Sally

What you describe - the mothers who "really want to breastfeed" but 
wont pump more than 3-4 times a day, sounds so familiar.   It's 
sad.  I think this is the outcome when breastfeeding has come to be 
undervalued by the mother herself, her peers, her family, in the 
hospital, in the community, by the healthcare system and especially 
as reflected in national policy.  In other words, breastfeeding is 
great up to a point (if it's easy) but it's just not seen to be worth 
the effort past a certain point (if it's hard).  Whereas 
formula-feeding is easy, and socially acceptable and often free 
(Healthy Start Vouchers).

When I worked in an extremely breastfeeding-friendly environment in 
Zimbabwe, where babies were not discharged from the maternity unit 
until they were breastfeeding, there would be a few moms who would 
seem to struggle more than the situation warranted (nearly all 
expatriate moms I hate to say....)  Eventually I'd ask them about 
their infant feeding goal - the answer would always be "I really want 
to breastfeed", but then they would just allow things to slide to the 
point where it failed.  I had to conclude that actions speak louder 
than words.... I think it's worth being really straight with these 
women in a kind but very clear way......If you do x and x, then your 
milk supply will fail (technical explanation....)  If that's what you 
want, then that's fine and of course it's your choice, but I want you 
to have all the information so that you can _choose_ not to 
breastfeed and not feel _forced_ to bottle-feed.... etc.

I wonder - on the infant feeding surveys which appear to show that 
more women want to breastfeed than actually succeed - if many of the 
failing moms are the ones who are not prepared to put in the extra 
effort?   If you google "breastfeeding help UK" you come up with over 
17 million hits in half a second, yet mothers who are apparently 
struggling and then failing just don't pick up the phone to call 
us.  This speaks to motivation.

I think we need to look motivation squarely in the eye and stop 
kidding ourselves that our present gently-gently 
breastfeeding-promotion tactics are sufficient.  IMHO what we need is 
more clear information about breast vs bottle from the top (think 
seat-belts....smoking.....)  Actually I think the UK IS making quite 
a bit of progress in breastfeeding initiation after birth - it's 
later, in the community, that we lose so many mothers, because 
no-one  who has any authority will actually say to them that their 
milk really _matters_ to their babies current and future health.  And 
of course our media just keep printing this sensationalist mommy-war 
nonsense .... to reinforce the message that formula is FINE... and 
when it's too hard to breastfeed (pump more than 3-4 times/24 hours, 
perhaps?) then no-one should be made to feel guilty for not trying.... :-(

In solidarity....

Pamela Morrison IBCLC
Rustington, England
-------------------------------------------------------
I agree with all your points Barbara. Even with this approach though 
I find very poor outcomes with the community I work with - these are 
mothers who all expected to breastfeed because that is part of their 
culture, but who find it incredibly difficult for a multitude of 
reasons to pump to establish their milk supply if anything happens to 
get in the way of breastfeeding getting off to a good start. I would 
love to find something that would give more success!
Having said that, women who have breastfed previous babies invariably 
do well. I know this is partly because getting things going is easier 
second time around, but not only - they pump frequently, whatever it 
takes. My first time mums just don't pump more than 3- 4 times a day, 
no matter what I say to help make it do-able, or to impress how 
important it is, and no matter how much they want breastfeeding to work.

Sally Etheridge IBCLC


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