I hope this is coherent as I'm typing one-handed.  (The other hand is
hanging onto my nursing gymnast!)  Plus, this is my first ever LactNet
post, so please be nice.  :)

I have been hearing about LactNet for a few years now, and received
snippets in my email from a friend on the list. (The "meconium heads"
comment was priceless!) I was a medic in the Air Force Reserves while
attending nursing school (that I just can't seem to finish with all the
military moves we've made!) and am now a LLLL.

The Air Force moved my family to a tiny island in the Azores, about 800
miles off the coast of Lisbon, Portugal.  There is no WIC here, yet
breastfeeding is poorly represented.  Generally, the people on this island
are poorer than the people in the US, yet I see more babies with bottles
than with breastfeeding moms.  The Americans here who are accustomed to
receiving WIC foods and formula are finding themselves in financial
problems, and the peds clinic on the base sees many babies who get
overdiluted formula.  Today even, I stopped to admire a new baby girl who
was 5 weeks old and asked the mom if she was breastfeeding... she looked
almost ashamed and said yes, since she couldn't get WIC!

In October, one mom delivered her first baby while on this island, and
since the US clinic is out-patient only, she was sent "dowtown" to the only
hospital on the island.  They pronounced her dry one Day One pp since they
squeezed her nipples and no milk streamed forth.  Bottles of formula are
routine for new babies, despite the fact that moms are breastfeeding.  They
also don't provide things normally found in US hospitals, like a bedside
pitcher of water, so this new mom went without until the visiting hours...
only 2.5 hours total for each day.  She had also become afraid to drink
much water worried that she would have to urinate, and at that time, the
staff hadn't taught her about treating her perineum with a sitz bath,
peri-bottle or anything!  When I went to visit her, she had only tried to
breastfeed once, and the nurses brought her a bottle of formula, so she
gave up.  She was clearly disappointed that she wasn't able to breastfeed
and had "no milk."  During my visit, we discussed latching the baby on, and
finally tried a "new" position with this mom, the cradle hold, and got a
wonderful latch-on.  Just a short time before he woke to latch on, she had
a small drop of colostrum on the tip of her nipple and broke into tears of
joy knowing that she in fact wasn't "dry."  She's not given a bottle of
formula since that day and has a thriving son, complete with a double chin
and dimpled hands.


In addition to pronouncing new mothers dry, there is very little
encouragment of breastfeeding in this Portuguese hospital.  I was admitted
for what we thought might be mastitis when my son was 7 months old - during
World Breastfeeding Week this past year - and was amazed to learn from the
nurses that they do not encourage breastfeeding. (They would all come in,
shift after shift, and stand at the foot of my crank-style bed in amazement
as I nursed my baby!) The maternity nurses referred to books with Nestle
products all over them.  One nurse got angry that I wasn't offering many
solids (she said "soups"!) to my 7 month old.  The OB told me that if I
hadn't been breastfeeding, I wouldn't have mastitis.  The surgeon who
performed a needle aspiration couldn't understand why I wasn't interested
in weaning.  It turned out to be a lymph infection and was cultured to be
effective with some antibiotic they wouldn't prescribe while I was nursing,
so of course, they said I must wean.  Needless to say, I showed the OB some
info on medications during lactation, and became an outpatient receiving
TID IM injections of gentamiacin.  We had only been on this island for a
month when this transpired. The GPs on the American base quickly became
aware of my desire to breastfeed.  :)

For the progresses that have been made in the US hospitals, and those in
other coutries, we are very fortunate!  Those on this base who have been
wonderfully receptive to promoting breastfeeding have listened with
interest to ideas of removing books from those given out to new mothers
(can I say the "What to Expect" series?), to promoting our monthly support
groups, to having a donor milk bank on the base for interested families, to
pursue setting up a Breastfeeding Resource Center, and to promoting
articles in our local publications that encourage breastfeeding.


Some of the obstacles I am facing are from the pediatrician, who encourages
or "gives permission" to mothers with 12 month old babies to wean and give
cow's milk.  She recommends giving 15ml of formula following nursings to
babies with jaundice.  She recommends supplementation frequently, according
to her, and indicated bad experiences with LLLL's.  However, on the
up-side, the RD has attended meetings, particularly when our discussion
revolved around weaning and nutrition, and has done further reading since,
that supports not substituting breastfeeding with foods of lesser value.
The Family Advocacy Nurse (FAN) pursued setting up a BRC, and has asked me
to introduce breastfeeding tips during their OB orientation classes. She
was most concerned to learn that some bf literature/videos they distribute
could sabotage a mother's successes with bf.  But, she also said that
they're pursuing setting up some sort of voucher system for formula as
well, and that if given a choice, she thinks many parents would pick
formula over donor breastmilk.  One of the Family Practice GPs has become
one of my biggest allies.  He offered to write letters to supervisors to
allow pumping time for employed moms, or make appointments for moms to come
to the clinic to use the in-house pump!

Collectively, I hoped that you could provide some suggestions to me for
introducing ideas that support and encourage breastfeeding to those who can
make changes on this base.  The FAN is coordinating a "conference" with the
Pedi, herself, the RD and myself, to discuss management of breastfeeding so
that "we'll all be giving out the same information."  I figure this will be
the best opportunity I'll have to get my foot in the door, so to speak, on
getting some of these ideas actually implemented.  Then hopefully once it
becomes a reality here, the military may take notice and set forth policy
to allow/encourage the same programs at other bases, especially with the
books given to moms!

I've enjoyed reading the ideas you all have had on teaching opportunities,
and making "infant care" classes assumed breastfeeding.  :)  If you have
other suggestions on what to do, when and how, please let me know.  Thanks
in advance.

Angela Howell, LLLL (other initials pending)  :)
and to think I resisted becoming a bf advocate!