How I sympathize with your frustration and feeling of ineficacy when dealing
with this mother!  

Many of us in public health deal with this daily, and it causes some to
become callous, others to leave the field, and a few of us to stay and
accept what happens without giving up before we even start!

Studies of African American women are finding that we can do very little
during their pregnancy to affect some of the outcomes.  Premature delivery,
small for gestational age, etc. are often not affected by early and frequent
prenatal care.  One of the theories, called the "weathering" hypothesis,
speaks to the stress that these women suffered when THEY were in their
mothers' wombs due to mom's own stress hormones being high due to stresses
she was suffering...  This stress continues when, as children, they also
deal with violence, neglect, etc. This does NOT mean we quit offering early
and frequent prental care - it means we need to measure our success with
different measures - connection to services, mother's ability to locate
resources and advocate for herself, etc. 

I have seen behavior similar to what you described in our own waiting rooms
and during home visits - baby/toddler reaches out to mom, tries to engage,
mom is tired, beaten down, and therefore unresponsive to her baby...  (NOT
just African American moms, by the way!)

How does this affect our work?  Well, we need to continue it! Because SOME
of these moms will hear what we say and decide to overcome their problems.
SOME will follow through on the resources we provide and get mental health
assistance, parenting classes, join support groups, and ... Things get
better NOT for this first baby, perhaps, but for the next one or the next
one.

What you said to this mom may not "click" right away ... But later on she
may remember it and decide to address the issues.  I've seen, in my short
time in California, changes in the parenting styles of quite a few moms -
not with their first, but with the next one.  This is one reason I really
admire WIC and Public Health Nursing.  Our WIC staff is getting fantastic
training on "brief interventions" and how, in their short 5 - 10 minute
visits they can "plant the seeds" by offering information and resources.  

NO ONE PERSON is going to solve these problems - and we have to, for our own
mental health, be able to say "what I did was the best I could at the time -
the best I could offer and the most she could accept".  We have to remember
BOTH the "giver" and the "receiver" have to be on the same channel in order
to succeed in communication!

At the same time we need to be VERY knowledgeable about what resources there
are in the community, who to refer mothers to, and develop good
relationships with the Mental Health as well as the Medical resources.  I
have even had to go to our crisis clinic to insist STRONGLY a mom be
hospitalized!  Our job and ethical responsibilities as a Lactation
Consultants include knowing our limits - and when and where to refer.

AND those of us who often come upon this type of situation should try to
learn from psychology and similar fields.  Those skills can help us to
communicate with mothers in all sorts of situations, so we will have a
variety of communication methods that MAY help us reach a mom under stress.
Right now I'm taking the series of "brief intervention" trainings along with
our WIC staff.

Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA

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