Most breastfeeding advocates aren’t eager to suggest a mother use commercial devices to initiate or continue breastfeeding. Nonetheless, we have all done it—and will do it again. Commercial equipment isn’t all bad—but it isn’t all good, either!
So many questions swirl around the use of commercial equipment in lactation practice. Most boil down to one issue: What is the specialist’s role? Here are 10 responsibilities:
Go through the problem-solving process.
Devices can be used in solving a problem, but to determine whether they should be used, start with a classic 8-step problem-solving process. You may have read them in another blog I wrote, but the steps are: (1) define the problem, (2) gather data, (3), analyze the data, (4) generate options, (5) select an option, (6) plan and implement the solution, (7) revisit the problem, and (8) continue to improve.
Explain to parents why you’re suggesting a piece of equipment.
There’s no way around it: When you drag out the equipment, the underlying message is that somehow, the mother’s body isn’t quite adequate for breastfeeding. It’s true you have a problem, but it can be a shock to the mother who expected to be able to breastfeed naturally, or easily.
Explain the connection between what the problem is, how the device will help to solve the problem, and how long you anticipate the device will be needed. (Just be careful not to over-promise.)
Be sure you read the “evidence” to confirm or refute efficacy.
This is one of my top pet peeves! I’ve seen hundreds of aspiring or certified IBCLCs who presume that a particular piece of equipment is “bad” (or “good”) based on an abstract they’ve read or word-of-mouth from someone else. That isn’t a full reading of the evidence.
It could be the “evidence” is based on a poorly-designed study with many variables, or perhaps it has been poorly interpreted. Don’t make that mistake; be sure to go to the source to know if it’s fact or fiction.
Believe that expert clinical skills are one form of evidence.
Does it seem like I’m talking out of both sides of my mouth, first saying “go to the original study,” and then saying, “rely on clinical experience”? No, actually, I’m not.
David Sackett, revered by all as the Father of Evidence-Based Medicine, identified the key components of evidence-based medicine as (1) consideration of the patient’s expectations (wishes); (2) our clinical skills; and (3) the best evidence available to us.
If your clinical skills and experience aren’t aligned with the best-available evidence (especially if there isn’t much published about it yet), maybe—just maybe!—you’re right and the study is wrong. Keep that in mind.
Give the parents information about the evidence surrounding the device.
Most breastfeeding devices have little or no evidence to substantiate their use. Don’t be afraid to tell parents that what they’ve heard or read is more marketing hype than actual fact.
Get input from the parents on their take about the device.
Sometimes, parents think a device works, and they love it. Sometimes, they think it works, but they hate using it. Sometimes, they consider it less than useful, but they don’t mind using it. Other times, they think it’s useless, and they hate using it. If the scientific evidence conflicts with the parents’ inclination or ability to use it, we need to help them find an alternative.
Scientific evidence alone, while necessary, is not sufficient.
Weigh the risks and benefits; use good judgement.
Commercial devices might solve a problem, but create a different problem in the process. Often, the expert is in the position of weighing the risks and benefits, but there are many factors involved. For one thing, we need to be aware that “intervention begets intervention.”
An aspiring lactation consultant recently asked me if we should “always” insist that the mother pump her milk if she is using a nipple shield. My answer was a resounding “NO.” In many cases, it might be wise and prudent for her to do so, but—as with any other intervention—“always” or “never” isn’t a good mindset to be in.
Teach how to use the device, and then use a teach-back approach.
Most commercial devices require the parents to use psychomotor skills. That means that we need to be prepared to show them how to use it, and then ask them to show us their skill. Otherwise, we are only assuming that they’re good to go when in fact, they are not.
Be prepared to problem-solve glitches.
At some point or another, some kind of problem with functionality crops up with a commercial device. It’s often a simple, easily-solved problem. It’s our responsibility to know how to solve the problem. If you want the parents to get reliable info, you’ll prefer that they come to you rather than turn to YouTube, or something else.
Have a clear follow-up plan!
If a mother needs a piece of equipment in order to breastfeed, she needs follow-up! Sometimes, she needs a one-time follow up; sometimes she needs extensive follow-up. Don’t assume that all is well. It might not be.
These days, we have many mothers using many devices to initiate or continue breastfeeding. Regardless of our exact credentials, the exact piece of equipment, or the exact situation—our roles are often the same or very similar.
What tips do you have for helping mothers with devices that aid breastfeeding?