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Supplementation and Milk Banks

Dear LLLI,

Please clarify what a Leader is supposed to do when a mother mentions during a helping call that she is supplementing with formula. After reading "Supplementing the Breastfed Baby" in the Aug- Sept 1999 issue of LEAVEN, I am wondering if we are supposed to persuade the mother to switch to banked human milk instead of continuing to use formula? Although a mother sometimes mentions that she is supplementing with formula, I have never received a call asking the direct question, "Should I supplement?"

Some mothers mention they are disappointed that the baby is not receiving human milk exclusively, but others appear satisfied with using formula. If we are to enter into such discussions, how can we do it without being too negative? Please explain how much we should delve into this issue.

I'd also like more information on the milk banking process. Where are the banks? Are the banks readily accessible to all or are they concentrated around major cities? Are there milk banks world wide? Is the milk screened for disease? Is a physician's prescription required? Is there enough banked milk for all or do the banks limit it to certain populations such as premature babies or very ill babies?

I was recently accredited and did not come across anything about human milk banking during my application. I have been unable to find this information in LLLI publications such as THE WOMANLY ART OF BREASTFEEDING, THE BREASTFEEDING ANSWER BOOK and in LLLI pamphlets. An informative article on the milk banking process would help all Leaders.

Christine Montano
Orange, Connecticut, USA

Dear Christine,

Thank you for writing to LLLI with your questions regarding handling calls where a mother says she is supplementing with formula. I am sorry that the article "Supplementing the Breastfed Baby" created some confusion for you. The authors did not intend to imply that it is a Leader's role to recommend specific supplements - that is a decision for the mother to make in consultation with her baby's health care provider.

It is appropriate for Leaders to address the problem by focusing on breastfeeding issues, and not the supplement used. Certainly, if a mother expresses dissatisfaction with using formula, a Leader can work with the mother to explore what options - including information on banked human milk - she can discuss with her health care provider. You could consider sharing a copy of the lead article in the August-September 1999 issue of Leaven with her. Because La Leche League's focus is on helping mothers breastfeed their own babies, La Leche League is not actively involved with human milk banking.

Your suggestion that Leaders would benefit from more information about milk banks is right on target. At the same time that you wrote this letter, the lead article in this issue of LEAVEN was being prepared. (See pages 19-23.) If you find it helpful, you may wish to share the article with Leader Applicants with whom you are working. You may also want to add "milk banks" under the Breastfeeding Management section of "Topics to Discuss in Preparation for LLL Leadership" checklist in your LEADER'S HANDBOOK. Finally, always remember that your Area Professional Liaison Leader has resources to help answer more complicated breastfeeding questions.

Once again, thank you for writing and thank you for the work you do to help mothers breastfeed their babies.

Anne Easterday
LLLI Board of Directors
Omaha, Nebraska, USA


Outdated Books

Dear LLLI,

I was pleased to find two copies of The Complete Book of Breastfeeding which is now being offered in the LLLI Catalogue, at a thrift shop for 25 cents (US) each. After I checked the Catalogue I realized that these were an earlier edition (1987) of the same book.

What is the LLLI policy for Group Library books which are no longer the latest edition or are slightly outdated?

Angie Burks
Fort Lee, Virginia, USA

Dear Angie,

There is no official LLLI policy on when to pull early editions of approved books from Group Libraries. Leaders need to use common sense and good judgment. It's important to keep the Group Library up- to-date and attractive.

Before 1988, the guidelines in the LLLI Bibliography stated that books marked as deleted had to be removed from Group Libraries. The specific book you mention, the 1987 edition of The Complete Book of Breastfeeding, is on the 1988 delete list and so should not be placed in a Group Library.

Since 1995, recent editions of the LLLI Bibliography state that books on the delete list "should be removed from Group Libraries as they become worn and are no longer circulating." The Book Evaluation Committee prefers to allow Leaders to make these decisions since Group situations and finances vary tremendously.

It is best to have the most current edition of any book that is included in the Bibliography. This is especially true for a book which contains technical or medical information. It is not helpful to mothers to place an out-of-date book about breastfeeding in a Group Library. Certain books with medical or scientific information are considered out-of-date after five years. Parenting or children's books tend to be more timeless, and there are some out-of-print books, such as THE HEART HAS ITS OWN REASONS, which remain in the Bibliography although they are out of print. It is fine for these books to remain in Group Libraries as long as there is interest.

I am frequently asked why particular titles have been added to the delete list in the Bibliography. There are several principal reasons. Most often the title has gone out of print or a better or newer book on the same subject has become available. Space in the Bibliography is limited. As we add new books, we need to remove others. The last printed version of the Bibliography is 35 pages long. It needs to remain at a practical length for Leaders to consult and for us to update. If a book is out of print, Leaders will find it difficult to locate a copy. There will be other books that are better investments of Group monies.

To keep up to date with the list of books that are suitable for Group Libraries, Leaders should order the annually updated LLLI Bibliography (No. 174-13 $2.95 US). The Bibliography, along with a complete list of deleted books, is also available on the LLLI Web site at www.lalecheleague.org/BEC/BEC.html*. The LLLI Catalogue carries a selection of books listed in the Bibliography, including some of the most recently added books. Every six months, a list of newly approved books and summaries also appears in LEAVEN. (See pages 28-29 in this issue.)

I hope this answers your question. Happy reading!

Diane Beckman Chairman,
LLLI Book Evaluation Committee
Cary, North Carolina, USA

* Note: Book approvals may vary in Affiliates.

* This address updated 11/17/06

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