Something I have been reflecting on in recent months is the extent to which mothers heed our advice (hopefully provided in an environment of consultation, with the mother's participation). While finishing an article from my earlier research I had cause to look into the literature on "compliance", or to use a better wording, whether clients or patients follow advice discussed with them. This includes the extent to which this is affected by other influences and mothers' own "agency" in their decision-making. I think we all can think of instances when a mother has come back to us or telephoned or emailed with an ongoing or worsening situation where we "know" it "should" have improved had they heeded a specific piece of advice we though we were agreed on.

What the literature shows, whether on other health matters or on breastfeeding, is that clients tend to make their own decisions, in the end, unless very dependent or aware of the critical nature of the situation. They will follow the advice more if they feel they have been listened to, that the advice was given in the context of their real lives and feelings, and that they have agency in how they proceed.  Recent literature includes studies of telephone advice services by nurses, on a variety of matters.  Jane Heinig and colleagues have published in JHL on mothers' compliance in relation to breastfeeding, with a useful discussion:
- Heinig MJ, Ishii KD, Banuelos JL, et alServoces and acceptance of infant-feeding advice among low-income women. JHL 2009; 25(2): 163-172.

My research examined mothers' experience of infant-feeding advice during a period when advice was very prescriptive and, because mothers were reluctant to admit to disagreeing, the health services and politicians believed (incorrectly) that attendance equated with compliance.  
- Thorley V. Accounts of infant-feeding advice received by mothers: Queensland, Australia, 1945-1965. Nursing Reports 2012; 2(2). Available at http//www.pagepressjournals.org/index.php/nursing/view/262 

If anyone is looking for a research topic, perhaps you might consider examining these issues in other settings. It would be interesting, for instance, to see studies on lactation consultant (IBCLC) services, or on counselling by mother-support groups such as LLL and ABA, or peer counsellors. Studies such as these would give points of reference for comparing and improving how we work with mothers and their babies.

With best wishes,
Virginia

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
Honorary Research Fellow
School of HPRC
The University of Queensland, QLD. 4072
Australia

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