Dear all:

From my read (and there might be some research I am missing), most of the research on the benefits of counseling have been on "peer" counseling.  Not all of the programs actually seek to train counselors to be "peer" counselors.  The distinction is important. We know very well that when you do focus groups, the choice of the group and how it is facilitated can really change how group members respond.  The ideal for focus groups is to select those who hold similar opinions and feel comfortable with each other so you can elicit opinions from them in a safe comfortable setting.  And the facilitator should not use "leading" questions.  

As near as I can tell from those who took Healthy Children's Center for Breastfeeding course to receive a CLC certificate - that is not how they approached the training for counseling.  They do one on one role plays where the goal is to solve the mother's problem.  Additionally, unlike other training courses which require a counselor to be a "peer" which means someone who breastfed her (or his in the case of Trevor) own children.  So therefore, the set up is NOT peer support.

Quite frankly, I see a lot of iatrogenically induced problems in the New York City area from the non face-to-face support where mothers with different parenting styles start bashing each other online.  The are some who seem to troll each others blogs to seek opportunities to attack blogs that are clearly geared towards mothers of different styles.  Then there is the "my baby" advice that is merely the advice that worked for that mother and baby that doesn't really speak to the specific problems that the mother who elicted advice is experiencing.  Since no one can see her baby or see her baby feed - it is untethered from much of the important visual and auditory information that humans use to assess "health".  On the other hand this advice is in the realm of mother-to-mother whereby most mothers realize that other babies are different from their own and it is often taken in this context - take it or leave it.  In a facilitated situation, the "peer" can mitigate those who tend to dominate the discussions and draw out those who are reluctant to share - and keep discussions civil and constructive.  At the same time, they can gently illustrate how there are different approaches that may be equally valid and/or work for different situations.

Not so the "expert" counseling.  This is where I see the most damage by those who are inexperienced or lack depth (myself included even with my IBCLC and PhD when I first started out).  Without this experience and without understanding the nuances of how to counsel in such a way as to not give false reassurance or false alarms - it is very easy to create the disappointed and often angry formula feeders which seem to inhabit the blogosphere.  These are women who tried hard, but felt disempowered.  These are women who very often didn't mourn the less than perfect experience and really understand and value the work that they did do that was beneficial for their babies.  I actually end up doing a lot of this work with women's birth experiences too - going over the things that they did give to their baby even if they had some unanticipated interventions along the way.  I believe that Kathleen Kendall-Tackett wrote an article in Clinical Lactation that was stellar on the topic of disempowerment - or perhaps empowerment.

In thinking about the creation of the angry formula feeders, I'll have to look up that article and reread it again.

In any case, I really do sometimes get tired of having to mop up after women who been given advice from someone who barely even listened to her and gave knee jerk straight off the factory shelf advice that didn't fit her situation.  

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