Bravo, Chris.  I really like the frame work you offer presenting the LC's
skills as similar to the midwife's skills in managing labor.  Care is
supposed to be individuated because we work with individuals.  There is no
"one size fits all" to breastfeeding support.  Each dyad is going to present
a unique set of challanges that require helpers to carefully craft
appropriate responses.  Sometimes the best thing to do is nothing.  Complete
hands off.  Sometimes the best thing to do is going to involve a lot of
hands on.

I currently am spending time mentoring.  It is fun to have people along on
consults who have mostly academic knowledge but have never seen some of the
things that challenge us in practice.  I spent an interesting afternoon with
one such student last week.  She got to see a woman with hypoplastic breasts
and a history of low milk supply problems and her second child, a little boy
with FTT (5 oz below birth wt at 3 wks postpartum).  The second client had
incredibly flat nipples and significant engorgement.  From another examining
room, the LC called the student in briefly to see a baby with a tongue-tie.
So I think the idea of having LC candidates shadow working LCs is a
wonderful opportunity to observe the various ways we must tailor our
interventions to specifically target the individual problems of real people.
The words "always" and "never" are not useful when considering strategic
interventions.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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