Hi Angie, 
First let me say that it is always a pleasure to hear from one of the nursing students from the UND. We appreciate your evidenced based approach to helping mothers with breastfeeding.

Regarding helping mothers with the decision to breastfeed, I use the focus group research of Carol Bryant. She found that women don't choose to breastfeed, not because they didn't get information about breastfeeding, but because of what she states as "barriers" to breastfeeding: embarrassment, lack of confidence, fear of pain, influence from family and friends, concern over lifestyle changes.  She recommends a three step approach: 1. Elicit the concern/feeling about breastfeeding, 2. Affirm the mother's concerns, and 3. Educate. I think we do too much educating and not enough listening and affirming! I use this approach when I educate health professionals as well...because they also have many barriers...That is why we can teach and HCP don't change their practice.

When we educate we must stop using lists of benefits of breast and bottle feeding. When we do this ,we use personal opinion and not facts. For example, a benefit of bottle feeding that is often quoted is: Others can feed the baby. That statement is a not a scientific benefit to an infant. It is someone's opinion. If we did this with infant car seats you might get something like: Benefit to using a car sear-Protects your child from serious injury and death in case of an accident. Benefit of not using a car seat-Is quicker an easier when you want to go to the store. Allows the child to freely move about in the car. You get the idea!

Rather, we should give women/parents the facts. Breastmilk is the milk that is designed for the human infant. It contains........It provides protections from.....for the infant.....for the mother....for the environment. It is less expensive. Formula is cow's milk modified so that a human infant can digest and utilize it.  It does not provide protection for the infant from.... or for the mother for.....I am working on this type of a pamphlet for parents.

We should stop using the words "best food", "ideal food", or "perfect food"(Thank you Diane Wiessinger!). Breastmilk is what human infants were meant to have. It is the minimum. Thus, anything else is below that, less than minimum or less than average. When we use the words "best", "ideal', and "perfect" it sounds too hard. Who can be ideal or perfect?

The issue of guilt has been discussed a lot on Lactnet. If you did a search you would enjoy reading the many comments. Basically, it is a non-issue. We don't discuss guilt when we educate moms about car seats, or tobacco, or immunizations, etc. So why is it an issue with breastfeeding?
Good luck!

Bryant C. 1992 A strategy for promoting breastfeeding among economic disadvantaged women. NAACOG's Clinical Issues in Women's Health Nursing 3(4):723-730.
Wiessinger, D. 1996 Watch Your language. J Hum lact. 12(1):1-4.

Carol L'Esperance RN, MSN, IBCLC

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