Re: melbournes child

[Kleimar]

I think this is an excellent response as it hits many of the issues involved when women wean early. I haven't read the article but  got from your response that the main issue was "insufficient" infant weight gain in the first week or so. I am also guessing ( because I have heard this from mothers) that the advice given by staff may have been diverse and thus confusing. I think this goes with the territory of lactation, since it is just a little (or a lot) different for everywoman. There are some essential basics, such as supply = demand but after that different positions work better for different women, nipples themselves have an enormous variation, skin types etc. etc. not to mention maternal and infant personality and preference. I think the very best advice is to somehow convince the woman in her antenatal period to attend a local ABA meeting (formally Nursing Mothers Association). This was by far the gem my GP insisted up! ! on almost 26 years ago in Brisbane, and even though I didn't become a member then, I was impressed with the variety of breastfeeding relationships between mother and baby. I also knew I had a 24hr hotline available. I don't know if Corinda Maternity is still open, but I do know they had a staff dedicated to establishing breastfeeding before you went home which was about a week then. I do think it is important for the mothers to be aware that the most important indicators  of the baby's well being are # of pees and poops and allertness vs irritability and/or lethargy in the baby. Slow weight gain is fine if all else is normal, if it isn't then why the mother's milk is not in by day 3 or 4 should be investigated. I hate to sound too medical but no weight gain/ continued weight loss do/does need to be investigated, nipple pain at every feeding can have other causes (Candida for one) besides poor latch, and previous breast surgeries may pose some difficulty.

Last year I worked with a mom (it was in the USA, I am here though now) who had had breast reduction surgery 7 years ago. Her milk was slow to come in and as her care givers the other midwife and myself had different ideas on whether she should supplement. Denise Fischer at BreastEd.com gave me and subsequently the mother excellent advice. The mother also accessed some excellent midwife/lactation consultants in Santa Cruz, California, who gave wonderful support. The baby had lost 10% of her birthweight and was irritable and lethargic, mom could pump some milk, so the process was working but the supply lines needed some time to reconnect (I think). Anyway, she did supplement always feeding first but comping before the baby got too tired. The baby was fully breastfed by 4 weeks and is still nursing and thriving over 12 months later.

For me the key ideas are flexibility on the part of the care giver. The other midwife had read the research on breastfeeding and AIDS mothers and taken from that that babies must be only ever given breast milk because otherwise the linings of their stomachs will be damaged (perhaps forever). She really and truly in her heart felt that supplementing that baby was wrong. So, she couldn't advise her to feed the baby anything but breastmilk.  I however could, after advice from Denise. Now, I am mentioning this just to emphasise how women can get different advice from care givers in this case in the same practice. The woman concerned was very well informed, a doula and CBE herself, so she had the resources to deal with the conflicting info, however I am sure that women without such connections must be overwhelmed.

Hence my plug for ABA. At a meeting you see the variety of styles for yourself and somehow it impresses upon you the uniqueness of the breastfeeding relationship: it is just you and your child.

marilyn