RE: the mom whose baby wasn't gaining and she wasn't tuned in -

Sometimes it helps to take her aside and just listen.  Period.  Don't advise,
instruct, teach, etc.  Just listen.  Something in her is causing the
dissonance between what she says she'll do, and what she actually does. Get
on "her side" by feeding back and carefully interpreting her feelings -
she'll clarify if you've nailed something she doesn't want to admit. She has
to trust you first, before she'll do what you suggest. And moms need someone
on "their side" or at least is willing to validate their  experience as
meaningful to them. This is what skilled lactation counseling is all about.
Eventually this mom needs some loving confrontation like Barbara Wilson-Clay
suggests. Confrontation will be seen as just another attack unless you can
establish sufficient trust with her (by listening and validating) that your
confrontation is taken as coming from your compassion.

Linda Smith, private practice, Dayton OH