Laurie talks about how to give information about what they need to do to 
have a full milk supply/bf successfully without upsetting mothers and 
getting poor reviews. And Hoda asks how much information we give a mom 
who doesn't seem as committed to bf.

I try to give information with empathy, which is the balance all of us 
that weighed in on this issue are trying for. "This is how bf works" is 
my usual way of expressing it. I explain why we need to remove milk 
often to increase supply, ask them what is making it difficult to take 
milk more often, and then invite them to problem-solve collaboratively. 
It might look like this:

Mom: I'm still only making 5 oz of milk a day (~140ml for those of you 
on metric).
Me: Tell me how you are taking milk out.
Mom: I'm using a rental pump (specify).
Me: How many times a day are you managing to pump? How many times did 
you get to pump yesterday? (gets a better answer, and "managing" and 
"get to" are clues that we are talking reality, and reality is sometimes 
difficult).
Mom: 3, but I pump for an hour each time.
Me: I can see how that would be very difficult. I wonder if we could 
help you with milk expression so it would be much shorter and then it 
would be easier to do it more often. I bet your nipples hurt after all 
that time pumping!
THEN we talk about where she keeps the pump, what the flange size is, 
does she use massage and compression, what are her expectations, 
anticipatory guidance: "At first it won't feel worth it, you'll get just 
a little bit, and you'll think you should wait until you have more milk, 
but taking out those drops often is how we tell the breasts to make more 
milk." (insert factory analogy, study results, whatever mom needs to know).

If moms need to make compromises, we talk about that and affirm that she 
is the one who gets to make those decisions. But I don't hold back 
information (again, expressed with empathy) based on my judgement of 
mom's commitment. Commitment grows with time as mom tries out bf and 
finds that it 'works' for them, and wanes when they are struggling. 
That's only natural when bf is not the default choice in our culture.

I hope this helps! I've worked it out over the past 27 years of helping 
other moms bf, first as a childbirth educator, then a LLL Leader, and an 
IBCLC for 21+ years now.
Cathy

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com

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