Hear hear. I truly believe for someone to be a really good lactation "therapist" - not just an educator - they should have educational courses from a multitude of disciplines. Not just an hour on the subject. Let me design my dream course and I bet it would be master's level. IN my classes working towards a master's in nursing (which I will never complete, by the way), I noticed QUITE a bit of overlap. I noticed the same when I was taking physics, chemistry, biology, anatomy and physiology and microbiology all at the same time or in close proximity. They called it "integration". Each science has places of overlap. My philosophy has always been if we can understand how things work, we can figure out how to make things that are not working, work better. This gives room for innovation and creative solutions. As long as we believe that there is a truth to be found - not that all paths lead to the truth or there is no truth to be found -just whatever you want to believe.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Susan Burger
Sent: Thursday, April 26, 2012 2:59 PM
Subject: Re: Didn't know anyone criticized Suzanne Colson's work
Dear all:
I am unaware of any criticism of Suzanne Colson's research. The two most well articulated research presentations I have ever attended on breastfeeding topics were by Suzanne Colson and Laurie Nommson-Rivers for different reasons. Suzanne Colson did excellent qualitative research on a small sample of women that really captured many aspects of what makes mothers comfortable when they feed their infants. I don't remember the specifics of her qualitative research methods now, but I do remember being impressed with her description of them at the time.
Similarly, Laurie Nommson-Rivers did something that training courses could learn lessons from. Instead of picking the traditional standard statistics package out of the box -- she actually did her homework and picked the best tool for looking at indicators such as diaper counts. She used receiver operator characteristic curves. This would be the equivalent of doing a very thorough examination and history taking of a mother and her baby and selecting the precise tool that would help that mother and baby breastfeed well, for instance a size 22 mm nipple shield as opposed to a size 24 or 16 mm for exactly 24 hours until the mother's engorgement subsided enough for the baby to attach completely on her own and because she was so skilled and thorough she would have known that the baby didn't need any other intervention than that.
What I find problematic are two reactions to her work:
a) The Magic Bullet
b) Certificatation of a method
and one comment that someone attributed to her that may have been taken out of context about low supply being an American problem -- which really I put into the category of comments such as "women in developing areas don't have breastfeeding problems. Pamela Morrison has written beautifully on those topics.
So, the problem with the Magic Bullet approach can be illustrated by vitamin A capsules. You absolutely can reduce vitamin A deficiency by setting up biannual distribution of the capsules and even temporarily eradicate it -- until you stop doing it. BUT this means that you always have to manufacture THAT capsule and distribute it twice a year forever. Furthermore, it doesn't fix all sorts of equally important nutritional problems. Only access to a rich variety of foods can bring that about and THAT is a complicated (meaning many steps) and complex (meaning many ethical choices involved) problem.
So, applying this model to the "METHOD" that many of those of us who have worked with thousands (and in thinking about some of my colleagues in NYCity who started in the days when La Leche League Leaders led the way into lactation consultating -- even tens of thousands of babies --- have used among many "methods" we are now seeing it applied to any and all problems women have attaching their babies. I am seeing chat boards and Facebook messages saying "I used this method and mom is STILL having pain". There are a lot of subtleties in attaching babies in which tiny shifts in angles can make a huge difference without it visually looking different at all. Furthermore, some mothers simply are not comfortable lying back. So instead of really analyzing what changes might make a PARTICULAR mother feel more comfortable -- a one sized fits all solution is being applied.
It is similar what happened to the "MISSIONARY position". For a lot of people who aren't interested in gymnastics, it can be a very comfortable position. I have no idea if this is true, but I speculate one of the reasons why MISSIONARIES pushed this position onto what they considered "heathens" is that they wanted to distance themselves from "animalistic" behaviors. And so this became the one "right" way to have intimate relations. What a dull world would it be, however, without the Kama Sutra and the Joy of Sex.
I have never analyzed how to help mothers feel better by grabbing for a "method", I LISTEN and FEEL what feels better to her. One of the least useful senses (but I still use it) is sight.
b) Certification of a method or a course:
First of all, I think we need to think not only about grade inflation, but certification inflation. I mean really, when I went through my college programs -- we didn't get certificates every time we completed 2 days, or 3 days or 5 days of training. We weren't awarded for "hours" of study. We had to complete an entire course. And even if you worked your brains out, it was hard to get more than 15 credits for an entire QUARTER or SEMESTER of work. I am wondering if this doesn't result from the overuse of the idea that people need constant rewards for everything. Recent research really suggests that affirmation doesn't work people are given rewards when the actually ACCOMPLISH something. Otherwise positive affirmation becomes meaningless and people actually feel devalued.
For instance, my son has dozens of trophies for merely appearing for team sports events. Some kids may even attend once and get a trophy. These trophies are completely meaningless. The ONE and ONLY important accomplishment to him -- is his black belt. During his black belt test, one mother completely humiliated her son by grumbling throughout the entire black belt test that he should just be given the belt. The fact that the test was grueling, three hours of hard physical exercise and mental challenges, remembering forms, continuing even when their legs felt like rubber, continuing even when they had to spar against two opponents, and get back up if they fell -- when they finished the test you could tell the sense of accomplishment. My sister sees this in her high school students. She deals with continuation students who have been patted on the back all their lives being told they were good enough and smart enough even though they really were accomplishing nothing. She makes them work. At first they grumble. Then they are GRATEFUL because somebody finally trusted that they COULD WORK HARD.
My colleagues in New York joke about the plethora of certificates for everything and have decided they might just make up a cupcake making certificate -- that you only get if you make THEIR cupcake, exactly THEIR way, after you take a course in how to make THEIR cupcake.
You don't get certificates from taking a course in college, you get credits. Those credits then build up so you can eventually get a degree. You CAN take a course in a discipline in many DIFFERENT colleges. You can learn about many different methods and techniques and theories while taking a course -- but you don't get certified for knowing ONE technique or ONE method or ONE theory. AND you can TRANSFER your credits from one institution to another.
Finally, in the many years I did educational workshops in developing areas of the world -- no one ever thought that they could create A SINGLE course for ALL DIFFERENT TYPES of professionals. Instead workshops were tailored to the specific needs for specific types of professionals, unless they were workshops where different professionals came together to bridge and build ways to complement each others skills. And someone told me that cosmetologists in New York City need 1000 hours of practice before they can become licensed. If someone needs that many hours to cut hair -- shouldn't we expect better of ourselves when it comes to elevating the work that we do??
Sincerely,
Susan E. Burger, MHS, PhD, IBCLC
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