I had a 3-hour long consultation today. The mother had a supernumery
nipple, bilateral periareolar incisions for fibrocyctic breasts, had pelvic
separation which meant she was unable to stand initially and now is only
capable of walking backwards, failure for some of her glucose tolerance
tests during pregnancy, growth of skin tags during pregnancy, widely spaced
breasts (though not conical), erratic periods before use of the pill,
excessive blood loss during delivery, and her baby experienced dehydration
and fever and was put on formula.  No, she wasn't taught how to pump in the
hospital, but she was diligently cup feeding her baby. Are we surprised the
poor thing has low supply at this point?  Should this be an exam question -
which of the above factor are unrelated to potential low supply? Her baby
was only able to transfer 0.2 ounces with lots of breast switching and
compressions. So, I cannot tell you pleased I was when she was able to get
an ounce out with the pump.  Even more, I am soooooo grateful that we hae a
breastfeeding medicine specialist to refer to who is well versed in PCOS
(which I'm not sure she has, but the specialist is really good at figuring
out) and galactogogues.

Anyway - before my early evening slump I had this burst of enthusiasm for a
dream of the next phase of a blueprint for a public health/clinical
program.  Imagine a program where you could byou have access to many of the
specialties in one place - the social workers - the speech therapists - the
feeding specialists - the nutritionists - the NICU nurses - the pediatric
ENTs etc. that could come together to do a really comprehensive job of
training for both public health and clinical breastfeeding management. Not
just those of us who become IBCLCs and have strength in one area and try to
dabble in all the other areas. If it was a combined teaching hospital and
public health university - you really could develop something like this.
AND you could have clinics for Medicaid clients and do public health
programs with peer counseling using some of the communications/social
marketing techniques.

I've often thought that one of the problems with peer counseling which is
one of the more successful methods of supporting breastfeeding could be
even more successful if one adopted the lessons that have already been
learned in focus group discussions (i.e. small groups of 6-8 mothers of
similarly held beliefs - rather than larger groups of mothers with more
varied beliefs.)  You could actually set up peer-counseling groups around
focal problems in breastfeeding.

Shall I tackle Bill Gates and tell him that we have the ultimate in
immunizations? (If you don't know already he's funding immunization
programs around the globe.

Even though its a bit pie in the sky - I really think one could look at the
next wave of "blueprints".

Dreaming on,

Susan E. Burger PhD, MHS, IBCLC

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