Respecting Differences Among Mothers
It is important to be sensitive to the individual, family, economic, and cultural differences among mothers.
Be sure to ask the mother about her situation before offering suggestions that involve help from others. For example, if a mother calls and complains about feeling exhausted and overwhelmed, before assuming she has a partner who can help her get some rest, ask her, “Is there someone who might be able to help you with the children while you rest?” If she says no, tailor the suggestions to her situation. For example:
- Keep the children in one room, if possible, so that she can watch them while she has a little quiet time.
- Set aside a time each day when she and all the children will lie down, even if they don’t sleep.
- Try breastfeeding the baby lying down at least once a day.
Between 12 and 18 months after an adolescent girl’s first menstrual period, her breast tissue is developed enough to produce sufficient milk for her baby (de Nobrega 1992). Research on the composition of mothers’ milk has found only minimal differences between the milk of adolescent mothers and the milk of mothers older than 19 (Lipsman 1985). One study found the adolescent mothers’ milk had higher concentrations of protein and found a difference in types of fatty acids that the researchers attributed to differences in the mothers’ diet rather than to age (Brasil 1991).
Considerations and Concerns of Adolescent Mothers
- Wants to be treated as an adult, not talked down to or lectured;
- May be fearful or unhappy about the physical changes of pregnancy;
- Peer-oriented but also concerned about the reactions of family, teachers, and the baby’s father;
- May be insecure, have a poor self-image, doubt her self-worth;
- Lives for the moment; may have difficulty in planning for the future.
Physical Considerations during Pregnancy
- May have had inadequate prenatal care due to early denial of pregnancy;
- Diet may be erratic or inadequate;
- May be reluctant to gain weight.
- May feel threatened and overwhelmed by the hospital environment, policies, and procedures, and may be reluctant to ask for help or ask any questions;
- May not be assertive in arranging for immediate or regular contact with her baby after birth;
- May lack confidence in her ability to care for her baby.
- May be strongly swayed by negative feelings about breastfeeding among female family members;
- May be concerned about how breastfeeding will affect her relationships with others;
- May fear, even more than most mothers, being ridiculed if she is seen breastfeeding in public;
- May be concerned about how breastfeeding will affect or restrict her other activities—how to manage the practical details of breastfeeding while going to school and/or work (expression and storage of milk);
- May be concerned about how breastfeeding will affect her physically—if breastfeeding will affect how soon she returns to her pre-pregnancy weight, if breastfeeding will affect the shape and size of her breasts, if she can smoke cigarettes and breastfeed, if she can breastfeed while taking birth-control pills, if the baby will bite her while breastfeeding.
- May be concerned about how her partner feels about breastfeeding.
When talking to an adolescent mother, it may be helpful to emphasize the benefits of breastfeeding to her, such as:
- Breastfeeding gives her something she can do for her baby that no one else can. (This may be especially important to her if she is worried that the baby’s grandmother or babysitter will usurp her role as the baby’s mother.)
- Breastfeeding right after birth causes her uterus to contract and reduces the flow of blood, helping to prevent hemorrhage and get the uterus back into shape more quickly than if she were not nursing.
- Breastfeeding mothers have been found to lose weight faster without restricting calories.
- Breastfeeding encourages a strong emotional bond between baby and mother and may help increase the mother’s confidence in her ability to care for her baby.
- Breastfeeding saves money—not only the cost of formula, but also doctor bills and medications, since breastfed babies have fewer illnesses. The mother herself may miss less school and/or work to care for a sick baby if she breastfeeds.
When working with teen mothers it helps to try to look at the world through their eyes. They may react negatively to breastfeeding education if it seems too much like school or if breastfeeding pamphlets or books feature photos of older mothers or are written at a higher reading level than they can understand. They may be more sensitive than older mothers to having others touch their breasts or of seeing a breastfeeding counselor demonstrate breastfeeding techniques by touching her own breasts. Unless carefully explained ahead of time, follow-up phone calls from the breastfeeding counselor may be perceived as checking up on the teen mother rather than sincere offers of help. Developing an honest, positive, and supportive relationship with adolescent mothers is essential to effective counseling (Podgurski 1995).
Family or Cultural Breastfeeding Practices
Breastfeeding practices that have been passed down through the mother’s family or are part of her culture may carry more weight with her than suggestions from others. If the mother mentions an unfamiliar practice, ask her more about it. If the practice will not affect breastfeeding or harm the mother or baby, do not make disparaging remarks about it or discourage the mother from doing it. If the practice makes the mother feel more comfortable, it will encourage her to breastfeed. For example:
If, however, the practice could affect breastfeeding or the mother’s or baby’s health, help the mother to understand why the practice could be harmful.
If the mother is from a different culture, be sensitive to the beliefs and customs of her culture. Each culture has its own outlook on health, medicine, and sexuality, and many cultures recommend specific practices during pregnancy and the postpartum period that the mother may want to follow. For example, a common practice for American Hispanic women is to stay in bed for three days after birth and to avoid eating pork, chili, and tomatoes. Hispanic women are also cautioned to avoid extremes in temperature when they are breastfeeding, because it is believed that cold decreases milk flow and extreme heat makes the milk curdle. So during the coldest days of winter and the hottest days of summer, the mother may be reluctant to go out. In a traditional Hispanic family, the baby may not be breastfed until the third day because the colostrum is considered “unclean.” Hispanic women may also be reluctant to breastfeed in the hospital out of modesty (Taylor 1985).
Rather than openly rejecting a mother’s custom or belief, take some time to talk to her about it so that it can be considered and respected when offering suggestions. For example, it would be unnecessary to suggest that the Hispanic mother eat pork, chili, and tomatoes. But it may be helpful to talk to her about the value of colostrum and point out that other mothers nowadays nurse their babies right after birth. Suggest reading on the subject for her consideration. It would also be appropriate to offer suggestions on ways to breastfeed modestly in the hospital, such as having the nurse pull the curtain around her bed when she is ready to nurse so that those passing by her room could not see her breastfeeding.
To learn more about cultural beliefs and customs regarding health care, family attitudes, pregnancy, and the postpartum period in various United States’ populations, see Meredith Mann Taylor’s “Transcultural Aspects of Breastfeeding—USA” (referenced at the end of this chapter).
Women breastfeed without any special equipment or paraphernalia in many cultures and in many parts of the world. Some families have tight budgets, and spending extra money may not be practical. If money is limited, suggestions that cost money may be perceived as barriers to breastfeeding. Encourage the mother in her efforts to find low-cost alternatives, and be sensitive to the options she may have. For example:
Differences in Parenting Styles
Many mothers are comfortable breastfeeding their baby on cue and allowing the baby to determine the length of the feedings, which is ideal for breastfeeding to go well, but some mothers are not, preferring instead to impose a feeding schedule. Some mothers keep their babies close at night to help get their rest, and willingly continue night nursings through their child’s toddler years. Other mothers are firmly committed to having their babies and toddlers sleep in separate rooms and eliminating night nursings as early as possible.
Some differences in parenting style affect breastfeeding and some do not. And the same variation may affect one baby adversely yet have no effect at all on another. If the mother prefers to impose a feeding schedule, for example, she will need to know that this may affect her milk supply, because her milk is regulated by how often and how effectively her baby sucks. She will also need to know that the fat content of the milk increases as the feeding progresses and that if she cuts feedings too short, her baby may not get as much of the fatty hindmilk as he needs and his weight gain may slow down. And she should know that keeping track of her baby’s wet diapers, bowel movements, and weight gain will be a good indication of whether or not he is getting enough to eat. Because of individual differences in mothers and babies, a feeding schedule may work well for some but cause problems for others. If the baby’s weight gain slows, the mother then has the option of either breastfeeding more often or introducing a supplement.
Some breastfeeding counselors find it difficult to remain objective when they strongly disagree with a mother’s choices. When feelings run high, it may help to keep in mind that your primary purpose is to act as a sounding board for the mother. To effectively fulfill this purpose, personal opinions, feelings, and experiences need to be kept in the background, keeping the mother as the main focus. The counselor’s job is to help the mother clarify her own feelings and to offer information and options that will help her make an informed choice.
Because a mother’s relationship with her baby is of paramount importance, she should be encouraged to make parenting choices with which she feels comfortable. The main message should be how important each mother is to her baby and how breastfeeding can be a wonderful part of this. Each mother should also be left with a feeling of acceptance and a sense of trust in her own judgment. Perhaps, most important of all, the mother’s feeling of self-confidence and trust in her own instincts should be enhanced. If the breastfeeding counselor’s feelings of disagreement with the mother are so strong that she cannot do this, it may be best to refer her to another breastfeeding counselor.
- When offering suggestions and discussing options, keep in mind that some mothers do not have husbands, partners, or family members to help.
- Adolescents are physically capable of breastfeeding.
- Adolescent mothers have many things in common with other mothers, but they may have some different concerns and outlooks.
- Emphasize the advantages of breastfeeding for the adolescent mother.
- It is important to be sensitive to the adolescent mother’s culture, her possible perception of the breastfeeding counselor as an “authority figure,” and other considerations.
Family or Cultural Breastfeeding Practices
- Family or cultural breastfeeding practices should not be discouraged unless it could be harmful to mother or baby.
- Cultural practices concerning childbirth, breastfeeding, and the postpartum period should be respected.
- When giving suggestions, offer options that do not involve spending money.
Differences in Parenting Styles
- Some differences in parenting style affect breastfeeding; others do not.
- If strong feelings about the mother’s parenting style make it impossible to give her effective breastfeeding help, it may be best to refer her to another breastfeeding counselor.
|❶||Introduction – Using Active Listening|
|❸||Giving Information and Suggestions|
|❹||Respecting Differences Among Mothers|
|❺||Helping the Mother Working with Her Doctor|
|❻||When Breastfeeding Doesn’t Work Out|