Before anyone gets too mad at Dr. Neifert, remember that when you are in a
practice which essentially sees the most difficult bfg. cases, you will see
a greater percentage of abnormal situations.  It does give one a diff.
perspective.   I am careful not to extrapolate from my own clinical
experience (seeing terrible problems) that all bfg is is this hard.  Nor
would I want to suggest (based on my personal experience as a nursing mom in
LLL) that bfg was always easy and anyone can do it.

Nothing connected with human health or behavior is ever simplistic, and
there is always a spectrum of system response. Eating works well for most
people, yet some people are obese, or anorexic, or get ulcers.  Walking
works well for most people, and yet some people limp. Some people need
glasses.

 Some moms have such an easy time they can't even imagine anyone struggling
with bfg, and tend to generalize and judge and make remarks about "some
women just don't try hard enough."  This judgementalism is like a knife in
the hearts of women like I see, who have awful experiences.  They have
hormone problems, or dreadful births with large loss of blood, or they've
had abnormal breast development, or get a horrible infection.  Or, they have
a baby who is born unready to feed, and they are mismanaged by a pollyanna
who thinks all babies can automatically make it work.  These moms often
develop an acquired low milk supply (to quote Michael Woolridge) which is
irreversible after a certain period no matter how many herbs they take.

 I have cut back on my practice some, but am still seeing an average of 5
new clients per week.  I would say it is SELDOM that I see any who have a
normal, easy to fix problem. They are ALL what I call "train wrecks."   Now
what percentage of all bfg moms in Austin that is I couldn't say.  I doubt
it's 5%, but if the other priv. pract. LCs and the MDs are seeing the same
type problems I am, with similar frequency, then there very well could be
maybe 2-3% of the moms giving birth in any given week having serious
problems.  Some of these problems could, without a safety net, easily
endanger the health of mom, baby or both.  So I have to say that I agree
with Dr. Neifert that we need to talk about the entire spectrum.  It isn't
fair to make the moms with real problems feel like they just didn't try hard
enough.

We don't need to be propagandists.  The truth about bfg is wonderful enough
without us having to protect anybody from the fact that it works MOST, but
not all of the time.  The reason there has to be real bfg. specialists,
along with the bfg generalists, is because it is the failure of the current
system to spot and catch and PROTECT the risky dyads that creates the
hysterical backlash of the Wall Street Journal article, etc.  The CH episode
was certainly dumb tv.  I agree with whoever said they didn't get any of the
other medical stuff right, either.

 Barbara Wilson-Clay BSEd., IBCLC
Private Practice, Austin Texas
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