Hi Debi!
I try to educate my moms on the choices for supplementing in a simple style,
so as not to overwhelm them.  I briefly "define" the tool, list the pros and
cons, and then I allow the mom to make her choice as to what will work for
her.  Of course, my assessment includes her readiness to learn and to
demonstrate the skills necessary to perform the task.  Some moms choose to go
straight to the bottle, and especially if I hear valid reasons for this
choice ie. I used an SNS with my last baby and I don't want to do that again,
then I support her choice.  But, if she's hemming and hawing about what to
do, I can usually sway a mom to try the other tools of the trade by giving
her a short timeline for its use.  Like, I'll say to use the SNS for 24-48
hours, preferably for all feedings, but if too tired during the night
feedings, then skip the night feeds, use it for the other feeds, and I'll see
you at our next appointment in a day or two.  Usually a mom can commit to a
lot of hard work with the tools for a day or two; bearing through it because
it's short-term.  Vigilant, short-term use has demonstrated to be more
successful for my clients than a mom who occasionally uses the tool for a
longer duration of time.  The tool usually proves to be ineffective in that
case, and mom usually quits using the tool out of pure frustration.  She
"thinks" it didn't work.  My viewpoint is that it didn't work because of user
misuse/disuse, but of course, I support her decisions and never say that to
her.  Mom's behavior of sporatic use of the tool means she's telling me her
decision on whether or not she chooses to use it, and I support her.  So,
other than the short-term period of use, I guess the only other thing I can
think of that works is for learners who analyze (I guess it takes one to know
one, doesn't it?  Ha!)  I briefly explain why and how a tool is useful.  For
these folks, the explanation/rationale motivates them to try it out.  The
overwhelmed mom, I handle by taking it a step at a time.  Her compliance on
using tools will be zilch if she's so overwhelmed she can't comprehend
anything. I see a lot of tools dispersed at the wrong timing for their
effectiveness.  I don't even offer the options if I've assessed she can't
handle it.  Most of the time, I'll begin to briefly mention some options, and
then if I see the "deer in the headlights" reaction, I'll steer down the
trodden path to get her at a comfortable, confident place first.  Then with
close follow-up and emotional support, I'll go back to the options and
display them.  It's amazing, isn't it, how different a reaction you get if
you encourage the mom to sleep tonight, get help with the baby, perhaps
supplement with her choice, which is often per bottle in our society, have
mom pump, and then the next day tackle the problem.  Think about our comfort
level.....when "stressed", I don't handle a new difficult situation well.  If
I have the option to return to a familiar, worn-out path that's proven
effective to me in my past, I'll choose to go there.
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services
Geneva, Il  where the thunderstorm has passed and I'm back on the computer!

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