Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Why Educating Our Patients is a Professional Responsibility and NOT About Guilt October 11, 2009

Filed under: Ramblings — NursingBirth @ 12:43 AM
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Yesterday I wrote a very long response to a comment left on my blog regarding a post I wrote entitled New Study Hypothesizes Bottle-Feeding Simulates Child Loss Increasing a Mother’s Risk for PP Depression

 

I woke up this morning and read all of the comments left on that blog post.  I wanted to take this opportunity to thank everyone who wrote in with support and encouragement!   You all keep me blogging.  Although I have many issues with a couple of responses, overall they were positive and well written.  Thank you! 

 

I have read FearlessFormulaFeeder’s response on my blog and on her own.  I truly don’t think I could write anything better to respond than this article emailed to me by one of my readers:

 

<tongue in cheek> Confessions of a proud breastfeeding zealot </tongue in cheek> by Katie Allison Granju

 

I make a conscious effort every day as both a nurse, an activist, an everyday woman, and a blogger to never use guilt based techniques to support any certain “way” when it comes to choices in labor, childbirth, and breastfeeding.  That does not mean that some choices do not carry more risks than others.  Not all choices are equal in their efficacy or safety.  This is a fact.  I also know some people do use guilt, either intentionally or subconsciously, to influence their peers or patients; Even nurses, doctors and lactation specialists are sometimes at fault for this!  And it’s not just breastfeeding supporters that sometimes use guilt; both sides are guilty of using GUILT to further their cause.  However I am NOT one of those people and I feel that my past posts on controversial topics speak for themselves.  I certainly have a strong opinion but I never (until FearlessFormulaFeeder came along)  have been accused of making other mothers feel “bad” after providing sound, well researched, evidenced based information to my readers.

 

I promise you that I will continue to educate myself regularly on the newest research and practice evidenced-based nursing.  Furthermore I will continue to ask my patients appropriate questions at appropriate times in order to assess their knowledge base, background, and learning needs with the aim of providing them with age appropriate, culturally competent information and care to assure that any decision that they make is an informed one.   In fact, it is my professional responsibility to do so. 

 

As a nurse I am so much more than an executor of orders.  I am an advocate, a caregiver, a leader, a listener, a teacher.  Since I do not personally subscribe to the philosophy that women should be guilted or bullied into making certain decisions I will not take responsibility for any other person who does choose to act in that manner.  I am only responsible for my own actions.  Likewise, if providing evidenced-based information, including the risks and benefits of a particular choice in a sensitive way at some point causes a person to feel guilty about one thing or another, it will not stop me from providing that information.  This includes reporting and commenting on the latest research. 

 

In my own practice as a nurse I often ask people the question, “Do you feel that you have received enough information on the risks and benefits of ______ to make an informed decision?”  (I have to ask about things like plans for pain medication/epidural, plans for VBAC/repeat cesarean, plans for breast/bottle feeding during my admission or triage interviews).  If a patient answers “YES“, I then ask, “Do you have any questions for me or your doctor/midwife?”  If a patient answers “NO” I ask more questions to find out what they still have questions about.  I have found this line of questioning to be the most efficacious when talking to many mothers/couples since the feedback I have received is that it is a non-threatening/non-judgemental way to open the dialogue between patient and nurse.  And boy have I stumbled upon some moms that have been given some misinformation! 

 

Here’s an example of an actual conversation I had with a patient once.  This mom was a 21 year old single white female with a long-term boyfriend.  She worked as a nurse’s aide, her boyfriend as a UPS carrier.  They had family in the area but lived together in an apartment in the city.  She was pregnant with her first baby and was being admitted for an induction for post-dates:

 

Me:  “Are you planning on breast or bottle feeding?”  [**see addendum below**]

 

Mom: “Bottle.”

 

Me: Do you feel that you have received enough information on the risks and benefits of bottle feeding to make an informed decision?”  [**see comments section**]

 

Mom: Well yeah, because I have to go back to work after 6 weeks so I can’t breastfeed.

 

Me:  “Many mothers feel overwhelmed about the fact that they have to go back to work very soon after having their baby.  However, some mothers don’t realize that any length of time that they breastfeed their baby is absolutely wonderful and even breastfeeding for the 6 weeks that you are home from work can provide you and your baby with many benefits.  Especially since the first milk you make, called colostrum, is filled with so many great antibodies that help your new little one stay healthy and grow during those very important first few weeks. 

 

Mom:  “I didn’t realize that you could breastfeed for only 6 weeks!  I thought if you were going to breastfeed you had to breastfeed for like a year!”

 

Me:  Some moms start breastfeeding without a set goal of how long they are going to breastfeed and just take it one day at a time.  Some mothers will stop breastfeeding before they reach 6 weeks.  Others will breastfeed up until they have to go back to work.  And others are lucky enough to work something out before they have to go back to work so that they continue to breastfeed even after they return to work.  The great news is that no matter how long or short of a time you breastfeed for, your baby will benefit from having your milk to help him grow and stay healthy!!  If I brought you some information in about breastfeeding would you be interested in learning more about it?

 

Mom:  Yeah!  That would be great!  Thanks!!

 

I had the priviledge of being a part of this mom’s birth and was honored to assist her in getting her son to latch on for the first time.  She breastfed her son throughout her hospital stay and did leave the hospital without supplementing with any formula.  Unfortunately I do not know what happened to her once she got home.  She could have had troubles and switched to formula, she could have successfully breastfed for her six weeks, or she could still be breastfeeding her 8 month old!  (This is one bummer about being an L&D nurse with no ability to follow up on patients.)  But I do feel that she learned quite a bit from our conversation during her admission interview and from the information I provided to her that she read during her induction and I am proud that I was part of the reason she decided to give breastfeeding a try. 

 

**Addendum**  After a great comment left by Lonely Midwife on 10/11/09 I have decided to make a change in my practice.  Instead of asking “Are you planning to breast or bottle feed?” she has suggested I ask “How are you planning to feed your baby?” as it is a more open-ended question with less chance of being perceived as judgemental.  I really like that and have decided to adopt that question into my practice.  This is also much more like the question I already ask about pain management in labor since during my admission interview with patients I ask “Tell me about your plans for pain management during labor” instead of the more common question “Are you planning on having an epidural or using IV pain medication for your labor?”  Thank you to Lonely Midwife for opening my eyes to some hidden judgement in my admission interview. 

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

My point is that the “mommy wars” are out there.  I certainly am not looking forward to them when I one day become a mother and often speak out against them.  But I personally have made a conscious decision as a nurse to not use guilt based techniques to influence or educate my patients.  I use facts and regardless of my own personal beliefs, I provide both the risks and benefits of any choice or option when counseling patients.  And because I do that I do not and will not take any responsibility for another person’s guilt even thought it is true that I feel badly that a person might feel that guilt.  After all, guilt is a cognitive or an emotional experience that occurs when a person realizes or believes – whether justified or not – that he or she has violated a moral standard, and is personally responsible for that violation. 

 

Fellow blogger Stork Stories has shared with me some very important wisdom that she has learned over her very impressive career as a labor & delivery nurse and lactation consultant fro 35 years.  I would like to share her wisdom with you all.  THIS (NOT guilt based persuasion) is MY philosophy on breastfeeding education.  I couldn’t have said it better myself and I thank Stork Stories for sharing!

 

* It is inappropriate for a health care professional to indicate to a mother directly or indirectly that formula feeding and breastfeeding are equal. Human breast milk is the superior food for human infants. Properly prepared infant formula is an acceptable substitute for those who cannot or choose not to breastfeed.

* The first approach is probably the number one factor in gaining a mother’s interest in what you have to say.

* The education process to a mother needs to be in small doses, sensitive to her unique learning abilities, her cultural beliefs and practices and most importantly, her choices and individual breastfeeding goals.

* With that in mind, try to provide her with the information she needs to make her decision.

* Never overestimate a mother’s desire to breastfeed her infant.

* Never underestimate a mother’s desire to breastfeed her infant.

* Listen to the mother; help her define her true desires and goals.

* Many times, the first question she asks may not be what she really wants to ask.

* The mother’s individual breastfeeding goals, how she defines them, how important they are to her and how she relates them to her actual breastfeeding experience all help define how she measures success.

* Support the mother, support the mother, and support the mother.

 

 

I’ve said my peace.

 

~NursingBirth

 

The conversation continues over at Stork Stories with her post:  **ROAR** on Breastfeeding Guilt 

Please check it out!!

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29 Responses to “Why Educating Our Patients is a Professional Responsibility and NOT About Guilt”

  1. briome Says:

    well said!
    I also enjoy Stork Stories — especially this part=

    Never overestimate a mother’s desire to breastfeed her infant.
    Never underestimate a mother’s desire to breastfeed her infant

  2. Rebekah Says:

    Excellent! Thank you for these last few posts. I have so much trouble talking about breastfeeding (or anything I feel strongly about, really) in a non-combative way.

  3. Suzanne Says:

    Very valid points, NursingBirth. And I think your story about the young mom you helped is a beautiful one – I am a strong believer that if we stop heaping pressure on new moms to breastfeed for an entire year, and instead do as you did, then we would increase breastfeeding rates even more than we already have – maybe 100% versus 73%! So I am glad you are out there providing this type of support.

    However – and I don’t mean to belittle your professional qualifications, as being a nurse certainly qualifies you to weigh in on these issues more than I can – but I do not believe you can truly understand the mommy wars until you are fully entrenched in them. I certainly didn’t. Prior to having my son, I would have considered myself a lactivist. And then I went through hell, and got a different perspective.

    Regardless- keep on doing what you are doing – I know you think I am anti-breastfeeding, but that could not be farther from the truth. I respect your stance and think you are doing a wonderful service.

    • NursingBirth Says:

      Suzanne, thank you for your comment. And you are right, I have no personal experience with mommy wars and an outsider’s view of them is certainly not the same as an insider’s one. I would like you to know however that I do not think you are “anti-breastfeeding.” I read your blog. It very clearly states that you are not anti-breastfeeding but rather are an “anti-lactivist”. That is why I posted about the babble article:

      http://www.babble.com/CS/blogs/homework/archive/2009/08/05/breastfeeding_2C00_-feminism_2C00_-activism.aspx

      I hope you will one day read that article. I also want to thank you for the tone of your comment. Very positive. On another note I would like you to know that it really bothers me as a lactivist when I hear about another lactivist walking into a store and telling a mother feeding her child formula that she is feeding her child “POISON” or something equally as unhelpful and hurtful. I know it happens and actions like that don’t help our cause, it actually hurts our cause.

      However, it’s hard for me to read you writing about how all you want to do is set up a blog to “support formula feeding moms” as if your blog is simply dedicated to helping those mothers purchase the best bottles and other supplies, research the best formula for their child’s needs, and provide a shoulder to cry on when motherhood throws us a curve ball when in reality you write posts like this ( http://fearlessformulafeeder.blogspot.com/2009/08/in-sickness-and-in-health.html ) that start off with the phrase “Guilt-inducing excerpt of the day” and continue with quoting an article published in the Holistic Pediatric Association that reports true information about the immunological benefits of breastfeeding “for as long as possible” including breastfeeding after a baby is 6 months old. There is not one judgmental statement about formula feeding mothers in the paragraph you quoted nor are there any untruths. If you are 100% supportive of breastfeeding as you say you are, willing to “bear your non-lactating breasts for the cause” then why would you write things like that? It is really hurtful and just as unproductive as a mother calling you a poison feeder! And also, I fail to see how that type of writing is helpful to formula feeding mothers. Does questioning the very well researched and documented benefits of breastfeeding make these women feel better about their own choices to bottle feed? I don’t know because I am not a formula feeding mother but it doesn’t seem right to me to do so. It seems extremely counter productive.

      You might be thinking “Well if you don’t like my blog then don’t read it.” And you are absolutely right. I don’t have to read your blog, and in fact, I probably won’t after today. I will speak out any day to support your right to freedom of speech and I respect the fact that you are exercising that right. However I feel like your intentions for your blog are not as innocent as you claim. I feel that while you have claimed you intentions are that of providing information and support you instead may be (subconciously, I don’t know) working to further the divide between breastfeeding and bottle feeding mothers. If you weren’t, you wouldn’t be taking paragraphs that report on the benefits of breastfeeding (that don’t even reference formula feeding anywhere in the paragraph) and labeling them “guilt-inducing excerpts of the day.”

      Just some food for thought.

      • JoyfulLove Says:

        I dont understand why you are choosing to pick a part her blog. I think her comment was graceful & tactul especially since you made a point to write an entire blog entry about her comment & make her look like a fool. She certainly isnt telling you how to write or manage your blog so the fact that you turned to criticizing her own seems like a petty attempt to attack her, once again.

        • NursingBirth Says:

          JoyfulLove, if anyone else, a random person, had left the comment she left on my blog I would have done one of two things: 1) ignored it, 2) replied with something small. However, FearlessFormulaFeeder runs a blog and says that she has been a “health/wellness/woman’s issues” writer for many years. I hold myself up to very high standards when I write, reviewing and citing proper research to back up almost everything I write about. I also hold up other bloggers to the same standards….not just any bloggers though, but bloggers that choose to comment on my blog. I don’t sit at my computer every moring and surf the web to find blogs I disagree with and proceed to cut them down! That would be silly 😛 However in the future if a blogger, especially a health/wellnes blogger or healthcare professional blogger, comments on my blog with untruths and claiming that research that they don’t agree with is “irresponsible” not for any other reason but that they don’t either understand the research or don’t like the findings of the research then I will once again correct them. Even if it takes a whole blog entire blog post to do that. My intentions were not to make anyone look “like a fool” but it is important for my readers to know that I 100% appreciate both assenting and dissenting comments on my blog, but you can’t just come here and write untruths without backing up your claims and feel good about it because “you can say whatever you want on the internet”. I know that flies in other places on the internet, but not here.

          I hope what I just wrote does not come off as angry. I hope you will read it with the tone it was written in: a calm mind. Thank you for your comment JoyfulLove. I hope you continue reading and commenting here at this blog. 🙂

          • If she is a “health/wellness/woman’s issue” writer, then I certainly have my work cut out for me. My law degree is going to be exhausted working against the Hannah Rosins of the world who claim to understand health issues, but do nothing but undermine women’s health with their own “guilty” tirades. Imagine how much harder we’ll all have to work to get policies put in place to protect breastfeeding mothers in the workplace, and women who breastfeed in public, when you have these “writers” running all over the internet with false information.

            Just great. For every percent we grow in our healthy baby goals, 50 more “formula-feeders-need-support!” (disguised as feminist blogs) pops up on the internet.

  4. Here is my perspective–that is all it is.

    As a mother of a large family, more than five, all breast-fed (including the preterm high order multiples), a labor and delivery nurse for 17 years and now a nurse midwife the mommy wars are alive and well and this feeds them. I wholly support breastfeeding. It is the best nutrition for an infant, add to that the potential for decreasing a woman’s risk for cancer later on and I am all over that. But, asking a woman does she know the “risks and benefits” with “risk” being the first word, some judgment is introduced there.

    For example, when we ask women on admission their feeding choice it typically is asked ”are you breastfeeding or bottle-feeding”–breastfeeding is usually first. This was brought to my attention by a mother who could not breastfeed-truly, medically contraindicated. I had never thought about it before. I changed my practice to asking–“and how are you going to feed your baby?” I always ask mom’s who choose either method what are their feelings about it, why did they choose it–I make it an equal opportunity discussion. One can tell from those answers if they need more information, believe myths, or are seeing barriers that are truly not there or that I can help them overcome for both nursing mothers and bottle-feeding mothers. I have found this to be an effective way for me to support women, their families and their infants. Yes, many times they will decide to “try to nurse” and I consider that a victory but I think we need to think about our own biases and convictions. We all have them-we wouldn’t be human if we didn’t. We all grow in our practice. Our life situations and the women we care for and their situations shape our practice as well. We are blessed and honored to care for all women.

    • NursingBirth Says:

      Lonely Midwife, I feel that I could benefit from what you have written by being more open ended in my questioning. I like how you ask “How are you going to feed your baby” as opposed to “Are you going to breast or bottle feed?” In fact, I am going to start saying those questions instead. You also write, ” I always ask mom’s who choose either method what are their feelings about it, why did they choose it–I make it an equal opportunity discussion.” Would you be willing to tell me what your exact wording is when you ask that question? I am struggling with how I would word that but I am very interested in stepping away from “Do you feel that you have received enough information on the risks and benefits of ______ to make an informed decision?” as I see now from your comment that my wording might be off putting.

      However as nurses, midwives, doctors, and other health care providers I also feel that we should not remove the terms “risks” and “benefits” from our vocabulary when talking to patients. There are risks and benefits to every choice we make, especially when it comes to childbirth. Contrary to what many women are lead to believe, its not all benefits and no risks. Epidurals do not provide only benefits. Elective Inductions do not provide only benefits. Repeat cesareans do not provide only benefits. etc etc etc.

      So in closing Lonely Midwife, I really really appreciate all that you have taught me today. I really plan to embrace a more open ended line of questioning. But a discussion of risks and benefits is something I still plan on doing for all of my patients, in an age/culturally/situationally/educationally appropriate way. I believe that childbearing families deserve to be provided with facts, in a non-judgemental way as possible, and I truely believe that when provided with appropriate, evidenced based information, mothers will make the choices that they feel are best for them and their babies. Whether or not they chose to breastfeed or bottle feed. And for those reasons, I do not feel that my past two posts are feeding the mommy wars. Hell, I’m not even a mommy. Because in the end I reject the attitude out there that some nurses and other health care professionals have that is that you have to be so non-biased when you educate patients that you should present all choices as equal, for example, that formula feeding and breastfeeding are equal with equal risks and equal benefits. This is inappropriate. So a discussion of risks and benefits is still warranted, although I agree with you that part of being a newer nurse is growing in my practice and learning to phrase things is as non-judgemental a way as possible.

      Thank you for helping me grow today. (If interested I have addeded an addendum to my post regarding your comment).

      • Risks and benefits always need to be present in any healthcare discussion. I completely agree. Pregnancy, in and of itself, has risks and benefits. I am glad that my comment could be helpful to you. I have learned so much from the great nurses I have met along my career as well as the women I have been privileged to care for. I have found I am able to encourage more women to breastfeed by making them feel comfortable enough to share their concerns and fears. The women who come under your care are lucky to have a nurse who has passion for them and their infant’ best interests.

  5. Karen Joy Says:

    Wow… reading all of this makes me feel glad that I have (apparently) been a bull-headed self-educator who never gave a rip what anyone thought… which is what, in retrospect, gave me the determination to birth my five children naturally and breastfeed them from 10-21 months (depending on the child; the one who nursed until 10 months self-weaned due to undiagnosed celiac disease; my milk was poisoning him, which he, apparently, figured out about 3 months before I did).

    I also never realized that, for all my isolationist/independent tendencies, I really have a supportive network of friends and family. I’m also blessed to be part of a circle of friends/family who already KNOW it’s best to breastfeed, as about 95% of my friends & family have done.

    Also, though I’m not a health professional by any means, having five kids the way I have has led me to be the resident “expert” in doing things naturally, and I’m very careful to word my questions and responses with… generosity. I would rather retain a friendship than lose it over bottle-feeding.

    That said, I do HIGHLY agree with your statement, Melissa, about KEEPING alive the awareness of risks vs benefits. Too many mothers — even well-educated mothers — have so little idea about many of the risks with, say, an unnecessary induction, or maybe they don’t fully understand (like your 21yo example — which brought tears to my eyes!!) the benefits of breastfeeding even a few weeks…

    Speaking of babies; mine woke up. Must run! 🙂

    • NursingBirth Says:

      Karen Joy, I so appreciate you weighing in on this subject. I wish everyone had the supportive network that you do!!!

      • Karen Joy Says:

        I do, too. 😦

        I’ve gleaned, over the years, a basic internal library of facts and understandings about birthing naturally, but it wasn’t until this year, that I was looking into helping my friend labor (like an unofficial doula) that I started REALLY educating myself on what could happen if things went wrong, and what each kind of wrong meant, etc. It was only than that I realized how unsupported so many, many, many women are. It made me re-think my possibly too-soft previous “live and let live” stance.

        I used to think if someone wanted help, they’d come to me. And, while that has happened on occasion, I have also recently heard a number of birth horror stories from friends or good acquaintances, and when I asked, “Didn’t you…?” suggesting a very simple alternative to the cascade of interventions (or whatever), the invariable response has been, “But, I didn’t know!” IOW, there are so many women out there who just don’t KNOW what to ask, don’t know the risks, don’t know the benefits, don’t know their options, don’t know where to go for help, don’t know that they are NOT helpless sheep in the hospital system, etc etc. I can no longer say, “Well, that pregnant acquaintance of mine will ask for help if she needs it; I don’t want to make her feel guilty by pushing my convictions on her.” I’ve come to understand that, while it might be MY personality and tendency to seek out help when needed, it’s NOT the norm for a great number of women, and even if they have the WILL to ask, they simply might not know WHAT to ask. So, I’ve come to believe that it’s important for women like YOU (and to a much lesser extent, me) to give a little light, to lay out the analyses, to delineate those risks/benefits… I’m still careful in how I phrase my questions, and gentle with advice, but I’m at least a tad more… interventionist than I used to be, a tad more proactive in lending help.

        So, thank you so much for your blog; I don’t remember if I’ve commented before, but I’ve been reading for 5 months or so.

  6. Mama Kalila Says:

    Mini vent here (sorry the timing is just wrong lol).

    In my experience in this whole “mommy war” thing those of us who do things the more natural way (in whatever area it is) are looked at as nuts and equaled to that person going around saying that all formula feeders are bad mothers & giving their child poison… When in realiity there are very few that do that… Yes, they do exist… but so do crazy bottle feeders who say breast feeding is immoral and sexual. The number of either of those types is extremely small and pretty equal from what I’ve seen… most of us are NOT like that (on ether end).

    Do I see someone buying formula or saying they bottle feed online and assume that they believe that way? Not a chance… (unless they literally say it and then I’m disgusted lol) But one of us opens our mouths to give advice (even when asked) or says what we believe or what we do and automatically we’re one of those nutty natural mommies who believes all formula feeders are horrible moms poisoning their kids. You can explain 10 ways from Sunday that you don’t believe that, but the stereotype remains. Is worse if you dare admit that you’d like to see formula companies stand up and make a better healthier product for those babies that use it.

    Like I said, sorry bad timing… I just got called crazy over something like this (not BF).

  7. Joy Says:

    I had a hard time nursing my first two daughters, partly due to lack of support in the hospital. So definitely hoping to give it a great effort this time (due in 9 days!!!). My motto is to at least TRY nursing.

    I went to WIC to apply for assistance and the worker/nutritionist doesn’t even bother to ask about formula. It’s always just “You’re going to breastfeed… aren’t you?” It makes me wonder how they’d respond if I said no!

    • Basiorana Says:

      I suspect in that case they are concerned about cost, and want to especially encourage women to chose breastfeeding over bottles, since they would then have to cover the cost of formula. I know WIC covers formula, and if you said you were not going to breastfeed, they might try to determine if you had a medical condition or the baby did, and if not, try to convince you to continue for the sake of allowing more women to use the limited WIC funding.

      • Kathy Says:

        That may be part of it, but I know some women who help WIC women b/f, and they don’t do it to save money — they do it to help women and children. Breastfeeding rates among lower-income women (who are going to be most if not all of WIC clients) are I think the lowest in the country, of all socio-economic groups. These babies are already at all sorts of disadvantages (statistically speaking) based on their mothers’ income, lifestyle, whatever. Increasing b/f rates among WIC clients is to do the most good to the babies that need it the most and will benefit the most.

        Sure, the more women who b/f, the lower WIC’s costs will be. (And the less they spend on those who don’t need it, the better! I’m frugal — all for saving money, whether my own or our collective money.) But also, the more babies who will benefit from nature’s perfect food.

    • Jenn Says:

      Well….I receive WIC benefits, and my baby (5th) will turn 1 this month.

      Yes, initially they were “all about” breastfeeding when I was pregnant. And at my first appointment after my baby was born.

      But then when I went back for my next appointment, it wasn’t quite that way. The nutritionist, she was just thrilled that I was still breastfeeding…and I think my baby was about 3 months old then. She seemed a bit surprised though. So I decided to shock her more–I told her how I was donating milk to adoptive mothers…and she seemed genuinely interested. But the front office lady who printed out the checks? “Hey, did you certify this mom?” she yelled back to the nutritionist, “is she really still breastfeeding fully?”

      Same thing happened at the 6 month, 9 month, and now 1 year visits. The nutritionist is shocked that I’m still breastfeeding–pleased–but shocked. The front office staff is in complete disbelief, and feels the need to verify it with the nutritionist every time.

      And they will only buy Gerber infant cereal (not that I use it anyway–I’ve got 7 unopened boxes, and a coupon to buy 2 more!), which is made by Nestle (Google “Nestle boycott” if you don’t understand the issue there), and Gerber infant juice (which I’ve got over a one month supply in my cabinet unused–they lecture you on not feeding your kids too much juice, then give you coupons to buy them way more juice than I’ve ever fed to my kids) and now they are buying jarred baby food as well, and at least in the grocery store I use, only Gerber makes meat that qualifies…not that I have generally used “baby food” with my other babies…the one month worth of it I’m getting for my 5th baby represents at least 2-3 times as many jars of baby food as I’ve bought for all 4 of my other kids combined. I wish they would have let me choose between getting the coupons for 95 jars of babyfood (approximately 20 lbs of food) or coupons for an equivalent amount of fresh produce/meat. ‘Cause I could have saved them a lot of money if they did it that way, and not supported formula companies.

  8. doctorjen Says:

    I agree so strongly that non-judgemental counseling works so much better in encouraging breastfeeding! On a personal level, I’m a breastfeeding fanatic – I nursed all 4 of my children, including my oldest for 15 mos when I was a single teenage mother, my middle 2 into toddlerhood while in med school and residency, and my baby for over 3 years, while I was a practicing physician. I can’t personally imagine feeding my children any other way.

    I have found out the hard way, though, that fanaticism doesn’t win many converts! I have the benefit of being in long-term relationship with my clients for the most part, so that helps quite a bit – we can have a longer dialogue rather than feel like I need to squeeze everything into a single session during prenatal care, for example.

    I find that exploring women’s beliefs and feelings is really helpful, and keeping my input factual and not emotional helps as well. I won’t avoid the truth, but there are ways to provide the truth without making a person feel bad.

    One of my goals when I talk about breastfeeding to a client who doesn’t plan to breastfeed, is for my language and attitude to be so non-judgemental and helpful, that people feel comfortable coming back to me with questions later on. I’ve had the experience now of a client who didn’t breastfeed her own 2 children calling me up and saying “My sister is having a big breastfeeding problem, and I know you know about this stuff and could help – can I tell you about it and can you help?” That’s what I want – to be remembered as someone knowledgeable and helpful, but not that zealot that you avoid discussing breastfeeding with because you know she’ll make you feel bad!

    I also find that if I can keep the conversation comfortable, eventually folks may change their minds. If I plant a seed now, if may flower in the future. I’ve now had clients breastfeed their 2nd child, when they weren’t at all interested with their first.

    I remember always, that many of us (and my little town is a prime example!) don’t live in a breastfeeding culture. We don’t grow up with breastfeeding as the norm, don’t see babies everywhere being breastfed as a matter of course. Many of us don’t think about breastfeeding at all until faced with our own first pregnancy, and there is a vague notion that “breast is best” but no culural and social background for how to make it work. Add in the extreme lack of support many women have – no family support, maybe an older kid or two that needs cared for, many responsibilities that must be resumed very shortly after birth, often paid employment must be resumed in 6 weeks – it’s really no wonder so many women struggle to breastfeed! My goal is to help women at least come to see breastfeeding as a normal and viable option, and then provide at least the best medical support I can to help it happen.

    • NursingBirth Says:

      doctorjen, I love your example of planting a “seed” of information that might one day blossom into a breastfeeding interest in your patients. What a great attitude to have!! Thank you so much for your input!

    • doctorjen, what a wonderful gift you give to your patients (and to friends/family of patients, it seems! :-))! What I especially like is that way that you distinguish between personal breastfeeding fanaticism and public breastfeeding counseling or support. And that’s because I think one of the best ways to “change the world” is to change people’s minds. And *this* is a very delicate task.

      I also think you’re right to point out that fanaticism doesn’t win many converts. In fact, I am keenly interested in discovering ways to win converts. And what I’ve found is that people do not often change their minds when they are presented with cold, hard facts about x, y, or z. Sometimes people need a personal experience to change their minds, sometimes they need an emotional link to whatever they are considering, and sometimes they just need a gentle guide to point them in the right direction.

      This is not to say that I don’t “like” the cold, hard facts. In fact, I love preaching to the lactivist, VBACtivist, and NCB-supportive “choirs” and relishing in how the cold, hard facts support our claims! 🙂 But I’m equally interested in discovering ways to present those facts in ways that change people’s minds about formula/breastfeeding, compulsory RCS, unnecessarily interventive birth, etc. And you and others on here (including Nursing Birth!) have offered some fantastic ideas for doing just that.

  9. StorkStories Says:

    Well said! Thanks so much for the inclusion!
    I have always had a hard time with co-workers and Docs NOT educating because of fear of making a mom feel guilty…. Wonderful story on how you helped that mom! I have had a lot of similar type conversations and hoped that I could make a difference whenever possible. I have also adopted more open ended questions over the years.. those are great suggestions! Our role for education, advocating patient rights for informed decisions and choices is so so important. There are so many who really make choices on what they’ve seen without real information.
    I feel so bad for those personally engaged in mommy wars over feeding. Just is too much for me to engage. I agree with Mama K….. and I think there are way more people out there who process education, information and choices in a rational way without getting in front of another persons view’s or choice with their own. Most individuals who try to provide education are doing just that.. like you nursingbirth. You educate and you do it well!!

  10. Margaret Says:

    Excellent article. My degree is in health promotion and I 100% agree that discussing the risks and benefits of any health-related choice is an important responsibility of health care providers. Women deserve to have all the information they need about breastfeeding and formula feeding to make an informed choice.

    Women of course deserve non-judgmental support whether they breastfeed or formula-feed, but withholding information about the risks and benefits involved in this choice is simply unethical.

    Unfortunately, I see some health care professionals more likely to avoid these type of discussions, whether for parenting or pregnancy choices or other decisions, simply due to time constraints or an unwillingness to appear judgmental.

  11. PurpleStarMom Says:

    In following this discussion, I am glad to read that you are choosing to ask “How do you plan on feeding your baby?” Reason being that when you say “do you plan to breast or bottle feed?”, you are forgetting one important thing…some mothers bottle feed breast milk (myself being one of those). So for you to assume that bottle feeding = formula feeding is an incorrect assumption. I hope exclusively pumping is an option you are willing to explore with an uncertain mother.

    I am glad to see that you have come out of this with a new perspective. Looks like Suzanne was able to enlighten you in some way, even if it wasnt directly.

  12. Maren Says:

    First let me say that I very much appreciate your blog and am so glad that there are L&D nurses out there working to educate women — both one at a time and on a larger scale — about their chidlbirth choices and the risks and benefits associated with them. I’ve been a little bothered by the recent discussion here on breastfeeding, however, and thought it might be helpful to provide the perspective of someone caught in the middle of the breastfeeding-formula feeding wars.
    After a rather traumatic visit to a lactation consultant that revealed that my five-day-old son had lost too much weight and was beginning to show signs of dehydration, I had little choice but to start supplementing him with formula immediately. Determined not to give up on breastfeeding, I tried everything I could to increase my supply, even after the lactation consultant told me that I might have insufficient glandular tissue such that I would never be able to breastfeed exclusively. Between my oldest two children I tried renting a hospital grade pump and pumping fifteen minutes past empty, using a supplemental nursing system (used it for more than 8 months with my second), Fenugreek, Reglan, Domperidone, eating oatmeal, and pretty much every other technique suggested to me to increase milk supply. The only major things I didn’t try were drinking beer (I don’t drink alcohol), acupuncture, and GoLacta (it was too new at the time). Pretty much everyone in my immediate family thought I was crazy not to give up on breastfeeding altogether. With my first son, who quickly rejected the breast in favor of the bottle, I only breastfed (while supplementing) for 8 weeks and then pumped until he was 6 months old. My second, though, I supplemented and breastfed until he was a year.
    All things considered, I feel like I did just about everything possible to make breastfeeding work, and I have really and truly mourned my inability to breastfeed exclusively.
    So every time I read an article or a blog post or a comment about how superior breast milk is for babies, how dangerous formula can be, or how formula feeding can negatively affect babies, it not only reminds me of the frustration I’ve felt at not being able to breastfeed correctly, it also makes me feel like I have been a second-rate mother to my children because I couldn’t give them the best and adds additional ways in which I have failed my children by not breastfeeding them. And yes, rationally or not, I feel guilty about it. Now that’s not anyone’s fault, and I’m certainly not accusing you or anyone else of intentionally making formula-feeding moms feel guilty (though it certainly does happen and I definitely think that amid all the breastfeeding zeal there is not enough information or support out there for women who are genuinely unable to do it), nor am I suggesting that you’re responsible for that guilt, but I can’t help but think that it might be beneficial for the world’s breastfeeding advocates to realize how those of us who really and truly cannot breastfeed feel. That’s not to say that we should pretend that breastfeeding is not superior to formula feeding when it clearly is, or that we should fail to educate women about that superiority, including new studies and new research. But I do think that there’s no reason that this information cannot be conveyed with a little more compassion for women who want to give their babies the best but are unable to do so, or at the very least a little more understanding about why they may not rush to embrace the latest study highlighting yet another way in which they have deprived their children, despite their best efforts.
    As always, thanks for a great blog!
    Maren

  13. […] The Mommy Wars over feeding babies continue..I guess it won’t ever be truly over. I’ve been following a discussion over at NursingBirth on  “Why Educating Our patients is a Professional Responsibility and Not about Guilt.” […]


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