I have to agree wth Jo-Anne in her post about respectng women's choices. 
Along with being an LDRP nurse, I also do maternal/child home visits on 
the side (a lot, really). It seems that private insurances (as well as 
Medicaid, of course) around here offer many women (even thoose with no 
documented problems)one or two home visits, which can of course be 
extended if I find problems which need to be addressed. So because of 
this, I have the good fortune to be able to follow lots of woman in those 
first few days and weeks in their homes after the baby's birth.In other 
words, I am going into their territory: a guest in their homes and at this 
time, they are no longer under the influence of "the medical model" that 
some of you have spoken out against so passionately.I go into the worst 
little one room rattle-traps that are filthy and cluttered (where I 
wouldn't want to even sit down), the subsidized low income housing 
projects where drugs are rampant,all the way to the palacial homes with 
the three or four car garages that leave me wondering how the couples pay 
for this. So, I get to see it all. I consider myself very fortunate to 
have this insight. None of my nursing or medical colleagues have this 
advantage. This may be why I approach this breastfeeding issue (and others 
like it) as I do.

What I have come away womdering sometimes, is how do these women even 
survive? How do some of the children even survive in the surroundings I 
see? Other times, I look at the young couples in the beautiful homes 
remembering what it was like to start out.

My point is that because of these experiences, I have developed a respect 
people for who they are and what they believe and how they manage their 
lives.They have grown up under circumstances that I can only imagine and 
who am I to assume that I know better for any of them? In other words, I 
have a healthy respect for people as individuals.

All of these people come into their pregnancies and resulting parenthood 
with their own ideas, experiences and backgrounds and because of that,many 
of them make choices that you and I would probably not make (no matter 
what end of the financial scale they are on). We can teach and teach and 
each person is going to hear what she personally wants to hear and she is 
going to do what she wants to do. It is NOT up to us to change them, but 
to meet each woman where she is and guide her and support her personal 
choices.

I once had a patient who told my manager I had said that "formula was 
poison." Now of course, I had never said that (and would never say that). 
What I had said was that "breastmilk is superior nutrition for human 
babies." She had no desire to breastfeed and was obviously looking for 
reasons that made it okay for her to choose NOT to do so. Turning my words 
around was her way to get out from under any guilt feelings she had about 
not wanting to breastfeed. This was just her choice.

We must meet women where they are, regardless of what they choose to do. 
It is the same for the women in the one room apartments right up to those 
in the big houses. They all have their own agendas and will take our 
information as they each choose. It is up to us to support their choices.

So when some OB's tell you that women are forcing them and come into the 
practice knowing what they want, they are telling you the truth. All 
practitioners deal with people's choices all the time. OB's around us 
don't even accept some women into the practice if they come in professing 
desires that are incompatible with the philosophy of the practice ( a 
rarity thank goodness). We had one practice that had to "fire" a patient 
out of the practice after the birth and PP care because she had 
jeopardized all of us (and herself and the baby as well). If the physician 
feels the woman in jeopardizing their practice by making choices that 
might threaten her health, they won't accept the patient. It is the same 
with many of the pediatricians who will not accept non-vaccinators into 
their practices.

So, the respect for choice goes both ways: from practitioner to patient 
but also from patient to practitioner.

Betsy Riedel RNC, IBCLC

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