THE question: a mom bf for years previously but is not planning to this
time--I get this response surprisingly (to me) often (the expected amount of
times being zero).  Anyway, I got it twice last week; both times the mom
changed her mind after our conversation.

MOM:  I was only planning to breastfeeding for six weeks anyway.

ME: That's a pretty short time.  How did you choose six weeks?

MOM:  Well, I breastfed my other baby for two years, but this time I'm only
planning to breastfeed 6 weeks (or, not planning to breastfeed).

ME:  Two years?  Wow, congratulations!  You did a great job!

(Pause while we both consider that.)

ME: Something has changed since then.  What has changed to make you want to
stop so soon this time?


My only thought on this is that the mom feels like she can tell me about
this pressure she's feeling, like she's not generating the problem but just
responding to it.  That gives me the chance to (first) empathize with how
bad this problem seems to feel to her, and (second) offer a possible
solution to her problem "just in case" she wants it.  (Candidiasis, return
to work, sore nipples, new younger husband (really!), medications, new urban
legend, etc.) 

After agreeing that her problem could be frightening to a new mother, I make
the offer to solve her problem in a sort of "off-hand" manner, assuring her
it's a common concern and has some really satisfactory solutions, should she
happen to want them (no pressure at this point, I'm just trying to capture
her interest, not make her dig her heels in and entrench herself in a
decision she doesn't really want anyway).  

At this point it comes out how much she enjoyed the first experience and how
worried she is about short-changing this baby.  

I agree with her on both counts (of course she enjoyed breastfeeding the
first, of course she's worried about the dangers of not breastfeeding the
second), and let her know her concerns are eminently reasonable, because of
course she's  a good mom (I just said so a couple minutes before so I am
quite believable when I repeat this). From there I just feel my way through,
asking for details and throwing her lifelines as she gives me clues about
what concerns are on her mind and what things she values will motivate her.


A staple factoid I include is that we all know that formula-fed babies do
not enjoy the health of breastfed babies and that in fact any group of
formula-fed babies is sicker on just about every measure scientists have
looked at compared to a matched group of breastfed babies.  (Yeah, I explain
about this--it's the only way to get past the "my neighbor's baby was
formula-fed and he's fine" rebuttal, "fine" being defined as "still alive,"
not a great measure of quality of life in any case.  But if you let them
think a single case is good science, you've nothing to stand on.) And then
there's the long-term consequences. 

Of course, this is the hook, but it would be unethical, unprofessional and
extremely dishonest not to give her this information to make sure she was
prepared to make a fully informed decision.  

I am careful to present this information sympathetically, because of course
I do sympathize with any new mother who chooses anything so fraught with
problems and anxieties as formula-feeding.  I also sympathize with a woman
who is being terrified by some new urban legend or sore nipples or
what-have-you.

If she still insists she's going to terminate bf prematurely, I say let me
know if you change your mind and I'll be glad to help you, and graciously go
on to the next bit of business.

One of the two last week was still saying "formula" when she went out the
door but came back in a few days later and told my colleague she had
definitely decided to breastfeed, quoting some of the things I had said.

It's a dance that takes time, but it allows moms to express their fears and
be heard and respected, and I think we recapture a lot of potential
breastfeeding this way.  If we don't find out what has changed to shut that
door, we can't help them find the key to open it.  

In the end, I think the need for all of us to be heard and respected is very
powerful.  So much so that I think the anger over the perception of not
being heard often overrides a reasonable desire to do right by the baby.

Arly Helm, MS, IBCLC

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