What is an appropriate level of care?

The main issue seems to be not enough care, or flat out bad advice, but I’ve seen stories of women being overwhelmed by the care they receive. Though they may not realize it at the time, or even later, to me –an outside observer it seems like there was a hint of a problem and their help became overenthusiastic in presenting solutions. Told to do this, pump with that, strap this on, and it leaves them so overwhelmed they stop. It’s quite rare to see someone saying they felt they got just the right amount of care and support. I read one woman’s story where her lack of engorgement when her milk came in caused her care providers to overreact and start her supplementing. Her baby never lost weight or anything, but that one worrying symptom was focused on and it caused her a world of problems getting fully back to breast.

For some an early aggressive approach may be appropriate. Some women do have the drive to do anything and everything and come out feeling relief at being helped, no matter the eventual outcome. Some do not. And there is nothing wrong with that. Quite the opposite. It’s really quite unfair to expect someone having gone through a major life change to be able to tackle such a large and unexpected problem- often with very little warning or emotional support. I think however, that the issue is presentation. Knowing why you are doing things, not just following medical orders. Knowing what your day will look like and how long you can be expected to work before you see results, as well as what those results are going to look like.

On the more common flip side you have a lack of access to care.  Just that lactation professionals can be difficult to see in the first place, let alone finding another one for a second opinion. People often take what they can get, if they can ‘get’ at all. It’s not like when you have a family doctor with a poor bedside manner. When that happens you start looking for another one. With a lactation specialist you start out paying high private rates,  dealing with referral wait times,  or have limited access.

I think the idea of presentation and informed choice is very important. If you present a woman with: ‘pump 8 or more times per day’ she doesn’t know what or why or how. If you present a woman with: ‘pump 8 or more times per day. Just for the next few days, ok? It’s important to remove milk to stimulate the production of more. Let me show you some techniques for effective removal. Keep a log, and after a few days your supply should be increasing. I’ll check back with you in a few days and see how it’s going. Then if it’s not working or you are having other difficulties we’ll try something else if you want, ok?’ it all seems much more manageable.

Here is what I think an appropriate level of care should look like:

  • Is there an issue or not?
  • Discussion of the issue with examination of causes
  • Discussion of options as well as potential solutions
  • If solutions are preferred then outlines of duration, technique and expected outcome of chosen solution.
  • If solution works, tips on maintenance. If solution does not work, repeat discussion of options and potential solutions.
  • Repeat as necessary, combined with a discussion of the diagnosis.

The goal should be have the woman come away understanding the choices that were made as well as being an active participant in them. Because she’s a person too, not just a malfunctioning baby feeding device.

Wouldn’t that be nice?

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1 Comment

  1. How to interview a lactation professional. « boobshalffull

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