Lactation Sparks

What questions do you need to ask to best serve your lactation clients?

A consult is a conversation, no matter the format. You could be on the phone, a virtual consult, or in the room with your client - in all cases, you are building a relationship and getting to know one another.

The conversation is fed by sparks - questions that help you get to the root of the matter at hand. Naturally, you want to get there efficiently, and you want as much information as possible to help your client resolve their issue.

Asking the right questions is a skill we practice each and every time we consult with someone - new or repeat. We learn from asking questions that get to the heart of the matter, and we learn even more from asking questions that don’t work - the ones that temporarily derail the conversation or inadvertently cause the client confusion or offense.

The skill of investigation is part of the counseling toolbox, and one can be an incredibly kind and warm counselor without truly being a good questioner, leaving them less effective. On the other hand, one can be a skilled investigator with poor counseling skills and a tendency to disrupt a budding relationship.

I’ve been keeping track of the questions I ask for quite a while now - the good ones and the less effective ones. I wish I had this list at the beginning of my career!

My lactation career began as a volunteer taking phone calls on a breastfeeding warmline. There was a form that reminded us what to ask and what information we needed to document as part of the process. It was helpful for a beginner to have those prompts.

My next practice setting was in a hospital, where my conversations with inpatients were organic and my documentation was, for the most part, free-form and narrative - what a gift to a lactation educator learning about what to ask, what to suggest, and what to do.

Today my work is all in the community - folks who are no longer in a hospital setting, and they are seeking my help. (I say this as a reminder that there is a really big difference between patients you are assigned to see in a hospital setting, some of whom don’t really want to see you but don’t know how to communicate that clearly to other staff or don’t understand why they would need to see you - and those who call, email, or come to see you in an office where they are seeking your assistance deliberately, even if they are not choosing YOU personally. If you’ve never thought of it that way, please consider this carefully!)

Today, I have learned to give my client space to say what they need to say right up front. They’ve prepared to talk to me, rehearsed how they would explain it, and they have NOT realized how emotional it might all be to finally be telling this story.

One thing that’s almost never in the story they are ready to tell is this: tell me about your last feeding or milk expression session. That’s one of the first questions I like to ask. It gives people an opportunity to tell me not only how that session went, but also to share the context, like “he took so long to latch and usually it only takes him a few tries” or “I pumped at 6 when I woke up but then I was getting the other kids ready for school, and now I haven’t pumped since then.”

The context matters in understanding how things are going overall. I love to hear “actually, the last feeding was so good, and once I got comfortable, we sat there for like a whole episode of that show and she was feeding the whole time! Sometimes my back starts to hurt in the feeding and I kind of have to stop.”

Wow, that’s a really important place to start, and some really vital information.

“Can you tell me about” allows a person to feel as if they are expected to describe the situation rather than rush through a short answer.

I believe that setting people up for success starts with giving them the opportunity to share what chest/breastfeeding or pumping or life with a new baby is like for them. I never feel like I can answer their questions (at all) until I get some sense of what is happening in their home, in their head, and in their heart.

I think that many of us are taught (or learn) very early in our lactation careers never to interrupt someone who is sharing their birth story. It took me too long to understand how important it is to also do this with their lactation story: to set up the scene for a client to just talk about their situation without feeling like they have to frame it all as individual questions.

It’s always the story for me. It’s what makes this work interesting. It’s what we anticipate with curiosity when we meet a new client, and it’s what we celebrate with joy when we are able to become a positive part of that story.