Dear Colleagues,
I have been enjoying this conversation. In my opinion, poor 
communication is a huge problem.
I have been re-reading Motivational Interviewing for the Health Care 
Professionals and it is astonishing how ineffectively most health care 
providers communicate. They don't have the skills or the time to do an 
effective job.

Our words can hurt. They can insult the person we are talking to (They 
must think I am stupid that I don't know this!) and make it clear that 
we are not really listening to or caring about what our clients are 
really thinking and feeling. By insulting and disregarding our clients 
agenda (or maybe not even finding out what their issue was in the first 
place) we are greatly lowering the odds that any positive change will 
take place. Why would they listen to us?

What is positive change? Well, there's another opportunity for being at 
odds with our client's agenda. Her agenda maybe that she needs more 
sleep. If we disregard this by emphasizing that she needs to feed on 
demand, babies wake up frequently at night and this behavior is normal, 
she may feel as if breastfeeding may be impossible for her. She also may 
feel that you are judging her for being a bad mother for not feeling 
able to handle the night interruptions.

Instead of giving her lots of info, you listen to her feelings, reflect 
them back to her to check for accuracy, find out what she has already 
tried, and then brainstorm how she might make her nights easier, she is 
more likely to be receptive to the idea A) that her little baby needs 
this RIGHT NOW but not for the rest of their lives and she can keep 
doing it for awhile B) come up with a way to make it easier for her or 
C) have her partner give a paced bottle or finger feeding of milk during 
the night so she can have a 4-5 stretch of sleep.

What? A bottle, sleep through a feed? Yes, if she is going to quit 
breastfeeding because she feels desperate, one missed feeding at night 
is better then tossing in the towel all together. In my opinion. Her 
agenda is crucial. But you will not have any idea at what her agenda is 
if you don't listen to her carefully. I find that most of my clients do 
keep going in very hard situations if they feel heard and cared for.

Good communication also opens the door to variations on exclusive 
breastfeeding, which is our agenda. Maybe she does partially breastfeed. 
Maybe she pumps and gives her baby her breastmilk. Not ideal in a 
perfect world but better than exclusively formula feeding. Most people I 
work with don't really see a little formula as a health risk. They know 
"breast is best" but they don't know the risks of formula. They are also 
already using it. And it has helped. Their fussy baby is calm and 
sleeping. How can you fight that? You can't fight it. But as you form a 
relationship you can check in with her goals (she usually wanted to 
exclusively breastfeed) and weave in info without insulting what they 
have already done. And with time get rid of the formula if possible.

I am in private practice so I see mothers who are already in deep 
trouble when they come to me. They have babies that aren't latching and 
half a milk supply. This is hard!

These moms didn't get to this place by themselves. Our culture, their 
doctors, the birthing process, their peds, friends, families, have set 
them up for failure for the most part. Lack of accurate medical 
information and support runs rampant.
Breast is best. This is so insulting to families. They know that breast 
is best.
What are your feelings about how you are going to feed your baby? This 
question opens up a conversation that provides an opportunity for 
understanding and information sharing.

I guess the bottom line is that if we are on our high horses yelling 
"breast is best" we will have lost a great many families before we have 
even started. They know I think "breast is best". I am an IBCLC after all.

-- Barbara Robertson, MA, IBCLC, RLC The Breastfeeding Center of Ann 
Arbor bfcaa.com

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