I've been quite behind in reading LACTNET, but wanted to respond to pediatrician Amy who wrote about a mom canceling a prenatal consult with her because she had decided not to breastfeed her unborn second child after all. She wondered how much to pursue the issue with the family and worried that she risked losing this family from the practice if she pushed too hard. I, too, have been faced with many similar situations, and the way I deal with them is still evolving. I feel very strongly about breastfeeding, and it is sometimes hard for me to not come across a fanatic. When I first started in practice, I tried hard to strongly encourage every pregnant patient I came in contact with to breastfeed. In an attempt to encourage, I think I sometimes came across as suggesting that anything short of what I was promoting was no good at all. I often put parents on the defensive, which prevented them from being able to hear me at all. I try now, to meet folks more where they are at. And when someone tells me they have decided not to breastfeed, or to wean early, or whatever, I try to meet them where they are at, and encourage them to do what they can feel comfortable with. I try to present evidence based info, and encourage them to make their own decisions. I especially encourage those moms who want to do only a little breastfeeding, or only pump milk, or only nurse for a short period of time. I feel successful if I can encourage a mom to nurse for her maternity leave only, if she was previously thinking to solely bottle-feed since she was going back to work. Sometimes, once these moms start, they decided that continuing after going back to work will work out after all. Sometimes they wean early. Same with moms who only want to pump for what seems to me strange reasons. I've had a few start off this way, then decide to put baby to breast. I've had more pump for a few days, then give up. I find if I'm supportive of their decisions to try a little bit, it opens the door to going further, either with the current babe, or with a subsequent one. I find if I'm not as encouraging, or push mom to fully, exclusively breastfeed, sometimes they think it's not worth trying if they have to do it some specific way they feel isn't compatible with their lives. A recent success story with this is a pregnant mom who could not latch her first baby due to what she felt were flat nipples. After seeing her niece successfully breastfed, she expressed an interest in pumping milk to give her second baby when. When she asked if she could just do this and not put the baby to breast at all, I supported that idea as a possibility, but also mentioned that maybe there would be some techniques to try to get the new baby to breast. She was very frustrated and discouraged the first time around and was worried about similar feelings this time. I suggested we try getting the baby to breast first, maybe try a shield if that didn't work, but keep the exclusive pumping idea as a backup plan if either the baby wouldn't latch well, or mom just felt too overwhelmed. She was relieved to think there were options. At her recent birth, she told me she felt no pressure about being "successful" putting the baby to breast, because she had her own back-up plans in place. And lo and behold, the new baby latched happily with just a few seconds of trying, and nursed like a pro! Mom's slightly flat nipples were no problem for this more aggressive baby. But if the baby hadn't latched well, mom felt she had support to try what would fit with her wishes. I continue to present breastfeeding as the norm, regardless of what choice the family has made, too. (For example, when asked when babies should start solids, I always say "Babies don't need any other food other than breastmilk, or formula if they are not breastfeeding for the first 6 mos." even to the formula-feeding parents, so that they hear that breastmilk is a normal food for infants. I also use the breastfed infant as the norm when I talk about infant behavior. (For example, by encouraging smaller, more frequent feeds for a bottle-fed newborn, since that is how the breastfed infant is normally fed.) I hope that by keeping breastfeeding in the conversation, it influences folks to view it more normally, and consider it again with subsequent children. I try to remember that most women I meet have not had much, or even any, life experience with normal breastfeeding. It is almost like suggesting they learn a foreign language to speak to their children! If I can make breastfeeding seem matter of fact, and adaptable to many lifestyles, I have better luck at encouraging some folks to give it a try at least. When I haven't been successful, I try to remember that most likely I am NOT the most important influence in someone's feeding decisions. I can only present the info, and cannot be responsible for what people do with it. I deal with it the same way I do any decision a patient makes that I'm not crazy about. I don't bring it up every chance I get and browbeat the person, but I do continue to portray breastfeeding as the norm, and reference it when it is naturally relevant to the situation. I have found I have very little resentment from folks this way, and sometimes even score some converts! Sorry for the rambling, it's hard to get across what I mean in the e-mail medium, and I'm also probably too tired to be trying to communicate! Jennifer Tieman Family Physician Mom to 4, including nursling Caroline Rose born 5/31/03 *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html