DR DELBANCO: Mrs C, a 35-year-old communications
professional, has a 3-week-old child and has been experiencing difficulty
with breastfeeding. Married and living in Boston, she receives care from an
obstetrician-gynecologist, Dr T, at the Beth Israel Deaconess Medical Center
and has commercial health insurance in a managed care plan.
Mrs C experienced menarche at age 12 years, had a miscarriage 2 years
ago, and gave birth after an uncomplicated pregnancy to her first child. She
ruptured membranes on her due date and had a vaginal delivery aided by oxytocin
and epidural anesthesia. During pregnancy, she noted mild breast enlargement
without nipple discharge. She attended prenatal classes at the hospital, including
1 focusing on breastfeeding, something she felt important for both her and
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