I struggle too with that balance between telling them what needs to happen and what I think they are ready to hear.  When  a mom is on the verge of tears at every suggestion, I know that the suggestion to add 8 pumping sessions to her already overwhelmed day is not going to happen.  My philosophy has morphed into "some breastmilk is better than none" when working with WIC clients. These moms are coping with a variety of barriers, including financial, & emotional.  While I want BF to be this wonderful bonding moment, Mom's desire has to be there to make it happen.  

One thing I have started to do is to identify a long term and short term goal.  This helps me to focus on what needs to be the priority and it keeps mom from overwhelm.  Sometimes the short term goal is basic skin to skin for the weekend, other times it is eliminating dairy for 1 week.  As an IBCLC working WIC, I can feel very conflicted over the issuance of formula and sometimes the short term goal includes the use of formula by mom's choice.  However, I go back to my "some is better than none" and figure if the use of formula keeps them sane, it is better than not BF at all.  I know that it is going to cause their supply to be less, but I can't paint too grim of a picture or they will give up all together.

Part of my job is actually determining their BF status for WIC, and I often cringe when I am obligated to offer a full formula package to a mom who is struggling with BF.  I tell them that it is their choice, even though I would like to see them go with a package with less formula.  Some moms with transportation problems cannot risk going home without formula, while others can get back for further help if more BF problems occur.  

In the end I feel it is part of my role to help them see BF in manageable pieces and give them tools to reach their goal.  I also feel that it is my responsiblity to see the dyad in relationship to their resources and recognize when their goal may be too lofty for their situation.  Confidence is a huge resource that is in short supply in the moms with which I work.  


Lisa Paul, IBCLC  

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