Morgan asked, <<At what point do we feel it's appropriate, to recognise the mother has been failed so catagorically, that a sideways step may be the best option?>>



Good question.  I guess it depends on the mother. Like some others in this thread, I am not comfortable with the concept of giving permission to my clients for anything, as it presumes that I am in charge, that it is my place to even give permission.  It's her life and her baby; I give information and support, professional judgment and recommendations, not permission.



What I do, however, may be close. Perhaps I’m just parsing words (or perhaps I just don't like that word - permission) but I like to know where my clients are at, emotionally, with respect to breastfeeding.  More importantly I like *them* to know.  Does she want to quit? Where is her breaking point?  I don’t necessarily ask those questions point-blank but I find that wanting to quit and *not admitting it* is worse for the nursing relationship than wanting to quit and *acknowledging so out loud*.  I can’t fix what she can’t admit to, and beneath every desire to wean very early (to quit in the first month or two) is generally speaking a problem that needs fixing.



So from time to time I'll ask a woman to be aware of how she's feeling about the breastfeeding.  Sometimes I'll tell them that every IBCLC practices a little differently from every other and that my own approach is that she should do whatever she needs to do in order NOT to quit -- because the minute she quits, Baby gets no more breastmilk, I say.  (They nod their heads knowingly.)  Therefore whatever keeps her from quitting, she should do, I say.  



Within reason, of course.  Generally speaking, once she and I get to that point in the conversation all she's really looking for is some hope, a resolution to her pain/physical discomfort and some sleep.  But to frame it in those terms - what do YOU need in order to keep from quitting? - reframes things in a way that I find helpful to my clients.  It's another way of finding out what her priorities are.  She feels listened to and seen, like her needs are important to me too, not just the baby and the breastmilk.  And it lowers the bar, so to speak - instead of deciding she's going to give a bottle of formula after every feeding, she decides that all she really needs is two good nights' sleep, or to pump and heal for a couple of days before she re-attempts breastfeeding.



I've never yet had a woman respond to that question with, "What I need is to quit," or "What I need is to do both."  



Nursing just one more day, sometimes that's the goal.  Pretty soon that day will have turned into a week, and the week into a month, etc etc. etc. ☺



It's kind of a false dichotomy, really - mother or baby.  It takes two, as we all know.  If mom doesn't want to breastfeed, baby isn't going to get any breastmilk, no matter how badly he wants it.  And if baby won't/can't nurse, then mom isn't going to be able to breastfeed, no matter how badly *she* wants it.  We have to take care of both of them.  You lose one? You lose the other.  Just my $.02 of course.  For such a long post, I hope it's a useful addition to the conversation!









Regina M. Roig-Romero, BS IBCLC

Senior Lactation Consultant

Miami-Dade County Health Dept

WIC/Nutrition Breastfeeding Program

7785 NW 48 St, Suite 300

Miami FL 33166

786-336-1333 x162

 

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