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**]
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.
The conversation continues over at Stork Stories with her post: **ROAR** on Breastfeeding Guilt
Please check it out!!