<So I have come to feel that management is really key here. Bf really
needs
to be something they DON'T need to worry about -- something default,
pretty
easy, normal, and extremely WELL SUPPORTED. If it is tough it is just
going
to get triaged out from these kids's lives, and in sympathy with their
overstressed parents I can see why, sad as it is to me.>
Pearls of wisdom, Elisheva!
I find myself confronted with this so frequently in dealing with WIC
moms! I find myself constantly thinking about how I can improve my
semantics so as not to insult their priorities, yet add to their possible
options, on their terms.
Example: I was called to the front intake area by a clerk who was
following her instructions that any mother who was breastfeeding and
asked to be issued formula must first talk to one of the LCs.
Perhaps the clerk was trying to spare her from walking unnecessarily, or
maybe she just wanted to hear the conversation so she could make her
computer entry sooner, but it was a pretty public place to talk.
This mother was 4 days postpartum, and had come in to get formula coupons
ASAP. I could see the defensiveness in her expression when I approached,
and her plan and her reasons tumbled out.
"I am going to continue just long enough to relieve the swelling, and
then wean completely because I am going to need extensive dental work,
and the medicines . . . . . . .etc." Her first child was 4, and not
breastfed. Her second child was 2, and she had combined breast and
formula for 6 months or more "and I didn't see any real difference in
their health"
I surmised that one of her main goals at the moment was to relieve her
engorgement. I recommended that if she was going to do this, that it be
done gradually, over a period of a week or more, so as to lower her
chances of getting a breast infection. Her eyebrows went up-that got her
attention.
I played the economy card, reminding her that the amount of formula WIC
provides does not increase beyond the amount needed for a newborn, and
that she could avoid the expense of later having to buy extra on her own
every month if she would keep up at least a partial milk supply.
Then, I assured her that many mothers need medications for dental and
other conditions, and very few meds need cause interruption of
breastfeeding, and that we could look them up for her in the latest
specialized reference books to be sure.
Only then did I mention immunities briefly. I assured her we would go
ahead and honor her request for a full allotment of coupons, but that it
was not an either/or decision and that we heard from several mothers each
week who changed their minds and went back to breastfeeding. I let her
know it was part of our services to help.
I supplied her a handout on the relief of engorgement, and tucked
underneath it, I gave her the clever LLL graphic sheet on early
establishment of comfortable feeding. I knew there was one paragraph on
warm showers and massage for the relief of engorgment, so I was
TECHNICALLY telling her the truth when I told her "Here are some comfort
tips on getting past engorgement!".
(I will confess that I afterward put in the mail to her three of my
favorite, easy reading level sheets of Diane Wiessinger, such as "What
if I want to Wean", "Breast or Bottle" and "He Can't Be Hungry-He Just
Ate!")
Were I to have the opportunity of doing it all over again, I would bend
my knees more and position myself slightly below her eye level, look up
at her and validate that when moms are experiencing discomfort in
sitting, temporary swelling, and interrupted sleep, it's not a good time
to make an important long-term decision, and issuing the coupons
requested gives moms more time to get comfortable and think about it some
more.
I plan to call her in a week just to find out how (and what) she and the
baby are doing. Sometimes I have to remember that "Half a loaf is better
than none!"
Jean
*******************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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