Ah Marianne just made me realize that I should have been more clear about the 
circumstances.

I am talking about the situation that is 95% of what I see here in Manhattan.  Mom has 
not put the baby to the breast sufficiently in the hospital for any number of reasons most 
of which are iatrogenically induced.  The milk supply is in the toilet and the baby has lost 
so much weight that it is too fatigued to feed.  Mom has been supplementing with formula 
for a week or two and then wonders why any one of the following occurs:

a) the baby gets royally pissed off when the flow slows down
b) the baby simply goes to sleep and won't take more, then wakes up every 30 minutes 
or so
c) the baby losing a whole bunch of weight all over again.

I mostly see babies for home consultations that are under two weeks of age.  In the 
group clinic I tend to see babies who are under three months of age.  Sometimes up to 
six months and the random mom with a toddler who comes back in.

In this particular subsection of the world's population, I don't find many babies capable of 
pushing the supply back up when it has been so seriously compromised by the diminished 
contact between mother and baby that seems to be pushed in Manhattan society. 

Plus, many others here MUST go back to work very prematurely because we have such 
abysmal protections for working families.  

So, of course Marianne and I would see very different data.

To clarify --- the reason why I said a baby CAN'T take more is that there really isn't a 
whole lot left for the baby to get out when mom hasn't been draining her breast regularly 
with either the baby or the pump.  Furthermore, a baby that has been compromised 
excessive separation; feeding episodes that are too short, rushed, or infrequent; and/or 
traumatic experiences with rapid flow bottles in positions that no adult would ever 
tolerate without choking is less capable of getting it out compared to the baby who has 
had a NORMAL initiation to feeding.  

I'm sure Marianne is sees far more NORMAL feeding than I see.

I would ONLY say that the baby is more efficient than the pump for the individual mothers 
for whom that is true.  BUT since Manhattan is particularly prone to an insane degree of 
efficiency standards, I cannot bring myself to use that term in reference to babies.  Just 
to give you a picture of how ridiculous it can be, I know for a fact that children as young 
as two years of age are asked at nursery school interviews to add 200 + 200.  I'm sure 
that is not the case in the Netherlands.

And I since I weight babies feeding from the breast and babies feeding from bottles and 
what comes out of the pump.  I do not find in this particular culture and environment that 
many babies take out more than the pump does, nor faster than the pump.  I've met 
about 10 babies to date for whom that was true.  I do not think of this as a standard that 
applies to the rest of the world, only the little minisegment within which I work at the 
present time.  I am sure if I had continued to work internationally, I would see a very 
different picture. 

It sounds like Marianne is working in an environment where it is much easier for mothers 
and babies to create that very essential synchrony.  

Finally, I try not to extrapolate my own breastfeeding experience to everyone else.  Here 
in Manhattan this is especially important.  I had the good fortune to watch women deliver 
babies by the side of the road, at home with the entire extended family (including the cuy 
or guinea pigs living under the bed and the dog) participating, in a hospital with no 
electricity for C-sections and watch women nurse their babies all day long without a 
thought.  I had the benefit of too many years of study to ever doubt the research that 
showed the risks of not breastfeeding.  So, while I could say to every woman I encounter 
that I fed my son 20 times a day and hated the pump when I was at work and loved 
breastfeeding him until he was 6 years old --- these women have not had the 
transformative experience I had.  So, I have to find other ways to entice them into doing 
a bit more and enjoying the experience than using my own experience.

Best, Susan

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