Dr. Jen, you are doing a great job! it is so important for the mother and
family to hear supportive bf messages from the physician. you have rec'd
some wonderful suggestions too. I beliieve Best Start Social Marketing has
done some excellent research w/ focus groups and found that messages about
bf benefits are not very successful in continuing bf. Mothers know this but
still wean due to other real/percieved barriers. Some barriers were found to
be: embarrassment, bf ties you down (and return to work issues). I would try
to find out the reason that mothers wean prematurely. For a brief time I did
some f/u phone surveys to that effect. The reasons for weaning were often:
return to work, lack of decent pump, told to wean (incorrectly) due to
mastitis or meds, milk dried up (usually someone doing breast/formula from
the start). Once you know some of the reasons, you can target interventions.
For example if working and bf are problematic you could even do pump rentals
from your office! You could have support group meetings there or working
moms meetings. You could invite the local LLL or other established support
network to meet there. You could have one of your staff do a brief f/u call
during the early postpartum (I try for day 3-4) and again at peak identified
times of weaning, if you were able to identify this. I believe Evergreen in
Washington does a very successful nurse/Ibclc run clinic for bf dyads to
come back at day 3-5, I've heard Molly Pessl say they leave the cord clamp
on and have the moms come back in to have it removed. This is a sneaky way
to get them to come for that early return visit. In my community babies are
d/c'd from hospital and return to peds at age 2 wks. Then they come back at
age 2 mos. Perhaps there are peak times of problems or weaning that are
coming in between there. Well visits could be scheduled then. Do alot of
your clients utilize WIC? If so, maybe you could hook up w/ them to see what
they are doing and make sure you work as a team. Good luck, you are
certainly on the right track and I predict will slowly get your rates to
increase.
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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