Lactnuts, I would like quick feedback before I send the letter, since I got
the article over a month late, I want to respond quickly. How does this
sound? Email [log in to unmask] with comments.

Dr. Vicki Seltzer, President
American College of Obstetricians and Gynecologists
409 12th St, SW
Washington DC 20090-6920

Dear Dr. Seltzer:

As coordinator of the Louisiana Breastfeeding MediaWatch, I received a copy
of a column in the Bogalusa [Louisiana] Daily News dated Monday July 7, 1997
("Breast-feeding: Nature’s most perfect method"). In addition, I just
attended the annual conference of the International Lactation Consultants
Association with many world-renowned speakers, and I wanted to comment on
some of your remarks.

Thank you for discussing the superiority of breast milk, its nutritional
completeness for 6 months and its anti-infective and anti-allergy effects.
 Thank you also for mentioning lactation consultants and for advising the
mother to have positioning and feedings evaluated prior to hospital
discharge.

There are some points you made that  I would like to address.  Instead of
advocating "demand" feedings every 2 to 4 hours, I would teach a mother to
observe "feeding cues" during the early days, such as sucking the fists or
blanket, as crying is a late sign of hunger.  Eight feedings or more per 24
hour period would be appropriate.  I agree that avoidance of dehydration is
very important, but wonder if parents could really assess the fontanel.  I
prefer them to count feedings and output until breastfeeding gets going. Your
statement, "Make sure the infant is wetting OR stooling at least 6 to 8
diapers per day (emphasis mine)" might be changed to "6 to 8 very wet AND 3
to 4 or more bowel movements per day by the end of the first week." Sometimes
babies getting mostly the watery (low calorie) foremilk have the voids but
not the stools.  This can be corrected by letting the baby finish the first
breast before switching to the second, in most cases.

I disagree with your statement that "breast-feeding is not a form of birth
control, so talk to your doctor about the proper contraceptive to use during
this time." This sounds so patriarchal. LAM, or the lactational amenorrhea
method, IS a form of natural family planning which is very effective in the
early months when certain strict criteria are met. This is one option that
should be discussed with the parents so that the parents can make an informed
choice.  

The AAP is working very hard to update their information and policies in
regards to infant feeding, including recommendations about babies being seen
by a knowledgeable health care provider very soon (days) after an early
discharge.  I hope that ACOG does the same.

Respectfully submitted,
Laurie Wheeler, RNC, MN, IBCLC