeeding," particularly chapter three has some
thought provoking situations. "Breasfeeding: Watch Your Language by
Diana Wiessinger, MS, IBCLC in CCL Family Foundations, July/August 1996,
pgs 12-3, has a look at how the words we use can have an impact vastly
different than we intended. "The National Assessment of Physicians'
Breast-feeding Knowledge, Attitudes, Training, and Experience." by Gary
L. Freed, MD,MPH, et al. in JAMA, Feb. 8, 1995; Vol 273, No. 6, pgs 472
-476, would be a good reference to help back your position up if someone
becomes defensive or (hopefully not) attacks your position. "A Fresh
Look at the Risks of Artifical Infant Feeding" by Marsha Walker, RN,
IBCLC, in J of Hum Lact, 9(2)93, pgs 97-107, is also a good reference
resource and she has a segment on informed decision versus guilt."Breast
-feeding; Time to Practice What We Preach," by Gary L. Freed, MD, MPH in
JAMA, Jan 13, 1993, Vol 269, No 2, pgs 243-245, is a good resource on
some statistics on Drs. 'lack' of involvement with encouraging and
providing information concerning breastfeeding. I believe it is in
Gabrielle's book, but I remember reading a commentary on HCPs asking a
expectant/new mom if she is going to bottle feed or breastfeed and/or if
she is going to 'try' to breastfeed and how this subtle wording either
closes the door to breastfeeding information or plants the seed of doubt
in the mom's mind as to her ability to breastfeed. What we say or don't
say and what we do or don't do is very important - please stress that.

Lisa, I also take some issue with the Rochester study, most of the moms
I see who are having actual problems (as opposed to 'new mom insecurity'
and worry) are those who have had epidurals. There are so many factors
to play into this issue - the mixture of narcotics used, the amounts
used, when in labor it is administered, were other meds administered
either before or after? and of course the size and condition of the
infant. These all change the complexion of the situation and certainly
has some impact on study results. But as Ruth Lawrence states in her
book "Breastfeeding; A Guide for Medical Professionals" - the reason
breastfeeding studies come with so many different results is because of
the variables involved with the definition of exactly what is
breastfeeding and how mothers interpret "I am breastfeeding or have
breastfed." I remember a couple of years ago a mother called concerned
with family risk of breast cancer despite the 'fact' that her mother had
breastfed eight children. I remember having to carefully state that
there is breastfeeding and there is 'breastfeeding' (with supplements,
token duration, early addition of solids [early weaning], etc.) as a
possible explanation as to how her mother ended up having breast cancer
despite nursing so many children.

Leslie Ward, LLLL; AAPL in Vine Grove, KY