I wanted to add one more word about truth telling.  I have noticed in my
practice that when I work with a client who got off to a terrible start due
to intervention or medical need, or extenuating circumstances, that
sometimes they are so relieved to hear the truth of how those circumstances
affected them.  For example, I had a client last year who had severe
pre-eclampsia requiring labor induction at just over 36 weeks.  Then, during
labor, because of the extra monitoring and medications needed, her coping
skills could not keep up (it's hard to labor in bed with mulitple IVs
running, constant monitoring, and when every time you move from your left
side your BP shoots up) so she got an epidural.  The her little baby was
born - near term, small for dates, and very sleepy.  Plus the mom needed
magesium sulfate for 48 hours after delivery due to really severe
pre-eclampsia.  Baby was small, sleepy, and had a bad case of "oroboobular
disproportion."  Talk about a set up for breastfeeding difficulty.  Then
they developed thrush on top of it.  For this mom, it was such a relief to
hear from me that SHE was not the problem - that it wasn't just that she was
failing at breastfeeding, but that all these obstacles were making it hard
for her.  It wasn't guilt inducing or discouraging for her - but gave her a
good understanding about why she had to struggle so for something she
thought would be a natural part of parenting.  She made it almost 3 mos -
pumping, breastfeeding, and struggling with sore nipples, and then
vasospasm, and then side effects from attempts to treat the vasospasm.  Then
a close family member died, and due to circumstances she was separated from
her baby and pump for 24 hours.  When she decided to wean, it was with
regret, but not guilt - and we talked about how much she hoped she wouldn't
have such a bad cascade of events with her next child.  

Truth doesn't have to be painful, and we don't have to choose between
sharing the truth and supporting the mom where she is at.  

I, also, have benefited from the experience of seeing families from so many
backgrounds and social situations.  It is vital to attempt to understand
where moms are coming from, and to know what their goals are.  We of course
have to adapt how we counsel and explain things to different women to meet
their differing needs and goals.  It is helpful to remember that sometimes
what a person tells you when you first ask a question may not be their final
word on the subject.  When a mom says to me that she has to give formula
because she doesn't have enough milk, or can't breastfeed in public, or
whatever, exploring that with her with open-ended questions and giving
several suggestions and some ideas on why we want to encourage exclusive
breastfeeding may well help her to see an alternative.  And if not, the
information has been shared and the woman herself is making her decision
based on good information.

I find that I don't have to compromise my ethical obligation to share the
truth professionally to meet the emotional needs of my clients.  I can still
treat exclusive breastfeeding as the norm and not shame my clients who
choose otherwise.  I find the same with smoking cessation counseling
(something I do regularly in my family practice)  I can easily acknowledge
the difficulties of smoking cessation, the realities that lead to perhaps a
lifetime of smoking, and plant the seeds that may help with quitting.  I
make it clear that my smoking patients have my total support while making it
clear that my medical advice includes quitting.  I find the same with my
breastfeeding counseling.  I hope that most folks that I counsel feel that
they received accurate information from me, while receiving support for
their needs, regardless of their choices.  I'm always pleased when someone
who perhaps didn't choose to breastfeed feels comfortable to ask me a
question for their sister or friend, remembering that I have the knowledge,
and not feeling that they can't discuss it with me because they chose
differently.  

Jennifer Tieman
Family Physician
Mom to 4, including my nursling Caroline Rose (age 33 mos.)

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