Wednesday, April 1, 2009

Reply turned post, on how to promote breastfeeding without coming on too strong

Over at Mom's Tinfoil Hat, she's writing about stories of "breastfeeding bullies" and wondering where those stories come from. She sees far more women being disrespected and the targets of pushy behavior from formula-advocated nurses and doctors than she sees nagging, pushy lactation consultants. This was my reply (now slightly edited and expanded):

I agree that I have never seen LCs actually do this - just heard stories from moms without getting to see/hear the other side of the story. I don’t disbelieve that there are a few bad applies out there, but I agree with Labor Nurse that some stories might come from a mother’s reluctance to say out loud “I want to quit” and the LC not picking up on whatever signals the mother thinks she is giving. Hands-on postpartum, I have seen nothing but positive support, patience and working toward’s a woman’s breastfeeding goals, whatever they are.

I will say that prenatally I could see more of a challenge, because that’s I think when people feel comfortable being a little more hardline, and it is hard to advocate breastfeeding without stepping into a minefield. Just a few weeks ago I was at a birth where the mom told me that at the last minute, she had made up her mind to formula feed. I asked her why, then let it go for a while.

But it was a long birth, and I kept sitting there and thinking, Was I letting this go too easy? Maybe she just needed someone to nudge her back in the other direction, since she had been equivocating so recently. I didn’t think her concerns (returning to work, getting baby used to the bottle) were such big barriers as she saw them. But maybe they were proxy reasons for some deeper issues. Would I be a good doula by giving her more facts? Would I be a bad doula by not supporting her decision? Might she think a year later “That dumb doula at my birth who nagged me to breastfeed” or might she think “I’m glad she sat down and talked to me, because that helped me decide to give it a try and now I enjoy it”? I think sometimes my drive, or an LC’s, to give all the facts could be seen as nagging even when we are doing our best to be nonjudgmental and supportive.

I confess I had a few other things on my mind. I realize that I softpedal my behavior when I'm talking to someone who in my mind is unlikely to breastfeed. If a fifteen-year-old says she's going to formula feed and her mother is sitting right there nodding, is there any point in me saying anything? They've made their decision. She has more on her plate to deal with at the age of fifteen than I have in my entire life. Why should I start nattering on about fewer ear infections?

What about African-American women? As a white woman, it is so easy for me to feel awkward about promoting something that far more white women do, and have the privilege of being able to do, than black women. I have only begun to understand the complex cultural dynamics behind those differences. Should that awkwardness get in the way of the discussion?

What about single mothers, poor women who have to return to work right away, women whose whole families have formula fed, women who have formula fed their other children? Am I doing them a favor or disservice by keeping my mouth shut?

You could say I'm doing them a favor by respecting their decisions. But is that what every other person they interact with in the health system thinks too? Are they going to be frustrated someday realizing that because of their race, class, culture, or other stereotypes about them, they were not given the same information as other women? For all I know as a doula, maybe that's exactly what has happened and I am the last person available to say, "Just so you have this to think about..."

So while I don’t see LCs haranguing new moms “Don’t give up! Or you’ll kill your baby!” I understand where the nagging label might come from. Because eventually I pulled up a chair next to the mom's bed (she had a very effective epidural at that point, so I wasn't trying to harass her during contractions!) and I told her I thought she might want to give it a shot, and I gave her some reasons. She said "OK, I'll think about that." I think she was just being polite. I wasn't able to stay after the birth as long as I usually do, so I wasn't there for any first feeds. When I came to do my postpartum visit, I didn't ask, much less nag or yell, about how she was feeding the baby. But I still don't know how she would label my talk to her before birth. So maybe there are some LCs out there who are doing something we could call nagging prenatally. I just hope most moms understand that it's not done in that spirit.


mrsculpepper said...

i have strugled with this very thing...the internal conflict btw being respectful of choices and giving information. is it nagging to give information? i don't know. i think it depends on how its done. is it repeated over and over and over? does it come from out of nowhere or is there some reasonable lead-in? having just completed lactation counseling training and hopefully reciving the vertificate in the mail soon....mainly to have more up-to-date and accurate information for my friends and in my blogging, i sometimes wonder, am i too pushy?

publichealthdoula said...

Congratulations on your lactation counselor training!

One thing I find interesting is that you can be as informational as you want before someone gets pregnant. I can tell my childless friends information about breastfeeding, and that always feels socially OK - it's interesting information and they often ask me questions. But as soon as someone is pregnant or has a child, that part is over. Now you're telling them how to be a good mother, and that's not OK.

MomTFH said...

Thanks for the link love!

It's a delicate balance, indeed. I think most LCs are more in your thoughtful, considerate camp than the bully camp. Maybe I'm biased.