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Lactation Information and Discussion <[log in to unmask]>
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Tue, 20 Mar 2007 10:44:50 -0400
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> I think it is splitting hairs to say that we are not contradicting an 
> HCP when we give contradictory information to a mom. I am not trying to 
> find a way around giving accurate info-I am trying to practice with 
> integrity. I also do not think it is fair to the mom to expect her to 
> rely on the "evidence-based" information and let it speak for itself. 
> How many moms want to sit and read a treatise on mastitis when they are 
> in pain. They want us to tell them how to feel better. They expect our 
> educated opinions, not just some obtuse language that they have to 
> interpret to decide what to do. If I am in pain and someone is giving 
> me an answer and the other person is beating around the bush, what am I 
> likely to choose? I cannot see how it is disrespectful to a doctor to 
> disagree with him, nor how it is disrespectful to him to take good care 
> of his patient. I do think, however, it is disrespectful to a mother to 
> play word games with her.


I am not sure how the post I forwarded yesterday re: thoughts on SOP was woven into that of a medicalization of breastfeeding, but since some of the comments in the above response seem to directly quote what I wrote, I'm responding in kind. In all honesty, I first felt perplexed that what I'd written could be interpreted in such an incredibly literal manner,  and then I felt insulted that a colleague would even think I -- or any of us -- is so stupid and insensitive to mothers as to simply throw a study/"treatise" or two at them as well as some "obtuse language" in a manner that could be considered "beating around the bush" and expect the moms to critique it and "interpret"/figure out what to do from there. 

Who on this ever suggested that a LC "play word games" with a mother? I don't find it's splitting hairs at all if the info I present to a mother happens to contradict that of another HCP -- no matter what that HCP's specialty is. My intention is not to contradict and is not presented that way. My intention is to offer a plan of care that is based on current evidence and fits the particular dyad's situation -- one that fits the mother's (and not my) current reality. If a mother says a particular bit conflicts with what her doc or other specialist has recommended, I might comment to the effect that the suggestions I made are based on the latest available research (and provide related info/rationale), that it would be a good idea for her to discuss what we've gone over with her HCP/specialist, and to let her HCP know that I'd be very interested in sharing the lit I have on the topic with her HCP or reading lit supporting the HCP's recommendations. (And when in private practice that included faxing a report -- sometimes with an abstract or such -- to the HCP.) I don't see how that compromises either my or the other HCP's integrity. But is that a "word game"? Maybe you interpret it as such. I don't, because I truly would be interested in learning whether the other HCP had supportive lit for his/her recommendations.

I'd also never simply "tell" a mother "how to feel better" -- and I doubt that's where you leave it.   (And actually that's sounds more of what I hear from other HCPs -- that many/most expectant or new moms "just want someone to tell them what to do.") But if I left it at that then I'd feel as if I was patronizing the mother and not respecting her intelligence.  I want her to know why the plan I'm suggesting is more likely to result in her or baby feeling better. It doesn't usually take long to provide rationale or use simple or straightforward wording to convey info supported by research/studies (and while doing so I often learn more details about this mother's situation or give her an opp to share her feelings). My intention is to provide the mother with what she needs to make an informed decision about how she will approach whatever the dyad's current BF problem is, but many mothers have told me they decided on the plan I suggested because I gave them good reasons. Is that a "word game"? If so, it's one I plan to continue playing.


> Remember, the doctor works for the mom and so 
> do we. We all have an obligation to give the best care and the best 
> information we have. It is foolish to say that we are the experts on 
> breastfeeding, but that we might really be wrong and the doctor might 
> be right--because he is a doctor--and well, we aren't so sure we are 
> the experts after all.
> 


Don't need a reminder that the first sentence is true, and the second sentence is clearly stated in the SOP that was posted and ILCA's Standards of Practice for LCs. Would appreciate clarification of the last sentence. Honestly not sure what is meant. 

Although some docs can be prigs -- as can some LCs, some RNs, some businesspersons, etc. -- I find most are rather reasonable human beings who recognize they, as experts, always have more to learn and who generally are fine with going along with with a plan when provided with rationale and related supportive lit and incorporated timeline re: outcome goals in a manner of mutual respect. 


> As to the issue of breastfeeding and medicine--I think if we agree that 
> breastfeeding is the domain of the practice of medicine, we will surely 
> impose restrictions on our practice that make it much more difficult 
> for women to succeed at breastfeeding. We will be more inclined to push 
> breastfeeding into the world of academia, demanding degrees in 
> breastfeeding in order to help women breastfeed. Breastfeeding is the 
> practice of mothering and mothering is not the domain of medicine. In 
> fact, all of the world is the domain of mothering and I think we need 
> to allow ourselves to create a style of caregiving that is outside of 
> the domain of any model we are familar with--the medical, academic or 
> public health models. While all of these areas are impacted by the 
> practice of mothering, the practice of mothering does not belong to 
> them. This is why I believe we need to tear down the model and rebuild 
> it--this is not negative or destructive, just a part of the natural 
> evolution of being conscious.
> 


Personally, I mainly agree with the above statement. But it isn't just a matter of what I think or what I may perceive as the current"model" or an ideal "model." And it isn't just medicine or academia that has "pushed" breastfeeding to the "model" it is today. I also don't think our work as LCs must be restricted re: either within or without the "domain" of medicine. I don't think the two must be mutually exclusive. To do so could result in even lower numbers of breastfed babies -- at least until the masses buy in to a new construct, which I think is worthwhile but will be a really hard sell in a culture of nuclear families. 

I also think a written forum that precludes nonverbal communication and immediate back-and-forth feedback will always lead to misinterpretations, so I apologize if I've done so in any way in responding to your post. I did not mean to. I also believe that all of us working with BF dyads come to our work possessing/offering different gifts and that none of us possesses/offers all gifts (and all gifts have a weakness as a flip side) -- that we as a whole truly are greater than the sum of our parts/gifts. So perhaps your gift is to work on evolutionizing the culture and its effect on BF. Mine may be to basically feel comfortable working within current dichotomies re: culture even if it chafes at times...(and please don't interpret that to mean I don't offer "best" info for "best" BF outcomes; it means I "punt" when those concepts are rejected so that BF in some form will continue!) The flip side of my gift may be that my weakness may be "giving up" on what is ideal or what I know works best (in order to "fit" a particular mother's/culture's reality). Since I'm more of a "shades of gray" person and don't view many things as either black or white, I honestly am not sure whether it is better to be able to deal with current culture "as is" or to "fight on." I vacillate!  

Sorry for the logorrhea! I appreciate the opportunity to bounce such ideas around...

Karen

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