Linda Wieser, Mahone Bay, Nova Scotia, Canada

 

Sometimes potential Applicants have experiences that are “outside the realm of the normal/physiological course of breastfeeding.”  To address this possibility, there is a Special Consideration Clause in Applying for Leadership, LLLI Policies and Standing Rules (PSR).

 

 

There may be many reasons why a breastfeeding experience is “outside the realm of the normal/physiological course of breastfeeding.”  Perhaps the challenges felt overwhelming and the mother weaned.  Maybe the person had little knowledge about the normal course of breastfeeding.  Or unfortunately there may have been little support for the nursing couple. Lack of support or inadequate information are not sufficient to accept an application under this clause. However, when there are “medical, physiological, or anatomical issues,” an application may be accepted under the Special Consideration Clause if the LLLI Prerequisites to Applying for Leadership (prerequisites) have been met.

When considering an application, it’s important to remember how LLLI defines breastfeeding in the Introduction to Applying for Leadership (PSR)

• LLLI defines the act of feeding the baby directly at the breast as breastfeeding. 

and recognize that the Special Consideration Clause applies only to the Personal Experience Prerequisites which are described as “mothering through breastfeeding.”  In Applying for Leadership (PSR) it states:

The experiences of breastfeeding and mothering are two parts of a whole that is described by LLLI as “mothering through breastfeeding,”…

If a Leader has a question about whether a potential Applicant can be considered under this clause, the Leader can turn to the Leader Accreditation Department (LAD) for guidance.

Recently several members of the LAD Council reviewed potential scenarios and offered a group opinion.

1. Aya

Aya’s baby suffered breathing difficulties and seizures immediately after birth. The baby was hospitalized for several weeks and during that time was fed by a tube. Aya pumped her milk and fed her baby with a supplementer and via finger feeding, occasionally using formula at times when she was unable to pump enough. She was eventually able to get the baby to the breast and stop supplementing, but continued to have difficulty with supply and the baby did not gain well. The baby’s doctors were not supportive of breastfeeding. The baby was finally diagnosed with cerebral palsy at a year. Aya continued to nurse using a supplementer until age two.

Things to consider:

• Baby was fed at breast and nurtured at the breast after some initial challenges.
• “At the breast” does include using an at-breast supplementer.
• Nursing and using a supplementer until age two meets the prerequisites.

Opinion of group: Likely to accept application.

2. Brigitte

Brigitte is diabetic and has struggled with low milk supply. She was told that diabetes can cause low milk supply and reluctantly supplemented with formula in bottles for the whole of the first year. Her doctor ruled out thyroid issues as a possible cause of low supply (by testing). Brigitte tried to use a supplementer, but said that it did not work for her: when using it the baby became easily frustrated and fussy at the breast. Brigitte is happy with the amount of breastfeeding she has been able to achieve.

Things to consider:

• Brigitte is nursing at the breast and supplementing with formula.
• Diabetes Type I may result in a slow start to establishing supply, not necessarily a permanent low supply.
• Is she using the breast as a tool for mothering?
• If she has a low milk supply, is she pumping?
• How long did breastfeeding continue?
• How does Brigitte value the breastfeeding relationship?

Opinion of group: More information is needed

3. Claudia

Claudia had a life-threatening illness and needed to take a medication that was incompatible with breastfeeding for several months. The baby was ten months old at the time and refused to go back to the breast later. 

Things to consider:

• How did Claudia continue to mother her baby with the bottle? Was she cuddling the baby in addition to offering the bottle?
• Ten months is close to 12 months; however, Applying for Leadership (PSR) clearly states breastfeeding needs to continue for 12 months.
• Could the application be accepted under the Special Consideration Clause?
• Was Claudia able to nurture her baby during her illness?
• How did she wean her baby to take the medication?

Opinion of group: Need more information

4. Dafne

Dafne breastfed her baby for only six months because of a lack of accurate breastfeeding information. She now truly regrets that she did not continue any longer. If she had had LLL information and support at that time, she would have continued breastfeeding. She is now playing an important role in the Group and would like to help others find the kind of information she lacked.

Things to consider:

• Does not meet the personal experience prerequisites of breastfeeding for 12 months.
• Lack of accurate information is not a special circumstance.
• Need to check whether there was a medical situation.

Opinion of group: Does not meet prerequisites from the information given above.  Dialogue with the mother and help her understand the prerequisites. Check whether any medical conditions were involved.

5. Eva

Eva was in a car accident when her baby was three months old. Unfortunately she was hospitalized for two months and unable to nurse her baby because of the strong medication. Before Eva left the hospital, she tried to relactate and offer her baby the breast. However, baby was too used to the bottle by now, and would not come back to the breast. Eva was able to pump some breast milk which she added to the formula and she kept pumping until her baby’s first birthday.

Things to consider:

• No breastfeeding after three months although she tried to relactate.
• How long did Eva try to get her baby back to breast?
• Did Eva try using a supplemental nursing system?
• How did she mother the baby? Did she try to use the breast for comfort?
• Is mother aware of the mothering/relationship role of breastfeeding in addition to being a food?

Opinion of group: Need more information

6. Fatima

Fatima’s baby was exclusively breastfed until six months.  At that time, Fatima had a serious accident and was hospitalized for two months, during which time she was unable to nurse. When Fatima returned home, she was unable to reestablish her milk supply. However, she continued to offer the breast and comfort-nursed her baby until the third birthday.  

Things to consider:

• Continued to offer breast and maintain the relationship with baby at breast—wonderful example of nurturing.
• Did anyone give Fatima information about pumping? Or was she discouraged from pumping?
• Did she try an at breast supplementer?

Opinion of group: Could possibly accept; need more information

7. Galina

Galina had breast reduction surgery as a teenager. She was never able to establish a complete milk supply for her baby. She decided to use formula in a supplementer and never used bottles. She finally gave up using the supplementer at 18 months and the baby continued to nurse until age two for comfort.

Things to consider:

• Continued to nurse until age two for comfort.
• Mother continued to breastfeed even after stopping the supplementer.
• Classic example of a case outside the normal course of breastfeeding.

Opinion of group: Likely to accept.

8. Helen

Helen has hypoplasia. She was never able to breastfeed either of her babies fully because of insufficient breast tissue. She tried using a supplementer, but it didn’t work well for her and her babies were fully weaned from the breast at around six months.

Things to consider:

• Unfortunately she will not meet the prerequisites if she did not continue to comfort nurse at the breast. Even when there is a low milk supply, babies can be comforted at breast.
• Both babies weaned about six months. Perhaps she wasn’t offering the breast enough?
• May want to ask more questions.

Opinion of group: Unlikely to meet prerequisites

9. Inge

Inge’s baby went on a nursing strike at four months. She did all she could to coax him back to the breast. He continued to nurse at night for a few weeks, but then stopped altogether. Inge suffered plugged ducts, mastitis, and a bout of influenza. She saw lactation consultants and took the baby to the doctor, but nothing seemed to work. She pumped her milk and tried using a nursing supplementer to no avail. As the baby continued to refuse to nurse, her supply began to dwindle and she gave up pumping when the baby was six months old. Inge was devastated and hated having to use bottles and formula. She continued to wear her baby and sleep with him at night. She believes strongly in LLL philosophy and wants to use her experience to help others.

Things to consider:

• She would be a great support to the Leader.
• Special Circumstance only applies when there is a medical, physiological or anatomical issue.

Opinion of group: Unlikely to meet the prerequisites; need more information

10. Jeanne

Jeanne adopted both of her children. She got her first baby when he was only a few days old. Jeanne had never been pregnant, but she was able to stimulate a milk supply by pumping and by putting the baby to the breast. Although her supply was not enough to meet the baby’s need, she supplemented with a Supplemental Nursing System (SNS) at the breast until the baby was 15 months old and continued to nurse for comfort after that. Jeanne’s second baby was already nine months old when she adopted her, and she was never able to encourage her to take the breast. She always held her close when giving a bottle to simulate breastfeeding as best she could and to establish a bond with the baby.

Things to consider:

• This mother meets the prerequisites for the first child as she had the experience of breastfeeding this baby for over one year.
• Didn’t get second child for 9 months; due to the adoption agency it was out of her control when she got the baby.
• She always held the second baby close while feeding with the bottle.

Opinion of group: Likely to accept due to experience with the first child. When the mother has gone through unusual circumstances, it helps to refer to her previous breastfeeding experience if any, although the LAD normally focuses on how she looked after her latest baby.

If you think someone might meet the prerequisites under the Special Consideration Clause, please gather as much information as you can about the potential Applicant’s personal experience before consulting the LAD. LAD reviews each application with fresh eyes, not comparing it to a similar situation in the past. Each potential Applicant has an experience that is unique to that nursing couple. Having a complete picture of the potential Applicant’s experience that is “outside the realm of the normal/physiological course of breastfeeding” helps the LAD reviewers make an informed decision.

Information shared with the person’s permission needs to include:

• Any medical, physiological or anatomical issues of mother or baby that may have affected the breastfeeding experience.
• Any advice or help the potential Applicant received from healthcare providers.
• Examples of how the potential Applicant demonstrates “mothering through breastfeeding.”
• What the potential Applicant did to establish, maintain or rebuild a milk supply.

If you have any questions, please consult the Coordinator of Leader Accreditation (CLA) for your Area.

Linda Wieser lives in Mahone Bay, Nova Scotia, Canada, with her husband, Jim. They have two grown daughters and four grandchildren. Linda has been a Leader since 1984. She was in the Professional Liaison Department for about 15 years and has been in the Leader Accreditation Department (LAD) since 2008. Linda is currently the Interim LLLI Director of LAD (DLAD).  She is also Contributing Editor for “Preparing for Leadership” in Leader Today and Contributing Editor for “How Would Your Respond?” in LADders, a publication for LAD representatives.