Breastfeeding in the Real World: Meeting Mothers' Needs Through Listening
I, along with hundreds of others, will be recharging my professional batteries this week at ILCA 2014 ( #ILCA14) in Phoenix, AZ. I will attend expert lectures, participate in clinical workshops, network with peers from around the globe, examine the latest research, visit exhibit booths of vendors and educators, and arrive home armed with new information and techniques to enhance my IBCLC practice. But what I will actually be doing is strengthening, fortifying, and improving my ability to counsel mothers. It's really the most important thing we do as IBCLCs. Our field has been amassing facts and statistics, developing hands-on techniques, and creating handouts for years, and the internet and digital media have supported this proliferation of words and data. Fundamentally, though, the impact we have on individual mothers is the lifeline of our work. Without listening and counseling skills, any individual IBCLC will never rise above the other voices in a mother's world to work in unison with that mother's own personal breastfeeding goals.
When women become mothers, their identity shifts. The person they previously were moves into the shadows of memory, and the confidence and self-worth they spent years accumulating sometimes follows the old self into the shadows. Women who practice law, perform delicate surgery on animals, teach foreign languages to 12-year olds, or who have successfully mothered multiple other children may suddenly find themselves feeling a loss of control over their ability to perform what they consider a fundamental act of humanity. They may question their ability to reason out solutions to breastfeeding dilemmas even though they have written a dissertation on anthropology. They may doubt their choices on baby care issues even though they have made life-and-death decisions in war zones. They may become angry and irrational when they face breastfeeding challenges even though they are generally even-tempered people who face the world with a smile. These identity shifts make mothers sensitive to others' opinions, which disempowers them further.
Every woman moves through every pregnancy with her identity, a unique story of where she has already been in life, and she imagines and dreams about what is to come with this new baby. Inside that vision is the understanding that nurturing, nourishing, and protecting her young is her responsibility. Many modern mothers express great trepidation at these responsibilities and display only small flashes of confidence in their ability to perform them. The idea of breastfeeding is, in Western culture, so fraught with controversy and differences of opinion that mothers-to-be can become trapped by feelings of helplessness. Somehow, through the noise, mothers arrive at a vision, be it cloudy or crystal-clear, of how much breastfeeding they want to do.
Mothers' personal breastfeeding visions range from never breastfeeding to nursing for years, but they don't always know that on the day their baby is born. Putting a baby to your breast is a visceral and intimate act, and there are women who find they cannot do it at all, while others cannot imagine mothering without the frequent repetition of that act. Truly excellent breastfeeding support persons are skilled at setting aside every bit of their own opinion or judgment and simply providing the information a mother requires to enact her own vision of what breastfeeding means. When performed in a culturally and emotionally supportive manner by a practitioner who is well-informed by evidence and research, the mother's need for appropriate lactation support is met and she can remain in control of her own vision.
When a mother begins to feel that her breastfeeding reality is not within her control, she loses the ability to follow her vision. Platitudes and patronizing statements about breastfeeding like "Just keep trying, it will get better" and "Isn't 5 months of breastfeeding long enough for you? If you just wean then 'I' can feed the baby, too!" or "You know, that's why they invented breastpumps/bottles/formula/etc." begin to sound the alarm in the mother's head that her vision is possibly out of reach or that it was unreasonable anyway. Likewise, if the mother is provided false or outdated information about normal breastfeeding, she can be derailed quickly and her long-term breastfeeding plan will disappear with her milk supply.
The breakthrough moment in a lactation consult occurs when the mother reveals her true, personal breastfeeding vision. It is not useful to assist her with improving latch if she is actually looking for information about exclusively pumping instead. She cannot possibly succeed at fulfilling her own vision if the IBCLC gives her the help and information he/she assumes she is seeking. (Experienced IBCLCs begin with the assumption that it's never really the first question the mother asks. It might be related, but that's not the real reason she called/scheduled a consult/emailed). Without quality counseling skills, the IBCLC might never reach the core questions. Without the IBCLC's 100% attention and focus, she might not notice the accompanying body language that belies her true feelings. Without setting aside a broad agenda of "helping mothers breastfeed longer," the IBCLC could easily miss a subtle plea for weaning.
Christine Staricka, IBCLC, RLC, CCE July 22, 2014