Rachel Myr said: 
"All women and babies need follow-up care after birth. That care should be sufficient to catch lactation problems before they are a threat to health..."

Oh, if that were only true where I live! 

The promotion of breastfeeding did not include a parallel plan consisting of planning and creating a good postpartum follow-up system.  

The only time I was able to see how this would/could work was when Jane Heinig was completing the WHO Growth Chart studies in Davis, California in the late 90's.  Those IBCLCs participating in it were a real team.  The LC in the hospital did not have to "do it all" or "teach it all".  She knew there would be others who followed the mothers at home, and they in turn knew they could chart and a knowledgeable IBCLC would be following up a few days later.  If there were issues this baby would be quickly referred to health care providers, etc.  

Unfortunately the moms I see now wait..and wait...and hope...and feel they "should not need help" (From my last home visit: a pediatrician with her first baby, her mother lived nearby and her husband worked from home...so she felt that she should "be fine" and not need to ask for help - from her mother or anyone else, even though she had a disappointing delivery a c/s and had pain both of her back and her nipples...).

Moms who come to our La Leche League meetings often do call - although I find this is mostly from mothers who attended with their husbands - either he calls or he "helps" her make the call.  Moms I meet through our public health department do not call WIC or their Public Health Nurse, but rather wait for their next appointment - which could be weeks in the future - even though they have been told to call and come in earlier.  

In other words, "No Cry for Help" is true as much now as it was when Dr. Heinig created a PowerPoint of this same name, in 2004.  Ref: Barriers to compliance with infant-feeding recommendations among low-income women.
M Jane Heinig, Jennifer R Follett, Kara D Ishii, Katherine Kavanagh-Prochaska, Roberta Cohen, Jeanette Panchula
Journal of Human Lactation 03/2006; 22(1):27-38. DOI:10.1177/0890334405284333

HOW do we create a network of support that contacts the mother rather than waiting until she calls us?  How can it be funded?  Staffed? (Sorry, is this more a US issue?)

Hypoplasia is only one of many problems that is not easily identified in the early prenatal period, especially as we discharge mothers in 24 - 48 hours.  

We talk about "empowering women" but I don't think it is the women we need to be "fixing"...

Jeanette Panchula
Vacaville, CA

I put this e-mail in my "drafts" as I had a LLL meeting to lead - at 6:30 this AM, I got a call from a mom whose baby is 2 weeks old - delivered in a "supportive" breastfeeding hospital, saw an IBCLC at 2 days but found she could not latch the baby on "as they showed me" so since discharge she has: 1) stopped breastfeeding due to pain in her nipples and engorgement 2) pumped through the engorgement 3) attempted to get baby back on the breast 3) used a nipple shield to get baby to latch 4) insisted baby go back to the breast and stopped both formula supplementation and nipple shield 5) has cracked and bleeding nipples - all without any resources except the Internet.  So she called me this morning  at 7 AM to ask when my next La Leche League meeting was!  (We just had one last night.)  This is not an "unempowered woman" - it is a "lack of timely, convenient, and effective support" woman!

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome