It's World Breastfeeding Week, and the theme is 'Communication'. (More accurately, the theme is the rather peculiarly worded 'Breastfeeding - A 3D Experience', with communication being the 'third dimension' we're meant to write about, and time and place of breastfeeding support being the other two. Which makes for an odd slogan, but you get the point.) I started writing a long and detailed post that I've now had on my 'really need to blog about this one' list for more years than I care to think about, and I'm still hoping to get that one up fairly soon, though I may or may not manage it in time for the end of the week. But, as I wrote, I found part of it needed to be a blog post of its own. Here it is.
It's fair to say that, despite my strong opinions on breastfeeding promotion and how it should be done, I've had minimal direct experience. This is because I work in a healthcare system where maternity care is midwife-led, and so I don't do the routine prenatal appointments that are where, in my view, it's best discussed. However, in sixteen years as a doctor, I've had a whole lot of experience with health promotion in other areas. I've had to start a lot of conversations on smoking and alcohol and diet and exercise. I've had a lot of occasions of seeing my patient's eyes glaze over as I start to speak, which has given me plenty of opportunity to think about what kinds of approaches make that happen and how to avoid it. Over the years, I've found my experience gradually formulating into a rule in my own mind: Start from where people are.
Start from where their minds already are on a particular topic, because, otherwise, anything I have to say won't touch them. When I've started talking out of my own viewpoint on a topic without acknowledging the very different viewpoint of the person sitting across from me, the mental image that has come to me has been of me sitting on one side of an abyss and yelling across to the person on the other side to climb over and join me. Why on earth should they want to? When I've found a way to climb across, meet them where they are, and see if I can look from their perspective to find a route I can point out to them, I can feel the difference in how well the consultation is going. Of course, they may well still choose not to take this route - but they're thinking about it. They're tuned in. They're listening.
A more formal term for the concept would, of course, be 'connection'. In reading about discipline and how to reach children, I've learned the importance of forming a connection with them to get the message across - which is, of course, a subject for another post, but I've realised that it works with people of any age and that this is precisely what I've been doing in my more successful consultations. Or, to phrase it the way it was always phrased for us as trainees, find out the patient's ideas-concerns-and-expectations (and, yes, we did indeed use that phrase so often it turned into one word). But the wording I still find myself repeating silently to myself when I hear myself rushing in with a generic health promotion speech to someone who isn't disposed to listen to it, is 'Start from where people are. Don't start from where people aren't - start from where they are.'
How do you do that? You find out where they are on the subject (and it may not be where you were expecting to find them). You acknowledge where they are, and the life experience that led them to that point. You think about how your advice might look through their eyes. And you see if, moving to their spot and looking at the route from their perspective, you can figure out that route from there to where you want them to be. Or to even a little bit closer to where you want them to be.
So, let's say you're a midwife or doctor seeing a woman for one of her prenatal appointments, and it's time to start talking about breastfeeding. You have your spiel on the benefits and the how-to of breastfeeding prepared, all ready to launch into. Now, let's say this woman comes from an area where just about everybody formula feeds. She herself was formula-fed, all her friends have formula-fed their babies, and she doesn't know anybody who's breastfed. She's distantly aware of breastfeeding as something that mothers in some other group that she doesn't belong to or identify with (middle-class women, maybe, or tree-hugging hippies, or just some undefined group in the Not Us category) sometimes do, but that no more impacts on her own life plans than the knowledge that some people go off and live on boats. What's going to happen when you launch into your generic spiel? It won't touch her, because there isn't any point of experience in her life that it can stick on. It'll whistle past or over her and leave her unaffected.
But if you explore her feelings with a few questions - such as "How were you planning on feeding your baby?" "How did you make that decision?" "How much do you know about breastfeeding?" or whatever else seems appropriate, then you find out where she is. You start from there. You acknowledge it, without judgement: "So, it sounds like you've never really thought about breastfeeding," and then see if you can find a way to move a few steps closer to where she is - "What would you think of finding out a bit more about it, seeing if it's something you might be interested in? After all, it's a lot more convenient when it works well, and it can cut down the chances of a lot of different illnesses for baby and you." You test the waters, you see how much she's willing to take in then, and whether she might be willing to revisit the issue. You do all this while trying to stay where she is, moving at most a step or two ahead so that you can see whether she'll move that much too.
Maybe she's somewhere worse than that as far as breastfeeding's concerned - maybe she's had a previous lousy experience and she isn't just indifferent to breastfeeding but actively hostile. Then, you can sympathise - "Oh, boy, that sounds awful! I can understand you not being too thrilled with the thought of trying again" and see if you can move forward at all from there in terms of opening up the possibility that her experience with feeding a different child might be different again. Or maybe she's someone who's potentially interested in breastfeeding, but has some specific reason for not wanting to do it. If you take the time to find out what that reason is and to acknowledge its validity, maybe you can figure out a compromise she'll be willing to try - breastfeeding for X amount of time, mixed feeding, breastfeeding with occasional supplements.
But always, always, aim to start from where she is. Because, if you do that... you've got a hell of a lot more chance that she'll be willing to move over to where you are.