I have been thinking about the discussions and questions related to how to
deal with situations where you have observed something that the previous LC
missed.
Having been the new LC at a time when there was no one else around (1985),
as well as the experienced LC who sees moms after other LCs have seen her,
I'd like to point out a few things:
The mom I see today IS NOT the same mom that the last LC saw. She is that
much further away from childbirth (which, as we all know, makes us lose our
brain for a while <grin>), and is usually a better historian, as well as
more experienced (having been educated by the previous LC and tried what
she had suggested).
The baby I see today IS NOT the same baby that the last LC saw. That
further away from childbirth, this baby is more alert, more responsive,
less sensitive to handling (I find the newborns need to be touched almost
exclusively by the mom, but as they get older, they can tolerate my
repositioning them a little better), and THEY have tried nursing this way
and that and have learned habits (good and bad ones).
No LC I've ever followed meant to do anything but help the mom and baby.
That they didn't "hit upon" the "right" answer can be due to inexperience,
but also the previous two factors and other factors such as the place they
see the mom, who else is present, what mood mom was in, what "degree of
fullness" the baby had, etc.....
There are moms that don't work well with one personality and work
wonderfully with another. The more experienced you are, the more sensitive
you are to the non-verbal messages that tell you you're "coming on too
strongly" or "too close" or "too verbal" or "too xxxxxx"...but there are
also times when OUR antennae are not at their best, (who hasn't had a bad
headache and had to see a mom, or has been terribly worried about a
previous mom, or ....)
There are LCs who have seen so many moms with XX that then EVERYONE seems
to have XX (we recently had such a spate of tongue tied babies, that when
one of our very good public health nurses saw a baby with trouble latching
on, she just figured it was that - she asked me to evaluate - it wasn't -
it was a very recessed chin).
The best way to create a breastfeeding supportive community is for the
professionals to develop communication methods that will be positive and
not critical. No one learns when they're told "you blew it"...but I DO
like to hear from someone who says "you know, when you saw xxx it seems
that the baby appeared tongue-tied, but now that the baby is xxx days old
and doing xxxx, it appears the baby has xxxx. In this way you are
reporting an OBJECTIVE symptom (and giving the LC the "out" that the baby
may not have been exhibiting that symptom when SHE saw them), and we are
sharing information.
In our county we have developed a breastfeeding coalition (and we're
working on creating an ILCA Affiliate - have to put a plug in for our
professional organization), our monthly meetings always include an
educational component and a period of sharing which includes times we
"blew" it and kudos to those who helped. Four years ago we had no
breastfeeding supportive programs for moms other than one La Leche League
group. We now have a lactation center connected to one hospital, with
follow-up phone calls to their discharged moms, another hospital has moms
come to the hospital 24 hours after discharge, we also have a nurse
practitioner who sees moms and helps us get medications them, great WIC and
Public Health Nursing staff support, and 7 IBCLCs.. as well as two LLL
groups that are overflowing. We have MANY MORE needs - but collaborating
will be the way to get there - not criticizing.
Whew! ... now I'm getting off my soap-box!
Jeanette Panchula, BSW, RN, PHN, IBCLC
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