I want to make a connection back to the original discussion of being
frustrated when one has to clean up other people's train wrecks.
Remember the part where someone pointed out that we're responsible for
what we say, but the mother either a) doesn't hear what we're saying or
b) doesn't remember some/all of it? I think there will always be
mothers for whom this is true, no matter how the information is
presented - one person isn't going to reach everyone, for a variety of
reasons. But I think one person can reach most of the moms s/he comes
in contact with once she understands how to communicate well, and most
candidates can benefit from this along with meeting the other standards
for certification (I know this has gotten more focus in the last few
years, BTW).
I would think that one of the most difficult components of compiling
this credential is the counseling component. Coming from a LLL and a
social work background, I feel like that's one of my most completely
developed skills, and one that I had to work the least at in order to
pass the exam (that's not to say I don't still work on it every day).
I had colleagues in my review course (yes, taken close to the exam as a
refresher of 5 years of LLL work plus study :-) who clearly didn't have
this at all, or who weren't in a position that allowed them to us
counseling skills to any advantage.
I'd venture to guess that a big part of what we're seeing once mom
leaves the hospital is due to the fact that many a staff nurse/LC, even
one with good technical and counseling skills, isn't given the time in
the hospital to sit down with the mom for any length of time. She's
got too many shoes to fill/too many patients to see. Someone mentioned
picking up things like a tight frenulum the first time she looked in
the baby's mouth - if the hospital LC stuck her head into the hospital
room, asked a new mom how things were going and got "OK", then she may
not have looked in the baby's mouth. If she'd had time to sit down
with the mom, admire the baby, offer some statement about the mother's
skill at mothering, and then ask if there were any concerns the mother
had, the response would likely be very different, and the LC would then
be more likely to look in the baby's mouth for some reason that nursing
wasn't comfortable.
One thing I tell LLL applicants as they move through the application
process is that the question the mother comes with is not always the
question she really wants the answer to. It's my job as a LLL leader
(and as an IBCLC) to sit with her long enough to find out what the
question is, and then how she can best hear my response to it. That
takes time that I'm guessing hospital folks rarely have, but I'm seeing
a lot of missed counseling/teaching opportunities that would have
prevented a lot of problems.
So my .02 to all the wisdom already shared in this discussion would be
on two fronts: 1) a qualified IBCLC (or candidate) needs enough
counseling skills to understand that this is more than just a technical
exercise and 2) those is hospital/clinical settings need to lobby for
time to use those excellent counseling skills.
Morgan Kennedy Henderson, IBCLC, LLLL
Wellesley, MA USA
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