This continues to be a very interesting discussion.  Several comments on
several peoples' posts:

Kathy D, you can validate and empathize with someone's unhappiness and
frustration without encouraging them to believe they can't function on an
interrupted night of sleep or encouraging their "whining."  Validating and
encouraging are two different things.  So if a woman comes in and looks
totally frazzled, says she's desperate to get some sleep, starts crying and
saying "I just can't go on like this"  one extreme would be encouraging it:
"Oh, that's awful!  How can you stand it?  I can sure see why you are
feeling like giving up!  I would too!"  The other extreme was what you
discussed in your first response to my post,  the "you think you've got it
bad, you should hear what women in other countries deal with," chin up,
stiff upper lip, quit yer whining approach.

The middle road way would be to say "You sure seem very tired.  Most moms
do at this point.  It can be really rough but you'll make it through it.
 Let's think of some ways  you can take care of  yourself and get through
this time when your baby needs to nurse several times at night."  As I'm
sure you know, there are also cultural differences in how much complaining
people do about a given problem.  For example, one side of my ancestry
(Irish/German) is more the "stiff upper lip" approach.  The other, Jewish,
is the "kvetch a lot and you'll feel better having done so" approach.  So
there is that factor we might consider when trying to decide if a given
woman is just complaining because it helps her feel better to have a
sympathetic ear or if she is about to quit breastfeeding because she thinks
she's got it so bad.

I do totally agree with you that women need to know what life with a baby
is like and what to expect and to help her set her priorities.  Probably a
very limited amount of that can be done, though, when she's exhausted and
in tears.  Hopefully, we can do some of that before the baby arrives.

Cathy B's comments on the two different socioeconomic groups she has worked
with reminded me of how many times I've marveled at how few complaints and
self-pitying comments I've heard from women in who live under what I
consider terrible conditions.  Maybe  the same quality that has  made
people in higher socioeconomic groups get where they are also makes them
more easily dissatisfied when things don't go as they expect? Just a
thought, I have no data to support this....

Judy LF's idea about telling moms to wear their baby to a local
neighborhood store where they'll get some positive comments and feedback is
a great one I plan to start using.  Unfortunately, it seems those little
stores are becoming more and more scarce, at least where I live.

Kathy D's later post "cogitations" about telling women the truth without
sugar coating reality:  Again,I agree that if women had a better picture of
what life with a newborn is like, they would not have such turmoil when
their false expectations don't become reality.  However, in my experience,
most health care professionals don't have the time to do the massive
reframing of womens' expectations about their upcoming life changes that
would be ideally covered and help them cope when the baby arrives.  Even
the CNMs and OB residents that are totally sold on breastfeeding don't do
the nipple check I suggest to them prenatally with their patients because
they are so pressed for time (it would probably take them one minute to
do).  Maybe the ideal place would be in prenatal classes.  Then we would
be, to some extent, preaching to the choir, but there would be some people
who would see things a new way and do a better job coping as a result. My
own experience with Bradley classes was that they do this some, at least
more than other methods.  But how many people take the time (I think they
meet ten times) and money to do something  like this?  NOBODY that I see in
my clinics.  Most of them don't even go to the free one day prenatal class
offered by the hospital (which would not include any of the type of
information we've been discussing).  As far as I know, I am the only person
in the clinic that talks to women about these sorts of things, and I see a
fairly small percentage of the patients. I also deal with things like
battering, drug use, etc. and sometimes discussing parenting and what they
should expect when their baby arrives, never gets into the discussion.

I also totally agree with you that people make choices and don't really say
(or see) it the way it truly is.  My sister-in-law once complained to me
that she and her husband couldn't afford to have their (only) child in
private school. We were sitting on their new deck, connected to their
outdoor kitchen (so he can fry his fish there and not get in her way in the
inside kitchen) and their Mercedes was parked out front.  Huh?  There I was
driving an old Subaru, with one old kitchen, no deck and two kids in
private school.  She was totally unaware of what she was REALLY saying, as
you point out.

Kathy D. on compensatory sleep or reduction in activities:  I do suggest to
people that they go to bed when the baby does.  The problem comes when they
are single mothers and there are other children that do NOT go to bed when
the baby does.  Also, there is an expectation in our culture that the
spouses should have some alone time to keep their marriage strong and
viable.  About the only time you can do that with young children is after
they're asleep.

Leslie W. made a good point in "helping moms where they are" that if we
meet them where they are even if we don't agree with their choices, we may
have some small impact that will help them do better the next time, or help
them help a friend out.  Maybe with the reality that most of us work in,
this is the only way to help them see the alternatives to the cultural norm
in raising babies. This also seems to be what GHertz does when she tells
parents of her patients that what is going on is normal, validates their
feelings and that it will pass.  I'm sure she doesn't have time to have
lengthy talks with parents about parenting and how our culture promotes
incorrect messages about what babies need.  But each small behavior or
concern she addresses makes one step toward better understanding on the
part of the parents.

I like ESUrbas' definition of the two lines of reasoning that have been
going on as the Speak Truth to Power and the Meet them Where They Are.  I
guess I tend to find the harmony between two opposites, whenever I can.
 The Chinese philosophy of balance, and all things in moderation is
something that has appealed to me for many years.  Perhaps what I have been
struggling with in the sleep and parenting issues we've been discussing is
"where can these two sides meet harmoniously in the middle in a way that
isn't too far from the cultural norm of the women we work with yet supports
breastfeeding?"  I have personally led my life much like what Kathy D. has
described as the way it should be for babies.  But I am way, way in the
minority of how people parent, at least in this community.  I used to
espouse my philosophy in its purist and most ideal form to the women I work
with.  Don't use any formula, meet your baby's every need, etc.  But it
wasn't being heard.  It turned them off.  If they heard that it was ideal
to nurse a baby for several years when they weren't even sure they could
handle several months, they seemed to decide that breastfeeding wasn't for
them.  I used to only discuss pumping with women who had to go back to work
or school because I didn't want their babies to have ANY formula.  But then
they quit breastfeeding when they had to go back to work or never started
to begin with because they knew they would be working.  Now I say "If you
can't or don't want to pump at work, the baby can have formula while you're
gone and you can still breastfeed when you get home."  They often don't
realize that and seem pleased with that option. So I haven't achieved my
ideal of a totally breastfed baby.  But some is better than none!  And
really good point, Elisheva, about the two different obligations of the two
different roles we are approaching this from in trying to promote more
breastfeeding. And a good point about people not seeing normal, dependent
(that's another quality people struggle with a lot), "delicious" babies in
their day to day life like we used to. Maybe we need more prenatal
discussion groups (variations on LLL) that have women coming in with babies
for show and tell on breastfeeding, sleeping, wearing babies, etc.

Thanks for all of the thought provoking posts!

Lucy Towbin, MSW, IBCLC