This is problematic. There are studies that have shown differences in 
health outcomes when babies are bf at breast vs bottle fed breast milk, 
so we do need clear definitions of not only what babies are fed, but HOW 
they were fed for good research.

I do agree with Mary-Jane that many mothers are afraid to exclusively 
directly bf, and as IBCLCs we are to help the mother where she's at and 
also provide alternatives that make bf work in her life. BUT, we also 
have the role of advocate for the baby and educator for the family as to 
what is normal and expected by human babies, and the breastfeeding 
relationship and the autonomic and immune crosstalk, lung development 
and face and mouth development that happen during breastfeeding is part 
of what we need to be teaching.

Catherine Watson Genna, BS, IBCLC  NYC

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