Frances asks
>Any ideas on ways to make it [bf] friendlier but not mislead women?  It
does seem that we can't say "it doesn't hurt" (at all...that is) and a
discussion of health benefits etc >is always nice, but when measured against
comfort/discomfort/sacrifice (!) it
>doesn't always stack up.

Good question, and one I wrestle with. I don't want women accusing me of not
telling them the whole story, which is that it can be pretty rough that
first month or so. OTOH, I don't want to discourage the
barely-convinced-to-give-it-a-try women. I really think we need to tailor
our information, as much as possible, to women in various stages of
involvement with the decision to breastfeed. The highly committed are going
to take the information on difficulties and use it to get through them. They
will find it useful to know about all the possible problems but it won't
deter them, it will merely give them information to use later. The barely
committed, however, need something different. When they're first
contemplating the decision to breastfeed, our information needs to
concentrate of the benefits for them and their baby. Once they're more
educated and more convinced, I think we can start in on the "how tos" that
may include difficulties and cautions that it may not be as easy as it often
looks. Too many women assume bf is "instinctual" and don't educate
themselves and regret that later.

The following is entirely on topic, but because I've been thinking about the
acquiring of behaviour through the Stages of Change (sorry, guys and gals,
to be on about this again, but it HAS been the most attitude-altering theory
I've encountered in my life...) I went to a program I've got that is
directed to pregnant women who smoke. The booklets are written for the
various stages. I think perhaps they could be a model of how to gently ease
into breastfeeding information. Unfortunately, we often don't get a chance
to see women over a period of time, so I'm not sure how I'd implement this,
but I'm working on that!

The booklet for the woman who is in Precontemplation starts out "Now that
you are pregnant, it may seem like you are under a lot of pressure to quit
smoking [insert: breastfeed]. You may not be ready to make the decision to
quit [breastfeed] just yet. No one but you can decide when and why to quit
[whether to bf]. Other people, like your doctor, your partner or a friend,
may be encouraging you to stop smoking [to breastfeed]. They may have told
you that, because you are expecting a baby, your decision not to quit [not
to breastfeed] affects your baby too.

"This booklet does not ask you to quit smoking [to breastfeed]. Instead, it
asks you to think about your reasons for smoking [for choosing artificial
feeding]. It also asks you to think about the ways smoking [artificial
feeding] affects both you and your baby...

You get the idea. The booklet then goes on to give information on "Smoking
While You Are Pregnant Can Hurt Your Baby, " "Smoking Hurts You Too" etc.
Not overly hard sell,but good information. At the end of the booklet there's
a little section titled "Okay, I'm thinking about it. Now what?" The text
says "That depends on what you want to do. Do you feel ready to stop smoking
now?" There are 4 replies with a little blurb under each. "No, I'd rather
buy another carton of smokes than read any more!"  The blurb reads:
"Congratulations on your honesty. If you don't want to read, don't read.
Think instead. What are your reasons for smoking? How important are they?
Hang on to this package and look at it in a week or so...etc.
"I'm not sure." (refers to another booklet, as do the ones below...)
 "Yes, but I need to think about it some more."
"Yes and I want to start right now."

The rest of the booklets deal with the other stages (Contemplation,
Preparation, Action, Maintenance). I think this approach could be done with
breastfeeding so that when we're discussing it with the unconvinced or
barely convinced, we're not overloading them or coming on too strongly.

Sorry to make this so long, but it's something I've been thinking about a
lot lately and Frances' question gave me the impetus to look at it again.
Comments are welcome.
Leslie Ayre-Jaschke, BEd, IBCLC
Peace River, Alberta, Canada