My friend Jessica Lang Kosa, PhD, IBCLC, a lactation consultant in the Boston area, and general new-mom-bad-ass, recently linked to this great post from Bay Area Breastfeeding, LLC, which tells new moms when to seek help for a breastfeeding problem. It’s a good check list, and reminded me that I’ve been meaning to blog about how new moms sometimes need help sorting out what kind of help would help.
I find that new parents’ needs tend to fall into three categories, in ascending order of prevalence: clinical help, information, and general support. Let’s talk about how you can get all those needs met.
1. CLINICAL HELP: This is the thing you’ll need least frequently, but requires the most expertise. Clinical problems are problems that require an expert and need to be solved or else something bad will happen.
If you have a concern about the baby’s health, the person to go to is his physician. If you have a concern about your own physical health after the birth, you should consult with your own health care provider. If you have a toothache, you see a dentist. If you are clinically depressed, counseling and/or medication is what will help. Etc. This much is obvious, I think.
If you have a clinical concern about breastfeeding, you should consult with an Internationally Board Certified Lactation Consultant (IBCLC).
Somehow that one is less obvious to people. So let’s explore it a little. If you had strep throat, you wouldn’t rely on your mother, or your co-worker, or your neighbor, to deal with it, right? Because it’s a clinical problem. Your mother (or co-worker/neighbor) has no training in dealing with your medical problems! She is not qualified. She might provide you with comfort by giving you tea with honey, and she might be very compassionate and do a load of laundry for you because you’re sick and can’t deal. She might help you not feel so down in the dumps about it. And all these things are super-helpful. But if you have strep throat, you also need clinical help for your throat, and your mom can’t fix that. So you go to the relevant expert — your doctor.
Likewise, if you have a clinical concern about breastfeeding, the person to go to is an IBCLC. Because your mother (or co-worker, or friend) has no training in assessing and addressing a clinical breastfeeding concern, and is not qualified to help.
If you had just given birth and you had strep throat, would you look to your Labor Nurse for a solution? No. The nurse is trained as a labor nurse. She does not have the training and qualifications to deal with strep throat. You’d see a doctor.
That labor nurse also doesn’t have training dealing with clinical breastfeeding issues, unless she is also an IBCLC.
(Why do so many of us assume that just because she was looking at your vagina for ten hours, the labor nurse knows about human lactation?? Yet many people mistakenly look to their labor nurse for clinical guidance about breastfeeding, and, unfortunately, many non-IBCLCs spontaneously offer clinical advice about breastfeeding, instead of saying, “let me send an IBCLC to see you right away since you have a question about breastfeeding.” It’s up to you to remember to ask whether the person advising you is an IBCLC.)
By the way, speaking of who is and isn’t qualified to provide clinical breastfeeding assistance: Let’s say your husband had a toothache and you happened to be at your kid’s pediatrician for a well-visit, would you ask the pediatrician what to do about his tooth? No. The pediatrician is not the expert you go to for that.
Guess what, your kid’s pediatrician also doesn’t have the training to deal with clinical breastfeeding problems.
Can you imagine if you sat at your pediatrician’s office and described what was going on with your husband’s tooth and she said, “it sounds fine to me” without even seeing him?
She might be right about his tooth. But it would not be right to take that as appropriate guidance. Your dude needs a dentist.
Even weirder, can you imagine if the pediatrician said to you “it sounds like his tooth is a problem” and then she told you what to do about it, without seeing him?
And what if she told you your husband should only be brushing his teeth once every three days and never flossing, because his teeth might not learn how to fight the germs off themselves if you let them rely on dental floss. Wouldn’t you be like, “Wait — aren’t you a pediatrician? With all due respect, have you ever had any training about dental health?”
Your kid’s pediatrician isn’t an IBCLC, either, and hasn’t had training in human lactation.
The person to see for clinical breastfeeding problems is an IBCLC.
Hopefully you’ll encounter many people who are gifted and knowledgeable about breastfeeding in general. A postpartum doula or a childbirth educator or an experienced nursing mother — or even your kid’s pediatrician — might turn out to be a great, helpful resource for general breastfeeding support. That is all that most people ever need. Just like most of the questions you have about your baby (how do I give a bath?) don’t require an expert fix by your pediatrician. But if there’s a clinical problem, you go to the expert. And if you’re not sure whether there’s a clinical problem, ask an IBCLC.
(I should mention here: I am an IBCLC. But most of what I do isn’t clinical practice, but, rather, the guidance and education and counsel that are more commonly sought by new moms. I got the IBCLC so that if I’ve developed a relationship with a client around our work on the logistics of going back to work, the challenges of sleep deprivation, the weirdness of developing a parenting style, or the marital strain that becoming a mother has entailed, I don’t have to refer her out just because she also has a bleb.)
2. New parents also sometimes need INFORMATION. (How much weight gain can I expect of my baby in the first three months? How do I give a newborn a bath? Why is my hair falling out? Where can I find a great new-mom’s group in my area?) Some of this kind of information can be answered online (you can find growth curves here) and sometimes you’ll consult a book, or your childbirth educator, or doula, and sometimes your friends and family will have answers. Try to distinguish questions that have One Correct Answer from questions that come down to personal style. If it’s a question that has a Correct Answer, you want to make sure you’re asking someone qualified to answer correctly — a lactation consultant, or a childbirth educator or a parenting educator, or a physician or midwife, or a tax attorney, depending on the question.
Other topics, such as how often to bathe your baby and how to do it, come down to personal style and don’t have one “right” answer. For that stuff, your mom or friends or even an email from your co-worker’s wife’s friend’s babysitter’s mother might be the best help.
But if you don’t like their “advice,” do it your own way! That’s the difference between “right answer” information and “personal style” information.
3. SUPPORT. More than any of the other issues, new parents need support and companionship. Most moms I work with never need clinical help. Their pediatric visits are well-visits, and their six-week followup with their own OB or midwife is a routine checkup. They mostly never need the clinical services of an IBCLC either. But they still need support, counseling and gentle guidance.
Good support is a blend of guidance and friendship. A great support person listens to you, helps you get the little stuff off your hands so that you don’t have to waste your energy on it, and gives you enough guidance that you have the tools to do the big stuff for yourself. She helps you sort out the advice you’ve gotten into “right answers” vs. “personal style.” She helps you figure out whether you’ve got a clinical problem, and if you do, she helps you get clinical help.
Mostly, she lets you talk about what’s bothering you and sort it out. You trust her judgment so it’s reassuring when she tells you you’re doing well, and if she tells you she’s concerned about you, it inspires you to make changes. She is looking out for you.
Every single new mother needs multiple support people, and they’re mostly going to be people you already know. Some of your support people will play a mentor or coaching or counselling role, and some will be more like helpers, and some will just be friends who make you laugh or make a good cup of tea. You should have lots of people in your life — this is what it means to have a village!
It’s right to need support, and it’s right to look for it. Too often the new moms I meet are embarrassed to admit how much help and guidance they need. But that’s kind of backwards. I think if we can remember that it’s so human to look to other people for support and guidance and companionship, and stop pretending that Good Mothers Have Everything Under Control All The Time, the whole world will be a happier and more gentle place.
So open up to the people in your life and ask them to come hang out with you. You’re not asking them to be experts and you’re not required to follow all their advice. You’re looking for a human touch. That’s not being weak or dependent, it’s being a human being — we humans take comfort from friendship. And when your need for support and information is more than your own family and friends is ready to provide, look beyond the nest — try going to new moms’ groups or working one on one to get the help you need so that you can find your way.