Giving Effective Breastfeeding Help

Giving Effective Breastfeeding Help

Asking Questions

asking questions
It is also important to know how to ask questions sensitively and effectively, so that while information is being gathered the mother feels supported rather than threatened or criticized.

The best questions are those that do not require a simple “yes” or “no” answer and do not put words into the mother’s mouth. In general, beginning a question with “what” or “how” will elicit more information. These words will encourage a mother to expand upon her answer. For example:

NOT: “Is the baby breastfeeding well?”
     INSTEAD: “How do you feel the baby is breastfeeding?”
NOT: “Is the baby sleeping through the night?”
     INSTEAD: “How long does the baby sleep at night?”

Once a mother feels at ease, it is easier to discover what the real problem is. Sometimes the first question or situation a mother raises is not really what’s on her mind. It may be just a “test balloon” to see what kind of a person she is talking to and whether she can be trusted with what’s really bothering her. One way to clarify the mother’s situation before jumping in with suggestions is to ask questions that will give specific information. Then, rather than making assumptions about a situation the counselor can find out the specifics.

NEW MOTHER: “My baby isn’t getting enough milk!”
     COUNSELOR: “What makes you think he isn’t getting enough?”
NEW MOTHER: “But I’m nursing him all the time.”
     COUNSELOR: “Tell me more about your baby’s nursing pattern. About how long does he nurse at each breast and about how long does he go between nursings?”

Some mothers need to be drawn out more slowly or gently guided in the conversation. A warm, sincere manner and tone of voice will help put an anxious mother at ease. If the mother is crying, reassure her it’s all right to cry. Talk until she can get more control, using her name frequently. If she has given you some idea of her problem, try to identify and reflect her feelings before giving any practical advice.

Some breastfeeding problems, such as slow weight gain or a baby who is fussy or refuses the breast, require that you ask the mother many questions to help find the cause. When many questions must be asked, it is important to listen attentively, taking notes and asking the questions in a calm, relaxed manner rather than in rapid succession. A calm and relaxed discussion will put the mother at ease. Some of the questions may deal with sensitive areas, especially if the baby is not doing well, so be sure to word them so they are not threatening to the mother.

Many mothers worry that they may have caused their breastfeeding problem, that it may be all their “fault.” To minimize the mother’s tendency to blame herself, make sure she understands that breastfeeding is not a by-the-book procedure; it is an intimate relationship with different dynamics from one nursing couple to the next. (A mother almost always notices differences in breastfeeding when she nurses more than one child.) Although there are general breastfeeding principles that are good to know (for example, the more often and effectively the baby nurses, the more milk there will be), there are no hard-and-fast rules.

Let the mother know that individual mothers and babies respond differently to the same things. For example, if the mother has been giving bottles, tell her that some babies are able to breastfeed and take bottles with no problems at all, while other babies become “nipple confused.” If the mother of a slow-gaining baby is asked whether she smokes cigarettes, mention that some mothers smoke and breastfeed with no problems, yet other mothers who smoke have babies who gain slowly.

If breastfeeding is not going well, the mother may feel especially vulnerable to real or perceived criticism. Breastfeeding difficulties often contribute to a new mother’s fragile sense of self-esteem. Be aware of the mother’s sensitivity to any questions or comments that may cause her to doubt her capability. And be sure to praise her for what she is doing right.

At least once during every conversation, say something positive, such as, “It sounds to me as though you’re doing a wonderful job as a mother.” This allays the underlying fear behind many of the mother’s questions. In addition to providing the mother with the basic information she needs, positive reinforcement can build a mother’s self-confidence.

It is essential to know what the mother sees as the problem so that the mother’s concerns can be fully addressed. Ask, for example:

What do you see as the problem?
How would you like to see this resolved?

Even when a problem is identified that the mother has not been aware of, it is best to address the mother’s immediate concern first. A mother may also bring up something that you would consider to be a problem but the mother does not. Keep in mind the old saying, “If it’s not broken, don’t fix it.” If the mother is happy with the way things are, don’t suggest that there might be a problem, unless there is a reason to be concerned about the mother’s or the baby’s health.

When a mother has many concerns, rather than starting with a series of questions, identifying and reflecting the mother’s feelings will usually offer cues on which direction to go.

MOTHER: “I guess I’m just going to give up breastfeeding. My doctor says John is gaining too slowly and that I shouldn’t have to nurse him more often than every three hours. My two-year-old got hold of some aspirin while I was nursing John. I’d been up all night trying to rock John so he’d sleep longer than two hours because I knew I had to tell the doctor he was waking all night and nursing more often than every three hours. The doctor would want me to supplement and I’m just not going to do both. I’m just not!”

Rushing in with information and suggestions is a common response to comments like this, but an even better response would be to express empathy and help the mother clarify what her most pressing need is.

     COUNSELOR: “You’re bewildered. The baby doesn’t seem to be doing as well as you had hoped. You are afraid your doctor will tell you to supplement. Your other little one needs attention—the aspirin incident scared you. Now you really wonder what to do.”

This statement recognizes the mother’s feelings. Notice the feeling words used: “bewildered,” “afraid,” and “scared.” Each area of concern is mentioned, allowing the mother to indicate which area needs attention first.

MOTHER: “You’re right. I feel like such a failure. I don’t seem to be able to handle anything. The aspirin incident really upset me. I know what to do about that though. I’ll just have to keep my two-year-old with me. I know that’s what I’ll have to do, but I’m so tired. Being responsible for anyone other than the baby seems to be more than I can bear.”
     COUNSELOR: “When you’re as exhausted as you are now, it seems hard to handle everything, but even as tired as you are, you’ve come up with a very good plan—keeping your two-year-old with you. You would like to be able to handle this, yet you’re not sure whether you can keep yourself and the two-year-old intact.”
MOTHER: “That’s it. I know the only thing to do is to keep him with me, but I’ve never had two children. How will I ever manage?”

Who would have guessed that the first thing on this mother’s priority list would be suggestions on handling two children? The immediate temptation might be to tell her how to fatten up the baby. Notice how the counselor responds empathetically to this mother until she clarifies her priorities. Even if the mother’s feelings had been labeled inaccurately (“bewildered,” “afraid,” “scared”), the mother would clarify these in her response. In this example, the counselor knew she was on the mark when the mother said, “You’re right. I feel like such a failure.” The counselor continues with empathy until the mother says, “I need help with handling two kids. What do I do?” This is the sign that the mother is ready for suggestions because she has specifically asked for information.

Summary In Points

  1. Questions should be phrased so they are not threatening or critical and so that they elicit specific information.
  2. Questions should be paced according to the mother’s emotional state.
  3. Emphasize the normal variations among mothers and babies.
  4. Look for opportunities to praise the mother for what she is doing right.
  5. Find out what the mother sees as the problem.
  6. When a mother raises many concerns at once, active listening can be more effective than questions in determining where to start.
Table Of Content
Introduction – Using Active Listening
Asking Questions
Giving Information and Suggestions
Respecting Differences Among Mothers
Helping the Mother Working with Her Doctor
When Breastfeeding Doesn’t Work Out