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

words. Yes, it seems like a “waste of time.” But we accomplish
two very important goals.
1. A mother will get to know us and develop a sense
of being heard and understood. Thus, we avoid
the trap of assuming we know what is truly her
concern.
2. We will hear symptoms in her words rather than
interpretations by others, which can often lead to
a different plan, and save us a great deal of time
in the long run.
We accomplish this through the use of what we have
learned through many different venues and professional
courses: Ask open-ended questions.
If we ask: Does it hurt We get a “yes or no” answer. In
contrast, if we ask: “What does it feel like,” or “What
was the last feeding like,” or “Can you describe your day
to me,” we get a much richer description, which often
leads to additional questions.
Continue to Clarify
After we have some ideas of what is going on, describe
back what you heard and make sure you heard it correctly,
or that you did not misinterpret a term. This is
especially important. Terms and language mean different
words to different cultural groups. For example, you
may assume you understand what “Hispanics” mean.
But if you are talking to a Puerto Rican, “ahorita” means
“in the near future.” To a Mexican mom, it means “right
now.” This misunderstanding can cause big problems in
terms of scheduling a visit, starting a treatment, or
arranging for a referral.
An African American mother may say to you that her
baby is “greedy.” Does that mean the baby is too demanding
Or does it mean that her baby is strong, knows what
he wants, and goes for it
Another important clarifying question: What have you
tried
Asking this shows respect for the mother. She must have
tried something if her baby was crying, or too sleepy, or
not latching on correctly. Listening to the mother can
often reduce the frustration often felt by IBCLCs who
say, “she refuses to try anything I suggest!” Some may say:
Asking all these questions will take tooo long!
In my experience, without asking questions and getting
a full picture, a lot of time is wasted, teaching what has
already been tried, or worse: providing education on
what is not the real problem. For example, a mother
calls and says her nipples are sore. Until we ask questions
about the age of the baby, when this started, what
happens and when, what it looks like, we could be giving
information about positioning when the issue is that the
baby bit her.
Reflect Feelings and Validate
After asking questions and clarifying information, many
IBCLCs launch into the “teaching” mode: “What you
need to do is: ….” Or “Let’s get the baby going…” Or “I
need to refer you to…” However, if a mother does not
sense that we understand what they have been through,
she often will just repeat a description of her problem, at
times almost verbatim, again. They seem to give us a
“broken record” report, stating over and over their issues.
For example:
••
“No one listened.”
••
“They didn’t help me.”
••
“The labor was horrible.”
••
“When the baby latches on it, feels like crushed glass.”
I’ve found that mothers need to know we “heard” them
and understand what they feel, and what has upset them.
It is hard at times to remember to take this step. We
want to get going on the “fixing” stage. However, when
working with mothers of our own, or of different cultures,
and especially with mothers for whom English is
not the first language, it is one of the best ways to establish
a feeling of trust and understanding. Choose words
you are comfortable with, and be specific so the mother
knows you care.
••
“It sounds like you’ve been very frustrated with
different solutions given to you.”
••
“How frightened you must have felt when you learned
your baby was losing weight.”
••
“You’re feeling guilty about not wanting to breastfeed.
But it hurts too much!”
It is important to use different and specific feeling words.
We don’t have to fear getting it “wrong”; mothers will
usually correct us if we didn’t get it “right” (e.g., “No,
I’m not frightened. I’m ANGRY.” ). Doing this gives us
18 Clinical Lactation 2012, Vol. 3-1