Official Journal of the United States Lactation ... - Clinical Lactation

Working with Families of Different Cultures I
Lessons Learned
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Jeanette Panchula BSW, RN, PHN, IBCLC, RLC 1
The Code of Professional Conduct for IBCLCs states that an IBCLC must “Provide care to
meet clients’ individual needs that is culturally appropriate and informed by the best available
evidence.” IBCLCs must not only have knowledge that will help a mother breastfeed. They must
also have the skill to help her to discern the best solution for her situation. The ability to communicate
with clients does not necessarily mean learning “everything there is to know” about
their culture. Rather, it means learning the basis for the mothers’ beliefs and actions.
Keywords: Breastfeeding support, ethnic-group differences, cultural competence
Clinical Lactation, 2012, Vol. 3-1, 13-15
Looking back on 26 years as an IBCLC, and 36 years as
a La Leche League Leader, I cannot imagine a more exciting,
awe-inspiring, frustrating, and worthwhile career. I
was raised in a multigenerational, bicultural, and bilingual
household and city, San Juan, Puerto Rico. In San
Juan, people of many different socioeconomic groups
mixed in the market, the stores, and schools. As a result,
I have always been comfortable with a variety of accents,
beliefs, and ways of life.
The concept that there is only one way—the way “I” was
raised—was truly never expressed or taught to me.
In fact, as a small child, I asked a nice man who was walking
right by my porch: “¿Por qué tu eres tan negro”
[Why are you so black]. Without missing a beat, he
answered: “Porque estoy mucho al sol.” [Because I am in the
sun a lot.]
That was the only education I received about race or
skin color, as my parents did not believe it was an
issue that I needed to be concerned with. It was only
when a TV arrived in my home, and I saw horrible
actions of others in the southern areas of the U.S. that I
learned why my father would not move back to the
U.S. with his dark-skinned Puerto Rican wife, and
very light‐skinned (unless I spent a lot of time in the sun)
daughter.
When I lived in St. Louis in the 80s with my own children,
husband, and mother (she lived with us for 25
years)—I did experience how sales clerks and others
“assumed” my mother was my maid. This preface is an
explanation of why and how I arrived at the philosophy
1 jeanette.panchula@sbcglobal.net
that I continue to practice today: All humans are different.
All humans have their own story to tell. You cannot
look at them and assume you know anything about them.
You have to ask.
Assumption: Father is not involved/
interested.
You go into a hospital room, and you see a mother in
the bed trying to breastfeed. She has a scarf over her
head, keeping the hair out of her eyes as she works, and
works at trying to get the baby on “right.” She is frustrated
and worried. Her husband is on the other side of
the curtain, at times reading a book, at times speaking to
her, urging her to “try this” or “try that.” Then he goes
back to reading.
Fact: Mom and dad are practicing orthodox Jews. Her
head is covered as she should during the period that she
is bleeding. She is untouchable at this time, and her husband
is following strictly the instructions that he must
not look at his wife’s body during this time.
Actions: I stand in a location that allows both mother
and father to see me. I use a doll to demonstrate positioning
to both (this is prior to Biological Nurturing®).
We then discuss how the father can help his wife by
identifying where she can sit and be comfortable, what
pillows she may need, what foods are comforting to her,
and how to burp and change the baby. He was so relieved
to know that he could do something instead of being
vilified as an uninterested or demanding jerk.
How did we get there By my asking: Can you tell me
what you need What are your concerns What help will
© 2012 United States Lactation Consultant Association 13