Thursday, June 2, 2011

The breastfeeding police, or how what you don't know can hurt breastfeeding mothers

Anne at Dou-la-la has a guest post up on The Leaky Boob and it is a gem. Here's a few excerpts:

YES, I do think that women who feel they ‘can’t’ produce enough milk have often been sabotaged (i.e. booby-trapped) in ways they are unaware of. And one of the things that most often thwarts them is misinformation.
HOWEVER. Statements that imply that really, everyone can breastfeed and if they didn’t succeed, they just didn’t try hard enough, mind over matter? EVERY BIT as misinformed as the bad advice that might have led a mom to undermine her supply or her belief in her supply. I know it’s highly unorthodox for a breastfeeding advocate to call other breastfeeding advocates out when their intentions really were good, but I see so much poor advice online that it’s really starting to get to me. ...

This does NOT mean that there is not a place for peer support. There so absolutely is is – La Leche League turned the tide on breastfeeding half a century ago and its very foundation was peer support. But part of being a trustworthy resource is knowing when something is beyond your knowledge – even for professionals, certain things are beyond one’s scope of practice, and it is crucial to have the honesty and humility to know when to refer.

I am a brand spankin' new IBCLC (just got my exam pass in October 2010). Before that I was trained as a breastfeeding educator (think peer counselor-type level) and as a doula, and I wrote my senior thesis on breastfeeding. I knew a fair amount about this whole feeding-babies-with-your-breast thing, I really did. But once I started training as an IBCLC, I suddenly realized how much I DIDN'T know...and when I started actually working as an IBCLC, I realized how much I STILL didn't know all OVER again. In fact, the more I learn the more I stop answering questions confidently, and instead turn to my mentor LCs (with their 5-20+ years of experience) and reference books to double- and triple-check what I THOUGHT I knew, before I give any answers. And in the meantime I hear loads of unhelpful or clueless "advice" being doled out left and right. (If I hear one more NICU nurse suggest "drinking lots of water" as a solution for low supply...)

As Anne says, this isn't a "leave it to the experts, ladies" kind of situation - there absolutely is a setting for educated, compassionate peer support and it it SO important. But let's have it be educated and compassionate - not rife with statements like "everyone can make enough milk" (I saw 2 women in the hospital this past week with classic signs of insufficient glandular tissue, and if they don't reach a full supply even with optimal milk removal, there will be a pretty darn good physiological reason that they CAN'T).

When they hear that I'm a lactation consultant a lot of people share their difficulties with breastfeeding with me (same goes for doula and birth!) I sometimes hear it as a defensive explanation, sometimes as a way of continuing to grieve/process the experience, sometimes as a simple "oh, you'll be interested in this" conversational topic. No matter what, it's hard to find a way to respond, but even when I hear something in their story that doesn't sound accurate or misguided, I try to focus on what I can simply validate and acknowledge. "Exclusively pumping is so hard, I'm impressed you stuck with it as long as you did", or "That sounds so painful, I'm sorry that happened to you". (One of my LC colleagues says, "I'm sorry things didn't work out; often people find breastfeeding is easier with the next baby" to help leave the door open for trying again in the future.)

What I don't do is ask questions or try to learn more about the situation. If a mother thinks things could have gone differently or wants to know how to change things with the next baby, she will ask me! In the meantime, support, empower, offer resources to help the mother learn more and get more advanced help - but let's stop assuming we know everything about a woman's situation, particularly after the fact. It doesn't do her any favors and it sets breastfeeding back as well.

Please read Anne's post for a thought-provoking discussion on this topic! And please share your thoughts - what do you say when a mother shares her difficult breastfeeding story? If you had challenges breastfeeding, what were helpful/unhelpful things that people said to you?


Elita said...

Everyone wants to tell me their story, too, when they find out I have a breastfeeding blog or that I am a CLC. I usually do the same thing as you, I show empathy for their situation or I pat them on the back for overcoming a tough obstacle. I never give advice or correct their misinformation, because it doesn't feel like my place to do so and I don't want to make anyone feel guilty. What I do find difficult is when I am with a group of women, some who have never had kids yet, and someone throws out an, "Oh my milk just dried up when my baby turned 3 months old" or "Lots of women don't make enough milk, everyone I know had to supplement" or "I had a 10 pound baby so I couldn't breastfeed because he was too big." You get the drift. In those cases, where the women don't seem traumatized or guilt-ridden but are telling total lies to other women who don't have kids and might internalize those bits of inaccurate information? Sometimes then I want to say something, but even still I typically don't.

Susan said...

I'm curious about your statement that you don't ask questions of women who share their stories with you. Sure, maybe not questions like, "Oh, well, why didn't you try harder?" But why not questions like, "How did that make you feel/how do you feel about that now?" (If appropriate - if a woman is just sharing a story because she thinks you'll find it interesting, it may not be, but for a woman who have experienced some difficulties, it could be a nice way to let her know that you're engaged and listening fully to her, and you want to know more.) I think it can be dangerous to assume that all women will come out and ask questions, too, so I was thinking that in some (again, appropriate) situations it might not be a bad idea to ask, "Is there anything I could try to answer for you?" or, "Do you still have any concerns about that that I might be able to help you with?"

But then, I worked as a health coach for over a year and got really in sync with the idea of motivational interviewing, so I just might be inclined to go a little further. And of course you know the situations you're thinking of, and I have no idea. :)

Rebecca said...

@Elita: Ugh, yes, that is the hardest situation. Sometimes I'm able to go with the drift and say something like "Wow, yes that is hard, I've worked with a lot of women who've had the same problem, and what worked for SOME of them was... [offer solution]". That at least doesn't single out the woman talking as being the only person to experience the problem, or that there was some perfect solution that they missed. Strictly accurate information may suffer in this approach but it can help. (I really struggle with this in Centering Pregnancy groups where we have some primips and some multips, and the multips may be giving really bad advice/information and I'm in a setting where I am actually supposed to educate while also empowering! Augh!)

@Susan: Interesting idea, although I would need to really prep all possible responses to my of the reasons I don't ask questions is to try to get off the subject as quickly as possible because there are sooo many wrong directions the conversation can go.

Anne said...

Thanks for the share, Rebecca! Fittingly, in the draft I have going for a brief follow-up I'm planning to post on that guest piece, I mention the "Drink gallons upon gallons of water!" thing as well. Another piece of information, passed along and misunderstood and exaggerated. "Being DE-hydrated can affect your supply, so . . . so, therefore, the more you hydrate, the more milk you'll make! Easy as that!" Except, well, no.

Elita, the group situation is the hardest, for sure. Your empathetic approach with individuals is right on - yet how to do so with a group WITHOUT perpetuating misinformation? Hard stuff.