Hello again,
Morgan, I thank you for your post.  
Just to give everyone a clearer picture, our initiation rate is 98%.  At least 60% of babies 
are breastfeeding, at least some, at 6 mos.
It is rare that I have a family in the class that do not intend to breastfeed.  It is with 
much acceptance that we discuss the risks of formula v.s. breastfeeding.  In the 
geographic region that I live, the "right choice" in infant feeding is to breastfeed, at least 
initially.  
Functionally I have found that the class has changed very little, because I can mention 
within the class that powdered ABM is not sterile and all the work (sterilizing) involved 
with supplementing as part of the reason why one should avoid it (ie., to compare with 
the ease of BFing).  And as I mentioned earlier, I do not show/demonstrate ABM 
preparation.  The healthfiles on formula preparation are available for families to take 
home; they are not handed out as a matter of course.  
The change that has been made is to include ABM as part of the topic of discussion, albeit 
within the context of extra risk and extra effort.  And to call the class "Infant Feeding" - 
again keep in mind that within my local culture this means breastfeeding by default.  And 
finally, we have made the healthfiles on safer formula preparation available, soemthing 
that we did not do before hearing Mary Renfrew speak.
The way we were teaching before, made no mention of ABM feeding in any manner.  I am 
concerned that when the class speaks only to breastfeeding - 2 things happen: 
1.  Those who might even consider ABM feeding are afraid to even identify themselves as 
considering this choice.  Given that the usual and accepted way to feed one's baby, at 
least intitially, here is to breastfeed, this means that these families increase the risk of 
their choice by isolating themselves from healthcare professionals.  It creates a barrier to 
ask for help/instruction to do something that you full well know, is not "the right thing to 
do".
2.  Despite relatively good rates - we still have a long way to go.  Probably 80-90% of 
babies have had some ABM before the age of 6 mos.  Again, if we have not even 
discussed that there are recommendations for how to reduce the risk to feeding ABM, 
then how will parent know to access this information?
What happens within other communities and in other models of care?  
Again, where I live, we have early discharge and a visit from a public health nurse with 
48 hrs. of going home.  At this point, most families are working to breastfeed.  It would 
be inappropriate to offer 1:1 instruction on ABM feeding at this point - it would give the 
family the wrong message at a critical point in the learning to nurse process.  Of course if 
a family self-identifies as formula feeding, then we instruct about safer practices in 
regards to this choice.
I agree with Morgan's comment:  the key phrase is "when needed".  
If your community is like mine, it means that almost no family receives information on 
how to do "safer" ABM feeding from a healthcare professional.  Despite the fact that 
many (most) families give ABM at least at some time.
When does 1:1 instruction take place in other communities?  By whom?  At what point do 
you consider that the family needs this information?
Interested in how others navigate this process.
Warmly,
Tina Revai
PHN, IBCLC, LLLL
Port Alberni, B.C., Canada  

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