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Counseling Challenges: Helping Mothers Handle Conflicting Information

from LEAVEN, Vol. 34 No. 2, April - May 1998, pp. 19-20

See also "Background Information for Leaders" from the April-May 1998 issue of LEAVEN.

By combining sensitivity and time-tested helping techniques in difficult situations, Leaders help mothers make informed choices

Dear LLLI,

I've come across many new mothers who are using or are hearing about a parenting method available in book, video and audio cassette form called On Becoming Babywise. It's written by Gary Ezzo and Dr. Robert Bucknam. As far as I know, their teachings are not validated by research.

Could you please give me references describing the process of milk production that would counteract any or all of the assertions about breastfeeding and feeding schedules in this program?

I would like to show new mothers the research studies, even the medical opinions of several doctors, that confirm that these statements are untrue. Then I would like to write to Gary Ezzo himself and tell him, too. Thank you very much for your time.

Kendra McClure Ann Arbor, Michigan, USA

Dear Kendra,

Thank you for your letter to LLLI, requesting information on refuting claims made in the book, On Becoming Babywise. Many Leaders and mothers have wondered about how to respond to some of the information included in that book because many of the statements do not agree with research and personal experiences that LLL uses to help breastfeeding mothers.

Leaders should feel confident that ideas taught in these programs are really nothing new. LLLI has been challenged many times in the past 40 years by "experts" who disputed our recommendations and philosophy. Our information has withstood the test of time and our Leaders have personally experienced the positive results.

First, let me suggest that you use LLL resources when you need references to help mothers who have received inaccurate breastfeeding information from any source. I'm particularly pleased with the excellent references in the new editions of both THE WOMANLY ART OF BREASTFEEDING and the BREASTFEEDING ANSWER BOOK. Much of what you are looking for is in one of those books. In addition, your Group Library may contain other helpful books. Your Professional Liaison (PL) Leader will be able to share information from lactation texts such as those authored by Ruth Lawrence, MD, and Jan Riordan & Kathleen Auerbach.

Doing a thorough job of looking up this information does take considerable time. In fact, sometimes claims like these cannot be refuted by studies. LLLI has a wealth of breastfeeding information, however, much of our knowledge is based on more than 40 years of experience in helping babies and mothers. In other instances, claims such as the effect of demand feeding on a marriage are more opinion than fact; they cannot be proved or disproved by studies.

Leaders can help mothers learn to evaluate information and read critically to determine the credibility of claims made in such parenting programs. Rather than attempt to disprove them, we can give a mother correct breastfeeding information. If she still seems uneasy or confused by what we say, consider asking the mother how her personal experience has supported or conflicted with the information she has read or heard from other sources.

When talking with a mother who is following On Becoming Babywise or another program, it's important to listen carefully to understand what's troubling her. Sometimes parents are told not to contact LLL because we encourage mothers to "trust their instincts" and "meet the needs of the baby." We need to be sensitive to the words we use. A mother may tune us out when she hears phrases that stand in direct opposition to the teachings of the parenting program.

It is easy to become frustrated if a mother seems to be on another wavelength, yet the fact that she has called or come to a meeting gives us the opportunity to share different options with her. Many times I've found that a mother has considered possibilities outside of what she has heard in the parenting program. We need to be gentle, respectful and encouraging, just as we would be with any person seeking information.

It is also important to explore possible problems, particularly inadequate weight gain in the baby. Going over the basic information--how quickly human milk is digested, how many wet and dirty diapers to expect, appropriate weight gain for the baby's age and the signs of healthy development--is of paramount importance when a mother is following a strict feeding schedule. Although we remind a mother to stay in contact with her health care provider, she may not do so. Hearing this information from a Leader or reading an LLL pamphlet may be her only reminder that medical problems can put her baby at risk.

As for writing to the author of a specific parenting program, remember that if you write as a Leader, it is appropriate to consult with the Area Coordinator of Leaders (ACL) or Professional Liaison (PL) Leader. However, as an individual who would not be identified directly or indirectly as a Leader or as a representative of LLLI, you are free to write to anyone you wish. Rarely, to my knowledge, has Growing Families International, the organization behind On Becoming Babywise, provided documentation for its claims.

If you have further questions, please feel free to contact a PL Leader. She has access to additional information and research studies on this topic. She can also help Leaders with ideas for handling difficult counseling situations.

Sincerely,
Nancy Williams
Area Professional Liaison
LLL of Southern California/Nevada USA

Cautions in Helping Situations

Presence of any one of the following factors does not necessarily indicate a problem; Leaders should watch for these in any helping situation. Presence of multiple factors is of special concern. While a mother must decide what is best for her baby, a Leader should encourage her to seek the advice of a health care provider when there are potential medical problems.

  • Baby is not gaining weight well or is losing weight.
  • Baby seems to be lethargic or is unresponsive.
  • Baby cries excessively.
  • Mother has not discussed the situation with her health care provider.
  • Mother states her belief in following a feeding schedule.
  • Mother does not have an understanding of typical infant development.
  • Mother uses phrases such as "awake time," and "child- or parent-determined feedings."
  • Mother has conflicting feelings.

American Academy of Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk

Excerpt from "Recommended Feeding Practices": Newborns should be nursed whenever they show signs of hunger, such as increased alertness or activity, mouthing or rooting (Gunther 1955). Crying is a late indicator of hunger (Anderson 1989). Newborns should be nursed approximately 8 to 12 times every 24 hours until satiety, usually 10 to 15 minutes on each breast (De Carvalho et al 1982; De Carvalho et al 1983).

Pediatrics December 1997

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