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Subject:
From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 16 Sep 2010 09:15:56 -0400
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Dear all:

I think it is great to emphasize what mothers are doing right and all the great things about her baby.   When I do home visits I immediately enter and look for the items I can praise and emphasize what she is doing well above all else.  

At the same time, the research from Paula Meier's work with infants in the NICU suggests that women resent it if you keep information from them about real risks of continuing with a particular behavior.  The women (many of whom didn't intend to breastfeed) who were told that breastmilk was the best medicine did not feel that they were pressured into pumping for their tiny babies.  In fact, they resented those who told them that formula was just as good.  

Sometimes it is easier to be the good cop and not broach topics that may be uncomfortable.  Yet, at a later point, if there are significantly negative outcomes from our reluctance to bring up difficult topics, we actually may have done that mother and baby a disservice and if that baby and mother suffer from negative outcomes because we were afraid to discuss it, then we may be liable for our negligence in providing full information.  There ARE ways of broaching a topic without making the mother feel blamed.  And sometimes, we HAVE to broach the topic when there is a serious situation where the mother IS endangering a child.  I can think of about 3 cases of this nature in the course of time I have worked with mothers and infants and it is always difficult.  Yet, we are obliged at least in the United States to report such cases.  

It would be lovely if we could always have the role of being completely supportive and cheery and finding that a mother is always doing the best thing for her baby.  And the vast majority of mothers really do want to do the best for their babies.  Mostly, we help them do a good enough job, compensating for whatever caused them challenges to begin with. Every now and again we do have to confront the fact that her baby or she may have conditions that neither she nor we can completely compensate for.  Less often we have to confront frank negligence or abuse.  

I think the key is to find some way to empathize with the mother even when that is a challenge and to also be honest when we provide information about potential future risks.  

While we all love to help mothers and help them feel good about what we do, we also have to realize that there is a fine line between that and becoming, to use a very overused term, "enablers" of behaviors that are not as healthy.  And often the "enabler" can become the object of hostility when the person on their own finally realizes that their behavior is not healthy or we finally realize we have reached the point where we cannot enable the behavior anymore and we finally do confront the situation.  In situations where there is a real solid high risk, I think we sometimes do need to be prepared to take the heat.

Best, 

Susan E. Burger, MHS, PhD, IBCLC

  

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