----- Original Message ----- 
From: "Rhoda Taylor" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 10, 2008 12:57 AM
Subject: [LACTNET] competent LCs

**Hi Rhoda,

>  I too hear nightmare stories. My line is that we all need to find
> professionals with whom we are comfortable and have a trust relationship.

**I think this is a tough issue... You know... moms are so vulnerable after 
the baby is born. Any HCP can sell off rubbish and have the mom trust her 
and feel comfortable, because she inadvertently and to the mom's 
disadvantage validates the misperceptions that mom has about breastfeeding! 
That is the whole difficulty in today's society: so much knowledge about the 
natural process of bf has gone lost, that many moms simply *believe* it when 
someone says that unfortunately the milk has not enough nutrients or that 
painful feedings are part of the drill and will probably disappear over time 
or that it will do no harm to baby or production to give a bottle with AIM 
every once in a while. Mothers may feel at ease with that, because they 
don't know any better. It does *in no way* empower them to overcome 
problems. It is fighting symptoms instead of solving problems. Heck, it will 
*cause* problems in the somewhat longer run; why else would the rates drop 
so dramatically after a couple of weeks or months...? :-(

> Just as we would not all be comfortable with the same doctor or dentist we 
> need to find an LC who suits us and our preferences.

**I do agree that personal aspects can have a big influence. But suiting 
preferences can be a tricky thing when it comes to an area you are not 
knowledgeable about. Your preference may be to combine AIM en EBM (because 
that is what you see being done around you), but unless someone tells you 
what the impact is on e.g. infant gut flora, you may not be motivated to 
keep up your production.
To be clear: I don't say mothers have to do what *we* as competent lc's 
think is best. But it is a sad reality that the inherent wisdom of what is 
best for an infant has been badly damaged over the years, over the decennia, 
due to all kinds of developments. Competent lc's have a mission to fulfill 
there.

I really do try not to
> criticize or appear to criticize. I am also VERY aware that especially in
> times of crisis what is said and what is heard can be two very different
> things.

**That is true. And I think that partly explains why subtle wording like "I 
think my collegue may have meant..." or "What was probably advised to you 
is..." often doesn't work. The mom has doubts, her gut feeling tells her 
something totally different that what she has understood, but she lacks the 
knowledge to back it up and she is pressed for time because her baby fails 
to thrive and she is tired on top of that. That is when I sometimes say: 
"What you heard, is rubbish. You yourself are on the right track, for this 
and this reason." Moms are confused; often they don't have the energy to 
thoroughly investigate the nuances in policies proposed. They just want 
clear answers. Even I don't always give them (because I often say that there 
are many options, but they will have to find out what suits them and their 
families), but when they are severely disappointed or at a loss what to do, 
due to the bad care they got, their fixing the problem and regaining 
confidence is vitally important to me. Advocating the bf dyad's right to get 
off to a good start is my #1 Standard of Practice. I will have to find a way 
to deal with problems I encounter that relate to suboptimal care and how to 
improve that... :-s

> So I request if you hear nasty things about me you give me the
> benefit of the doubt and I will return the favour.

**No, I don't think it would be the best option to give you the benefit of 
the doubt without any further action (or you doing that to me). What I 
*should* do, is call you and find out why this advice was given. This is 
hard, though. Not as much on Lactnet as it is on more regional/local lists, 
because then you all know eachother, have to work in the same area, and not 
everyone is able to take in comments and keep in mind that it is about the 
mom and *not* about who's right and who 'wins' (the mom should win!). It is 
human, to find that difficult, especially when you have tried hard to help a 
mom. That is where listening and conversation skills come in, as well in 
talking during a consultation as in a conversation with a collegue over 
differences in practising.
In the meantime, I should get the mom on track. Her succes in breastfeeding 
her baby is my primary goal. This is probably what Jaye meant, when she said 
she is not politically correct. I think it is Royce's quote: "What you 
permit, you promote." If we knowingly permit bad health care to continue and 
do not create some kind of awareness among parents, nothing will improve. 
When they know what to look for, bad quality will get marginalised and good 
quality will prove itself. I don't think my position is more important than 
the mother's and baby's bf experience. Their success, sometimes enhanced by 
my skills, is what is most important. To achieve that, it is indeed 
important to remain on good terms with collegues, but then again... how to 
break through an unconsciously incompetent attitude...? (Not unconscious 
incompetent, Esther... in that case I would call a doctor! hahaha ;-))
What we *do* need to learn and to be taught, is how to give and receive well 
formulated feedback. I just got a mail from Esther Grunis off list this 
morning. We were discussing the possibility of setting up some kind of 
intervision/supervision thing for Lactnetters who will be in Vienna in 
October. I would really *love* to do that. Secretly, I was already dreaming 
of having Diane among us, with her fabulous way of handling the instrument 
of language, but anyone with good ideas or a craving to expand competencies 
could join. What about it...? Any great suggestions...?! ;o))

Warmly,

Marianne Vanderveen, Netherlands (who will see and hear the Matthew Passion 
with orchestra and choir tonight and really looks forward to that soul 
stirring piece of music)

             ***********************************************

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