I changed the subject line, because I am starting with some information that
is not breastfeeding - but I believe can be translated to what we were
talking about.
For the last few years in my county, we have been working with Dr. Ira
Chasnoff on interventions with women who are pregnant and are at risk of or
are already using drugs: tobacco, alcohol, MJ, heroin, cocaine...you name
it.
What his research has shown is that during pregnancy is one of the most
effective times to offer interventions to promote healthy behaviors.
He has also developed an excellent tool, the 4Ps Plus, which we use to
screen women by asking questions that help us identify those most likely to
use drugs (and yes, tobacco and alcohol in this scenario are considered a
danger to the baby and worthy of interventions.)
Now - what we use the tool but have established rapport first by asking a
lot of open-ended questions - but then, if the woman is identified as "at
risk" we offer an intervention called "I am concerned"... In other words,
a mom says "yes, I'm drinking...but I drank with my last two kids and
they're fine!" and you reply "I am concerned because studies have shown..."
Then you use a book that shows the effects of whatever drug she is using on
the baby, as well as pictures of the brain or of older kids - whatever would
be the most clearly show the effects of the drug. We have a "cheat-sheet"
that reminds us of what to say and we can just go right down the line...
Important points are NOT arguing, NOT demeaning, NOT condemning - "I
AM CONCERNED" is delivered in a clear voice but not with drama. The words
and the voice and the demeanor MUST be REAL and convincing.
We administer the 4Ps Plus at least 3 times during the beginning of the
prenatal care, even if she denied problems, because Dr. Chasnoff's research
has shown that it may take a while before a woman feels safe enough to give
the true answer to the screening questions.
Another important part of this project is that we have a system already in
place so that a "warm handoff" can be made to specialists in drug abuse if
the woman identifies that this is a good time to talk to her.
Do you not see how this can be translated into breastfeeding promotion,
education and support?
We can be clear about being concerned that moms are choosing to give formula
to their babies...or concerned about mothers starting solids too soon - we
can give them the data and information without saying "YOU are a bad
mother"...but rather "I am concerned for your baby's (or your) health and
well-being".
It's funny, but in a way I had developed a similar message routine with moms
I knew had a history of drug use by using Hale's book and reading to them
what drugs would affect their babies and how...but I was wondering if we
could go further...
Would it be possible and effective to develop intervention tools that
clearly identify the risks of not breastfeeding...but instead of saying
"you're hurting your baby" we can say "I am concerned that your baby will
have more illnesses, etc" and we offer support...
What do you think? Diane W...you have the right words...
Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA
(Due to copyright and the fact that I am NOT an expert on this program by
any means, please go to his website for more information:
http://www.childstudy.org/)
...and by the way, I make NO MONEY from sharing with you any of the
information above or the website or program <grin>
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