I support the idea of a standardized approach to breastfeeding, and indeed
any, problems.  That isn't the same as a standard response, at all.
In our protocols I mainly want to see a list of the factors that are to be
considered in every case before the treatment plan is made.  I don't ever
want to see a treatment started unless the protocol or algorithm has been
followed.  They don't have to be impossibly complicated, but they do have to
reflect the competencies inherent in our field.  And if the same factors are
considered, you will not end up with a cookbook response, you will end up
with the individualized care that serves mothers and babies best.  

When I was learning midwifery, which I did in a formal educational program
that combined didactics and supervised practical experience (in contrast to
the way I learned about helping mothers with breastfeeding difficulties,
which was through unsupervised experience gleaned as a peer counselor, then
later in my work as a midwife, all the while accompanied by voracious
reading of current literature and later by systematizing my own knowledge so
I could present it in teaching my colleagues, and also by participating on
this list), it was always a revelation to work with an experienced midwife
who could put her knowledge into words.  Having an older colleague describe
to me the consistency of a perineum and how she assessed the need for
support or how to guide a woman through an atraumatic birthing of her baby's
head, was nothing less than brilliant.  It was also very rare to find a
hands-on practitioner who was so articulate.  

On the very few occasions I have been able to work with mothers together
with an IBCLC colleague, and those occasions number less than five in my
career, it is my own structured knowledge that enables me to rapidly
incorporate the new things I have learned so that my own practice improves.
The collaboration we enjoy from this list is one hundred per cent dependent
on our verbal communication ability.  In e-mail, that's all there is.  No
body language, no nuance of voice, just the information contained in our
words.  That's how I learned to do RPS.  If Jean hadn't been able to write
down how to do it, I never would have learned it, nor would many of us on
the list.

Much of what we do after many years of practice is intuitive; that is, we
don't need to think consciously about the individual components of it.  We
can see at a glance that a baby is badly positioned or attached, or is
struggling with a feed, when someone just starting out would need to have a
checklist in hand to make sure they observed body position, breathing,
suck/swallow rhythm, and all those subtle things that we just take in
globally because we have done it so many times.  But for someone who doesn't
have that knowledge, it is vital that we are able to spell out what it is we
do, because otherwise, outsiders will think that anyone at all can do our
job at a glance.  When we make something complex look easy, it is likely
because we are good at it, NOT because it is necessarily that easy.

That said, I will put my tongue in cheek and say that for most problems I
see, skin-to-skin is a good starting point, and you could probably bluff
your way impersonating an LC through the first round of a
guess-my-profession quiz show by simply placing babies in skin contact with
their mothers.  It's the observations we make while baby is there, and the
fine tuning we do afterwards based on that particular mother and baby's
characteristics, that separate the novice from the expert, and that is
knowledge that can indeed be expressed in words.  I won't claim it's fun to
sit there and get this stuff down on paper, but it is necessary.

Rachel Myr
Kristiansand, Norway

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