I am really glad we are discussing the issue of communication. I know that I, at times, become so overwhelmed by the workload that I slip into brief, poorly thought out messaging with too little listening.  There is a long history of paternalistic treatment of 'patients' by healthcare workers and I had to work hard to train myself out of that kind of language early in my nursing career.  Listening shows respect and is the key to any communication, especially so when people make themselves vulnerable by seeking help.  However, there is no question that breast is best, we know it, we say it among ourselves. I don't know if I have EVER said it to a client.  

So, how do we navigate the landmines of being absolutely upfront about the risks of artificial feeding without sounding judgmental towards those who must or choose to feed formula (fully or partially)?  

One way that I have found is to couch my message in terms of biology. I always start my breastfeeding classes with a short discussion of humans as biological AND cultural beings.  Each household has a unique culture that exists within the culture of a close network of family and friends which exists within the broader culture. That is a lot of culture to navigate and I start off right up front telling them that it will be up to them to develop the parenting style that fits within their cultural framework, but that I will be focusing on human biology because that is what their newborn, yet to be acculturated, baby knows and expects.  

As an example I explain that babies expect to be held constantly, that to be put down leaves them vulnerable to a very scary unknown world, think wolves. And then contrast that to our modern culture where we live in small nuclear family units without enough arms to give the baby all the attention they expect. I then pose the question, 'What are some ways we can fit our baby's biological needs into our modern day culture? Into the family culture? Slings and baby wearing? Extended family? Call in favors from friends?  

I have found that prefacing my talk in this way allows people to let down their guard and be willing to accept new and unfamiliar information, such as 'extended' breastfeeding, that may otherwise turn them off.  By acknowledging that they will need to take this information and tailor it to their own situation I have already assured them that I will not be making any judgments about how they ultimately choose to parent. 

I maintain this frame of reference while working with individual families, asking them to help me understand what they need from me and working together to create a plan that is appropriate for their family.  In this way I think I can speak boldly, respectfully, and without perceived judgment, even to those whose choices do not line up with my ideal. 

Janie Akerlund IBCLC RN 
Doctoral Candidate, Immunology
University of Colorado School of Medicine
Fort Lupton, CO

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