Sir.—I would like to respond to the article on breast-feeding in the September issue of the Journal (132:885-887, 1978). I am a nurse practitioner in a private pediatric office where about 70% or 80% of mothers breast-feed, and our results are quite different from those presented in the article.
I cannot accept that 104 of 106 mothers experienced difficulty in breast-feeding unless one includes such things as mild engorgement and sore nipples, which are quite normal in the first weeks. Furthermore, a figure of 20% outright failures most likely represents not maternal failures but iatrogenic failures. Both of the studies from which these statistics were drawn were done in the 1940s and 1950s, when the pendulum had clearly swung toward artificial feeding.
In the past two years, only three patients in my busy practice have failed to establish weight gain at the breast in spite of every effort on the