Dear Melissa, it is so hard when you work in an area such as the one you
describe.   I, too, live in a rural area and have been a "lone ranger"
for several years.  Our C/S rate is not as bad as in your area, but I am
frequently appalled at the misinfo moms get from their local physicians.
I have tried without success to get someone to start a LLL group here. We
don't even have that.  I have been IBCLC certified for 5 years, worked in
the OB department as an RN, and had a private practice for the same
length of time. I have faced my share of opposition, but what is worse is
the apathy from people who could be doing more to promote breastfeeding,
who are positive toward breastfeeding, but who simply are interested in
getting out there and doing much.

I recently finished nurse-midwifery school and had plans of starting a
practice locally, and hoped to do more from that base, having put much
time and energy into laying the foundation for this, but am not able to
do so after all because of local medical politics (spell that no MD
backup). So I have started a new practice elsewhere but am currently
commuting a long distance in order to work. Fortunately I am working with
a physician whom I am philosophically in tune with. Unfortunately, that
does not leave me with much time or energy to deal with issues locally,
though I am still trying, and I feel in a quandry myself.

What I can tell you from experience is:
        - Don't take the opposition personally you are encountering. As
someone else put it, these people are "informationally impaired".  They
may also be "learning challenged".
        - If necessary, keep a journal and write down every positive
little thing you have accomplished day by day.  Give yourself lots of
strokes.
        - Learn to recognize even small (okay, microscopic if needed!)
improvements and rejoice.  Otherwise you will go crazy.
        - Reach out to others who share your sentiments for support.
        - Keep working on identifying allies. There may be more people
who are upset by the situation you describe than you think.  Put feelers
out to start a Breastfeeding Task Force as a way to meet and maybe get
something moving.
        - Along the same lines of the above, never underestimate the
power of parents. Ultimately, if there is going to be change, you will
probably really need parent power to make it happen. Therefore, find ways
to reach out to parents, to identify those who are potential movers and
shakers and to recruit them to work for change.
        - Do nice things for yourself.  When you feel worn down, take a
break. I treat myself to an evening or weekend of working on my quilts
which is very satifying and takes my mind away from other stuff that bugs
me. I often find that I feel burned out when I have neglected maintaining
a healthy balance in my life, but caring for others begins with self care.

Hang in there and good luck.

Ione Sims, CNM, IBCLC