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Discussion of paper by Valdés and Schooley


Professor Howie

I suggest that factor X is important, and it almost comes back to the sort of things that Dr. Van Esterik was talking about. It is the whole culture and atmosphere, and I was very impressed with that picture of the maternal support group. It was the warmth and the smile of the health professional in the middle of the group that really made an impression on me, and I don't know if the other people in the group felt the same thing. I felt that she was exuding a very large dose of factor X. The real challenge is how to get everybody exuding factor X. It has to do with smile and atmosphere and less to do with the mechanics of the videos and the material. I suspect that factor X is the key to the sort of things that you are achieving.

Dr. Valdés

I think the important thing is that factor X is contagious. Once you learn the style, you can't make a traditional, boring course. Now, people get there and they are received maybe with candy, maybe with some touching things. That's the only place where working women come and charge their batteries. The doors are open, they sit, they chat. We have become sexual psychologists because all their concerns come to us and they are heard. I think that's the reason they come back to the programme. They follow us, and they believe us.

Dr. McNeilly

When Professor Howie and I set up the first breastfeeding study in Edinburgh, we were aiming to recruit 200 women. We assumed the average time of breastfeeding was four months, so there would not be a problem. We would finish the study in two years. We had to have a meeting after four months, because none of the 20 women who had entered the study at that point had even thought to stop breastfeeding. We couldn't understand why, but the reason was that the research nursing sister who was recruiting them, Mary Houston, talked to these women about problems with breastfeeding, children, anything. They kept going because they would save their problems up, and she would visit them every two weeks, and they would keep going until she arrived and pour out their hearts to her. She would fix it, and they would carry on. Now, having subsequently done a study on that, we found that the difference between the women who gave up and the women who carried on was not that they had fewer problems or anything like that; it was just that they had somebody whom they could rely on to discuss their problems with, and Mary Houston certainly had factor X. So, I think that from our point of view, we stopped at 45 women rather than 200 because factor X interfered with the programme.

Dr. Garza

I enjoyed the presentation. It obviously shows what one can do with a good system. But I was struck by the complexity of what is needed, because we have dismantled the family structure that used to support it, and in some ways there are parallels with formula. Whenever we try to replace a natural system with an artificial one, we keep discovering that many things are missing. I'm wondering what you are doing to get yourself out of business. Because that would be our ultimate success; that is, when we wouldn't need those very complex systems to replace a family structure.

Dr. Valdés

I'm trying hard to get out of business. First, by including breastfeeding in the medical curriculum so we don't have to retrain professionals. I think the next step would be to include breastfeeding in the schools and change what children are taught in school. I have now gone to my children's school because I'm horrified at what they teach them. That would be another step. When you see that 60% of the mothers are breastfeeding, these children will have had the opportunity to have seen breastfeeding in action. So, I think we are reversing the situation.

Dr. Lawrence

A very nice presentation. I would add that before we change things completely, we have to go back to the school system. In New York State we have created, with the Department of Education, a curriculum for kindergarten through high school that is currently on trial in one part of the state. Our aim is to educate all children, not just girls, that breastfeeding is normal and to put it into the curriculum: not to have them take a course in breastfeeding, but to have it as part of the curriculum. The second piece is the education of the health-care professional, and that, too, needs to be part of the total curriculum and not something you can choose or not choose. We have tried a model programme doing that as well, in which our first-year medical students get something about the value of human milk in their nutrition course. They get the anatomy and physiology of the breast in their second-year course on women's health, and in the third year all of our students spend a week in the newborn nursery, seeing mothers, helping them breastfeed, and learning what the practical questions are. But, in response to Dr. Garza's comment, we have to weave it into the normal curriculum for everybody in their culture, plus the health-care professional.

Dr. Valdés

I completely agree, and it is important that it be present in all of the schools to send the same message.

Dr. Perez

I discovered Veronica Valdés in 1985, and because we had to start a research project, I asked her to go to Wellstart. She stayed there a little over a month. When she came back, the first thing she did was to give us a one-day workshop on breastfeeding. There were 18 obstetricians and gynaecologists from Catholic University's Department of Obstetrics and Gynaecology. Some of us have been in this department almost 40 years, several of us have a lot of experience, and some of us have some background in breastfeeding research. After the one-day workshop, we could not believe how much we had learned about very simple breastfeeding techniques. I'm sorry Dr. Valdés didn't talk about how to teach a woman to breastfeed, because she knows a lot about that, and she is a genius about that very simple thing. We, with 40 years of practice, did not understand that, and she, after being in Wellstart, taught us in a fantastic way. I believe this first step of Dr. Valdés in our university is a very important step in any breastfeeding programme, which is to teach the health team.

Dr. Valdés

Thank you, Dr. Perez. It was quite a challenge, because we had to teach our teachers.

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