Rhonda writes, "I don't necessarily think most women need expertise on a
level higher than mother-to-mother to successfully nurse their babies".

Jumping in to this thread, I was pondering this very question while writing
up my notes after seeing a baby in the Neonatal Unit.  Baby had been born at
33 weeks, quite a good weight (1750g) and the paediatrician was anxious for
her to begin breastfeeding, mom's milk had been slow to come in (only
producing "drops" by Day 3) but was more plentiful by day 5.  All *should*
have been OK, but it wasn't.  Baby was having difficulty latching.  Mom and
I went through my standard latching bag of tricks and the baby made valiant
little attempts to sustain the suck, but being immature and probably
overwhelmed, kept falling asleep. We talked about techniques and strategies
she could use to latch the baby, feed the baby and enhance lactation. I left
with that humble, thankful feeling that this baby was being cared for in an
environment where no-one would let her starve because of this mom's
inexperience.

As I wrote up my notes I wondered what would have happened to the baby and
the breastfeeding if we *didn't* have the skilled OBs, the specialized care
in the NNUs and - yes, even though I say so myself - the special techniques
of the LC.
Now we have more babies surviving because of all the technology, and I think
we have more babies breastfeeding because of appropriate info and hands-on
assistance given at the time that it's needed.

Actually, the more mothers and babies I see the more I begin to realize just
how much can go wrong!  Although *most* of them do just fine, there are
others who really do need more than mother-to-mother help, important though
that is. I see the roles as complementary.  I can't count the number of
grandmothers who come in with their daughters and grand-babies and go out
saying, "I wish *I* had had someone like you to help when I had *my*
babies."   I know just how they feel: *I* wish I had had someone like me
too!  I did okay, I exclusively breastfed twins for 7 months, and partially
breastfed past their fourth birthday, and yes, I had mother-to-mother
support and encouragement, and I had Karen's book (Hi, Karen!) which I know
off by heart now, but it would have been so much *easier* if I'd had an LC
to come and *see* what was going awry and iron out the difficulties promptly.

And then Karen writes, "Unfortunately, a lot of babies in our culture are
born after all kinds of medications and interventions that can affect
breastfeeding ability for a while  .... Many new moms today have never seen
a baby breastfeed before they give birth, much less see moms work through
minor breastfeeding difficulties."

I agree that seeing how breastfeeding works from other mothers is the very
best way to learn, and that unnecessary interventions don't help.  But I
don't think you need to be too hard on your culture!   I work with moms from
many different cultures and backgrounds, and I can tell you that I see the
same kinds of difficulties occurring when women have grown up handling other
babies since they could walk (you see little tots with younger siblings
strapped to their backs), and watching every sister, auntie and cousin
breastfeeding their babies, and many of these women have had *no*
interventions of any kind during labour/delivery, yet *still* they sometimes
experience the unexpected, and when they do, receiving that little "extra"
that we have learned about, helps.

We're getting better, we're learning more all the time. I think
mother-support groups are necessary, and I think more technical help is also
sometimes necessary. IMHO the LC, like the OB and the paediatrician, is
going to be used more and more, for both the routine hiccups and for the
major train-smashes. With better outcomes for everyone.  I think we're here
to stay!

Pamela Morrison IBCLC, Zimbabwe  (who gets a special kick out of "fixing"
something without the mom ever knowing it could have been a potential problem!)

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