Over here in the Azores, we get our programming after you do in the US...
and I just saw the 20/20 report last night.  I fully agree with all the
comments here, and most of that, fortunately or unfortunately, never
crossed my mind during the segment on bf.

What did go through my mind were my own experiences after a breast
reduction, and in post-partum with my three kids.  I was told by my plastic
surgeon that no one would know if I could breastfeed until time came to
try, but that my nipples were never severed from my breasts.  (I went from
an I cup to an E; F during the early months/year of nursing.) When I had my
first child, almost every time I nursed him, a nurse was there to observe
*milk transfer* and was not concerned with the length of time he was at my
breast.  When I had my second child, no one really came to see if there was
milk transfer, since I had successfully nursed one child already.  That
baby didn't gain... wasn't getting milk.  The staff was only concerned with
how long and how often she nursed.

What I noticed missing from the reports were the statements from this
mother's postpartum records showing that someone had observed milk transfer
before discharging the mother... I guess this is the high-risk miss that
we've all mentioned.  Even if output were the primary target in determining
if a baby gets enough milk, isn't milk transfer equally important?  How
could she possibly be discharged if there's no milk transfer?  Why did no
one at the hospital show her how to tell when there is milk transfer?  Did
anyone tell her what to look for once her mature milk came in?  Would a
hospital be accountable if a formula-fed baby were discharged when no one
had observed him swallow?

And as for those who have posted the comments about how precious every drop
of colostrum is, like "liquid gold," I want to add that with my first
child, this was the idea relayed to me, too, and it gave me so much
confidence to keep going!  When I work with new and expectant mothers now,
I only call it colostrum once, at the beginning, then "liquid gold" every
other time.

What I liked best about the 20/20 report were the implications that this
mother wasn't trained or informed to notice the cues that her baby wasn't
getting enough milk, and that the responsibility of teaching falls back on
the doctors and nurses in post-natal and pre-natal care.  Someone obviously
reinforced the idea that her baby had a "healthy apetite" since she
reiterated that phrase several times, but apparently no one reinforced the
ideas that her baby was swallowing as if he could barely keep up.

This brings us back to the very recent discussion of how to teach LAM by
giving out ALL the information, and not just tiny pieces or none at all.  :)

How does the medical process as a whole expect mothers to know what the
latest information about breastfeeding is, if they aren't sharing this with
new mothers?!  I personally was outraged when I learned what I did about
breastfeeding from a LLL meeting, and not my doctor or during nursing
school.  Isn't that information important?!  (rhetorical!)  Thankfully,
someone did encourage me to find a LLL meeting, but I still think that
those basics should be taught before discharge, and not once there are
problems!

When I had my babies, I had to watch a 20 minute video on using a car seat
before I could be discharged, but got no information on breastfeeding.

Angela Howell
LLLL in the Azores