I attended Karin Caldwell's session about evaluating and solving 
difficult breastfeeding problems at this summer's LLL International 
Conference.  One of my "aha!" moments was when she said that if you 
ask what a mother's goals are, you will often get the response she 
thinks you want: 6 months, 12 months, whatever is common in your 
area.  The mother will give you the supposed "right" answer.

A better approach is to ask the mother, "What matters to you about 
breastfeeding?"  This is much more likely to evoke the mother's true 
feelings, desires, goals, needs, etc.  You can follow with "what 
matters most about it?" to get an even clearer picture.

Caldwell talked about "narrative-based practice" where the discussion 
between the mother and the bf helper is an essential part of the 
care.  One of her slides says, "Listening to, appreciating, and 
interpreting patient stories is a core clinical skill."

It was an excellent session!

Margaret
Longmont, CO

>I work for WIC and we want staff to ask more questions to avoid 
>problems later and to know how to address the counseling. When I am 
>assessing moms, I ask moms what their feeding goal was during 
>pregnancy? Breast or bottle? When they say both, I ask "what does 
>that mean?" and let them explain. This opens up a discussion and 
>lets you give the information that mom really needs rather than 
>lecturing her or not addressing her needs.
>
>But getting staff to ask more questions and take more time in 
>assessment is like climbing a huge mountain. It is easier just to 
>skim the surface and ask one question than to take more time and 
>really find out what mom is thinking or planning or willing to do or 
>commit to.
>
>Kathy Eng, BSW, IBCLC

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