Hello Everyone,

What is the ethical and legal implications of advising a breastfeeding
mother over the phone and telling her to do something against what her team
of care providers who are counseling her, examining her, and working with
her everyday and multiple times during day while still hospitalized?

Do you tell a mom to stop supplementing because "she has more colostrum than
she knows" before a meeting, an exam?

I am an avid reader of lactnet but sometimes I get peeved when people get on
their high horse and blame everybody else and force a mistrust of other
people's judgement. I remember as I was training to become an IBCLC, I
received messages that MDS and nurses were not to be trusted, "don't let
anyone tell you your baby can't breastfeed if you have flat nipple" among
other statements I heard. Well guess what. When women in classes only hear
messages such as these, they become problem focused, defensive, anxious,
depressed, closed minded, and unable to work on a solution. Let's prepare
them to solve any problems they may encounter.

Using the example of a woman with a flat nipple, she may not be able to
adequately breastfeed her baby in the first days after birth. Some may be
able to. Others need lots and lots and lots of support and training to get
their babies directly to the breast and* transfer* milk during a suckle. The
baby needs to be fed alternatively until that time whether that is mother's
milk or ABM. The mother may have a laundry list of medical issues including
infertility that will affect her milk supply. Let's tell the truth and
practice honest and ethically. Stop setting up mothers to fail mentally.
Breastfeeding is darn hard for a lot of women. At least in the population I
work with. Face it!  They need loving support not a LC on a  tirade.

 Within the NYC area where I work, we have a 40% cesarean rate. Women have
been on hours worth of epidural medication. Everything gets swollen
including the boobs and areolar complexes. Their babies are at high risk for
jaundice because the mother's were so drugged during labor. Babies  are
hypotonic and lethargic for 24-36 sometimes 48 hrs. These babies need to get
fed. We want them home with mother and not in the ICU on an IV because they
are dehydrated or get forced formula because the baby is jaundiced and
mother's milk is not "in" yet.

So please, stop passing judgment and making mothers feels bad. She does not
have to be experiencing what you read in a breastfeeding text book. If you
are that concerned and upset about what you are hearing, offer your services
for free and come help her out with every feeding.

I am baffled by this phenon I'm seeing...Where is the milk? Are there trends
that are being researched? Are there any papers out there that you can
forward to me? But sadly yes, I see many many mothers 3-5 days pp with no
clinical signs of lactogenesis. Unfortunately, those babies need
supplementation.

I look forward to your comments.

Tamara NYC

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