I guess my reponse to Dawn's mom ("heart of gold...non-compliant") would be
real similar to what I had to say in response to Kym's client a couple of
weeks ago: breastfeeding works by certain "rules", about the only
hard-and-fast of which is the supply and demand thing. It doesn't work by
intentions, or by good hearts, or by "really wanting to", without the
behaviours that would bring it into being. I really, really WANT TO lose
weight, but apparently not quite enough to make the necessary moves that
would reasonably lead to weight loss. If I were a weight-loss counselor
working with myself as a client (stay with me here...), I would drive myself
crazy: obviously, as a nurse who has worked in a nutrition program (and in
fact as an aerobics instructor, long ago & far away), I "know" what a person
needs to do to lose weight. But I don't do it, or I don't do it with enough
oomph to get the results I "want". But still,  I wake up every morning
wondering (or wishing) by some miracle I would have lost 50# in my sleep.

Same with BFing, more or less. All we can do is share with our clients what
we know, and pull out every trick we have at our disposal. But they're the
ones that have to put the baby to breast, or do the pumping, or take the
herbs, or stand on their left foot and shout "Toodles", or whatever it
takes. If the mom isn't willing/able FOR WHATEVER REASON, she won't be
breastfeeding, at least by definitions most of us would accept. (I don't
call these women non-compliant, myself - to me, that implies a judgement,
and I'm not there to judge them, I'm there to help.) When I'm working with
these women (and believe me, at WIC we see lots and lots of this), I explain
carefully about supply and demand, I go through with them what their days
are like and make suggestions that I think would help, and I ask them if
those suggestions are things that would work in their situation - i.e. "Do
you think these are things you could do?". When it becomes clear that they
can't/won't (as an example) find ways to nurse more frequently, or keep the
baby close so they can pick up the little cues, or whatever, I turn my
attention to helping to keep her going, even if the baby isn't ever going to
get to "exclusive" BFingI try to help her understand the value of what
breastfeeding she has done, and encourage her to keep nursing at a level
that will work for her and her baby.

Am I a wimp? I don't think so. I think that if a woman can't or won't follow
the suggestions that we give, she still deserves to be supported in whatever
she is able to do. (Cathy says, climbing up on her soapbox again...) And, as
we all know so well, it's not just about food. The value to that mom AND
that baby of WHATEVER amount of nursing they are able to do is way more than
just the nutritional aspects.So once we've explained it a couple of times,
and taken a look with a mom at what her day looks like, all we can do is
emphasize the positive; I think that when we can do that successfully, we've
laid down a basis for communication about all kinds of other things.
Lactation consulting is a kind of a "gateway" enterprise, and before we
really know it we're talking with these moms about co-sleeping, or holding
their babies more, or talking to their babies rather than just parking them
in front of the TV, or who knows what all.

I guess this is my area of fanaticism!

Cathy Bargar