I agree with recent posters who describe resistance when trying to
communicate with new parents.  It is really difficult to strike a balance
between appropriate clinical management with respectful and sensitive
communication. I'm pretty bossy by nature, and really have to restrain this
impulse because it is not a strategy that has worked well for my ooutcomes
as an LC.   I think counseling and adult education skills are more useful in
these situations, and these can be learned. The book, Counseling the Nursing
Mother, is all about this type stuff.  LLL offers HRE communication classes,
and even books like How to Talk So Kids Will Listen, have influenced my
counseling skills.   Actively seeking to learn these techniques has really
improved the way I communicate with anxious new parents -- all of whom
arrive with lots of baggage and opinions.  I'm a firm believer that all
lactation conferences should have sessions on counseling skills --
unfortunately, few do.

Validation of feelings is the place to start.  When people feel that I will
accept them where they are, and am not going to judge them, all of a sudden
it becomes much easier for them to really hear my suggestions.  People are
so turned off when they feel controlled, manipulated by subtle
guilt-tripping, or they are made to feel (even inadvertently) that they are
doing a bad job of parenting.  They just stop listening at that point and
start to resent you.  (Any reader who doesn't believe this is true needs to
recall the last time their mother, sister, or best friend tried to tell them
something "for your own good.")

  I think the first rule of consultation is:  Make friends.   Oddly, one
trick that works well for me during home visits is to not pay too much
attention to the parents or the baby right at first.  Generally people have
anxious pets or often other children or even a grandparent present.  While I
am setting up, I make a big fuss being nice to the animal or other child, or
I chat up the grandmother. The parents get a few minutes to observe me as
nice, friendly and safe, and their reserve goes down a bit. (I am a stranger
after all, and a bfg assessment is pretty intimate. Additionally, studies
indicate that the baby's feeding success is a way parents "grade" themselves
as parents.  When it isn't going well, they are sensitive about "failing".)
I also make a small show of washing up carefully and wiping down the scale,
etc -- which also demonstrates my concern for their safety.  I always let
the mom tell me a little about the birth.  Birth is a story that mothers
need to re-tell a lot.  By this time, some rapport has usually been achieved
and my assessement seems more trustworthy because I seem to be on their
side.  Which, of course, the LC should be.

If the baby is doing poorly, I try to say things like:  "Part of my job is
to help you learn to tell when the baby is feeding well and getting enough
milk. " (Instead of:  "The baby isn't sucking well.")  Then I say:  "Let me
show you how to tell the difference between non-nutritive and nutritive
sucking " (identifying behavioral cues).  I always have pictures of good
latch vs pinched nipples,  photos of volumes of poop, proper colors, etc.
so that all through the consult I am teaching and giving information that
empowers the parents to tell ME whether things are going well or poorly.
That way I don't have to tell THEM.  Then we problem solve together and it
feels like a partnership, not a situation where someone (me) is acting
bossy.  Empowerment is impt. but it takes a lot of time.

The test weights should be done with the explanation that they are really
only a snapshot of one feed, but that they can be used to confirm
IMPRESSIONS of how the feed has gone.  Having some feedback to confirm
impressions is useful.  It is a way for a parent to become more able to
control what seems like an uncontrollable situation because it provides
information about what to do next.    I lay out menus of choices rather than
only one option (for alternate feeding methods, pumping scheds, use of
formula, etc.)  I always plant the suggestion that all problems are but
temporary blips with every hope of eventual resolution.   I try not to be a
purist about anything at this point.  No one who needs an LC visit has a
normal situation, so really all bets are off on doing things "perfectly".
My hope in these situations is for resolution of crisis and a return to
normal, with a nice long, happy lactation to follow.


Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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