Mira,

During my breastfeeding classes I do approach "drying up" because not all
these mothers will breastfeed or breastfeed beyond a few days.  I tell them
that, in most cases, if they do not BF their milk will come in anyway.  I
suggest that they hand express (and I do demonstrate how to do this on a
stuffed breast) just enough milk to make themselves a little comfortable but
not enough to encourage additional milk production.  Cold compresses may help.
Cabbage might help. Consult with their physician about mild pain relief. This
would apply in the case of infant death.

To the mothers who have an established breastfeeding relationship with their
baby, I suggest that they eliminate one feed per every 3-4 days (2-3 for the
Mom in a hurry) and substitute a bottle of ABM.  I stress that "cold turkey"
is inadvisable because of the physical and emotional strain on the mother and
baby.  To those who look or sound doubtful I will go into the possibility of
plugged ducts and breast infections and the pain of engorgement.  Now, many of
these mothers are not that postpartum that they have forgotten engorgement so
this usually catches their attention. I also offer them alternatives.  Many
mothers do not know that they can combine breast and bottle.  We then discuss
partial weaning.  It is amazing how many mother will "latch" on to this.
Discussing the whys of weaning sometimes helps the mother to see that weaning
is not necessary or desired.

One of the suggestions I make is for the mother to try a small amount of
formula before they get into the weaning process.  I have found that the baby
can be allergic to the formula and may show signs early on if not immediately.
A half ounce to an ounce is all I usually recommend for the first couple of
test tries.  Unfortunately some babies do not show signs of allergy until they
have been on the ABM for about 2 weeks.  Then the mother goes on a search for
the "best" formula for her baby.  I will also tell the mother that this is a
possibility so to watch her baby carefully.

There is the mother (and there are unfortunately many) who wants to wean just
because she wants to.  She might have private reasons or just doesn't want to
do THAT anymore.  When her baby shows that s/he is allergic to formulas, Mom
will still insist she will not breastfeed any longer.  No matter how many of
these mothers I run into I still cannot begin to imagine a mother who will
sacrifice the health of her baby for her own "convenience." I give her the
same information as I would any other mother but also include relactation.

I will be speaking to a group of residents and nurses at a local hospital next
month along with the hospital LC and another long time LC.  We have a very
broad outline, just touching on the high points that residents will encounter.
This is our first visit to this particular hospital and are probably too
enthusiastic and want to give them ALL the information we have is an hour!
Obviously, we need to trim down our outline.  Going into a hospital on an
ongoing (monthly ?) basis could help tame this obvious enthusiasm and allow us
to approach each aspect of BF in a more thorough manner.  Maybe giving your
conference physicians the time on the topic the organizer has chosen and then
one you feel needs the most attention and tying them into each other, would
work.  Sounds like they need several more panels on breastfeeding!  Many of
the physicians (nor the mothers they work with) you will be speaking to will
not be reading up on the topic.  They need the "how to" information then and
there.  Giving them the accruate information will ultimately help the mothers
they see. I think that if you cover the topic thoroughly, they will benefit
more then if you cover too many topics giving minimal information.

Hope this helps.  Good luck!

Linda Barrett, IBCLC