Helping Mothers Create Breastfeeding Allies

Cynthia Good Mojab, MS
Hillsboro OR USA
From: LEAVEN, Vol. 37 No. 6, December-January 2001, pp. 123-127.

In countries where formula-feeding is the cultural norm, the behavior, growth, development, and health of formula-fed babies are seen by many as appropriate and desirable for breastfed babies, even the standard. In such societies, culturally based beliefs and behaviors may poorly match the biology of breastfeeding. Breastfeeding may not be understood as an endeavor worthy of effort or support. The smallest challenge may quickly result in culturally-based suggestions to wean the nursing baby. Even when the importance of breastfeeding is understood, full knowledge of the art of breastfeeding has been lost in many families and societies. Myths and misinformation may be easier to find than accurate and up-to-date information. In such societies, mothers may contact La Leche League Leaders for help in dealing not only with breastfeeding problems, but also with people whose actions are undermining—or are threatening to undermine—breastfeeding. Mothers may seek a Leader’s help for coping with criticism from family members, misinformation from a health care provider, lack of support from an employer, or problems with the legal system.

When the solution to a breastfeeding-related problem seems interpersonal, Leaders can help mothers explore ways to create breastfeeding allies: people who will promote, protect, and/or support breastfeeding in critical, practical, and specific ways. Breastfeeding allies do not need to be experts on human lactation or even to be broadly supportive of breastfeeding. Their motivation and assistance can be quite limited and unique to their specific role in a particular mother’s life.

Change Is Possible

We are all subject to the influence of our culture. Mothers, friends, family members, heath care providers, educators, policy makers, judges, employers, and religious leaders are no exception. But culture is changeable—and it changes one person at a time. This truth is evident in the fact that breastfeeding was once the cultural norm in all societies of the world—the human race would not have survived otherwise. It is also evident when a mother becomes the first woman in her family to breastfeed after several generations of formula-feeding: the lost art of breastfeeding can be relearned (Good Mojab 1999). To work toward change, we must first believe that it is possible. We must also believe that most people do not intentionally seek to hurt one another. Actions that undermine breastfeeding are often based on misinformation and misunderstanding rather than on the intent to harm a mother or her nursling. Accurate information is often the key to resolving interpersonal barriers to breastfeeding.

Processes of Change

When new information about breastfeeding challenges familiar cultural values and practices, it is difficult to accept. People may experience grief as they come to terms with the loss of old beliefs and behaviors and the acquisition of new ideas. At first, they may respond with disbelief, then doubt. Unsure of the risks involved, they may hesitate to acknowledge the important role they can play in supporting breastfeeding (Anand 1994). Becoming a breastfeeding advocate may evoke a sense of regret about choices made in the past. Sensitivity to the perceptions, motivations, and feelings of others can make the difference between a defensive argument and a meaningful interchange. Respect and patience are critical. From the pediatrician who recommends weaning at one year to the grandmother who doubts her daughter has enough milk, people do the best they can with what they know and with the resources and support that they have at any given time. An invitation to change will be most effective when we begin wherever a potential ally is and appreciate the challenges change poses to everyone (McGinnis 1985).

Effective Persuasion

The impact of a lack of support for breastfeeding can range from mildly annoying to life threatening. The tired mother of a nursing one-year-old enduring a long delay in an airport may choose to ignore a stranger’s remark that her child is too old to be breastfeeding. That same mother, however, may feel quite differently if her child’s pediatrician makes a similar comment. If the statement is made by a judge with the power to make life-altering decisions about custody, visitation, or jury duty, a mother is likely to feel real fear. The importance of creating breastfeeding allies increases with the degree of their potential impact on the nursing pair.

The creation of an ally is a form of negotiation or persuasion. A mother wants someone to do something that he is not already doing: support breastfeeding in a specific way in a particular situation. Many approaches to persuasion exist. Given that ignorance often underlies a lack of breastfeeding support, effective persuasion almost always involves breastfeeding education. This takes some homework—and even a little strategy. Leaders and mothers may feel uncomfortable thinking in terms of strategy because they do not want to be manipulative. But persuasion is not manipulative when it is geared toward creating dialogue and finding the best solution for all involved. Manipulation occurs with such things as the intent to control, deceive, or harm, the use of misleading evidence, and the testing of wills (Conger 1998). The following (nonmanipulative) steps show how principles of negotiation can be used in the context of breastfeeding persuasion. However, Leaders should not assume that all techniques work well with all people in all cultures. Due to personal and cultural differences, approaches to negotiation and persuasion are never universally applicable (Triandis 1994) (See page 126, “Conflict Resolution across Cultures”).

Attend to Emotions

The more impact that a person has on a mother’s breastfeeding experience, the more powerful her emotional response will be to his lack of support for breastfeeding. When faced with ignorant comments, out-of-date recommendations, and other barriers to breastfeeding, a mother may feel the urge to spontaneously express her emotions of anger, frustration, or fear. Yet such self-expression could make the situation worse (Steibel 1997; Woolf 1990). People need to feel respected, especially if they are being asked to do something differently (Cohen 1980). A mother’s angry outburst, when directed at her potential ally, is understandable (and culturally acceptable in some societies). But it’s not likely to help create the environment of respect that is needed for change to occur. Expressing her feelings to a Leader, however, can help a mother think more clearly and decide which emotions (if any) could be expressed to the potential ally without undermining efforts at persuasion. When the Leader attends to the emotions of a mother, she gains insight into the mother’s perceptions, motivations, and needs. This helps the Leader understand and empathize with the mother’s experience of the situation and provide information that will effectively address the mother’s concerns. The same is true when the mother attends to the emotions expressed by the person with whom she is in conflict about breastfeeding.

Gather Information

The more the Leader and mother know about the potential breastfeeding ally, the more effectively they can address the ally’s concerns. The Leader can help the mother learn how to actively listen to what the ally is saying and how he is saying it. By actively listening, the mother can assess his understanding of breastfeeding and child development, his concerns, the context that influences his actions and beliefs, his goals, and the ability and power he has to take action. Understanding what the other person truly cares about is critical (Hass 1994). Once the mother genuinely understands the other person’s position, she can offer an empathetic response: “If I were you, I’d feel the same way” (Rusk and Miller 1993). Responding to the valuable points the potential ally raises will defuse hostility and create a sense of connection. For example, an American judge may describe jury duty in terms of good citizenship. A breastfeeding mother can create a feeling alliance by expressing agreement with the importance of juries to due process and her willingness to fulfill her civic duty when her nursling has weaned.

Misunderstanding or True Disagreement?

Determining whether there is a misunderstanding or a true disagreement is critical to any negotiation (Steibel 1997). Misunderstandings are often at the root of poor support for breastfeeding. In such cases, the provision of correct breastfeeding information may be all or mostly what is needed to enhance breastfeeding support. If the problem would disappear if the mother and her potential ally understood each other better, they just have a misunderstanding. True disagreements, however, are not resolved with increased understanding. They involve the conflict of goals. Breastfeeding is often negatively impacted when motivations such as profit or power are involved. Mutual understanding alone for example, is unlikely to motivate the formula industry to desist from engaging in unethical marketing practices that undermine breastfeeding. (However, legislation that enforces the International Code of Marketing of Breast Milk Substitutes is effective.) In true disagreements, the other party benefits from downplaying the problem and may attempt to hide the disagreement.

Steps to Creating Breastfeeding Allies

Attend to emotions.
Gather information by actively listening.
Determine whether there is a misunderstanding or true disagreement.
Develop conviction.
Recognize and respect the process of change.
Envision the next step.
Match approach to perceptions.
Anticipate the response.
Provide accurate, respected information.
Acknowledge change.

Develop Conviction

Confidence and enthusiasm are contagious—and persuasive (McGinnis 1985; Woolf 1990; Anand 1994). The more information a mother has to back up her breastfeeding goals, the more confident she will feel and the better able she will be to negotiate with conviction. Self-doubt and unanswered questions are best addressed before she begins trying to create a breastfeeding ally. Leaders can help mothers explore any ambivalence or doubts. Maybe there are options or aspects of the situation that the mother hasn’t fully considered. A mother may modify her beliefs and goals as new information or experiences change her view of things. Leaders can encourage mothers to listen to their hearts, clarify their rights, and move forward with confidence.

Recognize and Respect the Process of Change

Change is not easy, especially when it involves long-held behaviors and beliefs that are culturally based. The potential ally’s first reaction is likely to be denial that any problem exists. While frustrating, this is normal and serves a useful purpose: denial creates time and space in which to consider change. In a respectful environment, people are more able—and likely—to move to other steps of change: recognizing the problem while not acknowledging any responsibility to resolve it, doubting the possibility of change, fearing the risk of change, wanting to find possible solutions, believing that change can be accomplished, becoming determined, and successfully making the change (Anand 1994).

Envision the Next Step

Support for breastfeeding comes in many forms: up-to-date information from health care providers; a clear welcome of breastfeeding families at a business; flexible work schedules for breastfeeding employees; the postponement of jury duty until after weaning; or acceptance of on-cue nursing from a family member. Knowing what she needs is a mother’s first step in creating a breastfeeding ally. For example, one mother might need her physician to discuss treatment options for depression that take breastfeeding into account. Another mother may need her physician to review breastfeeding literature so that they can discuss research-based recommendations for the care of her premature baby. The Leader can help a mother identify exactly what she needs in her situation. What is the first concrete step her ally would need to take to make that happen? Is it within the ally’s power to do? If not, what is the next best thing that he could do instead? Or, who does have the power to take the step that is needed? An active search for specific solutions takes the focus off of problems and is highly effective at bringing about change (O’Hanlon and Weiner-Davis 1989).

Match Approach to Perceptions

Some of the information the mother gathers about her potential ally involves his perception of the situation. What is his view of things? How is supporting breastfeeding in his best interest? For example, employers may be reluctant to support breastfeeding because of misperceptions about the costs and benefits: they perceive financial hardship with no return reward. Information that emphasizes reduced absenteeism of breastfeeding employees addresses that perception, as do examples of how and why other employers have worked to support breastfeeding (Bar-Yam 2001) (See “Resources Regarding Breastfeeding and the Law” on page 126). In the United States, for example, cultural beliefs and behaviors include a widespread acceptance of separation of mothers and babies (Good Mojab 2000). A judge unfamiliar with breastfeeding may initially not appreciate the hardship that jury duty poses to the breastfeeding mother and her nursling. The judge, however, may decide to postpone a mother’s jury duty once given information about the effect on a mother’s body if she cannot breastfeed or express milk, such as leaking milk in the court room, breast infections, or abscesses (Michels, Good Mojab, and Bar-Yam 2001).

Anticipate the Response

Based on the information that the mother gathered about her ally, the Leader can encourage the mother to try to put herself in the potential ally’s shoes. Might she feel threatened, put down, or out on a limb? Might she agree in theory, but feel powerless to act? The Leader and mother can role-play approaching the potential ally to try to uncover concerns that may still need to be addressed. For example, a mother may want the baby’s father to stop asking her when she is going to introduce a bottle. What is the father’s motivation? Does he feel this is the only way that he can bond with the baby? Does he want to go out more with the mother but feels the only way to do so is to leave the baby with a caregiver (who he thinks must then feed the baby with a bottle)? Is he trying to be more involved in child rearing decisions? His response to her request that he be more supportive of breastfeeding will vary depending on his perceptions and motivations. The Leader can pretend to be the father, creating likely responses based on the mother’s understanding of his perspective. This process will help the mother more effectively engage in a conversation with the father at a later time.

Provide Accurate, Respected Information

Leaders can help mothers gather breastfeeding information that addresses the concerns of all involved. The needs and perspective of the potential ally should be carefully considered. Consistent, up-to-date information from respected sources must be found. These sources can be formal or informal, individuals or organizations, oral or written—whatever best matches the needs and perspective of the potential ally. Asking a religious leader or family elder to encourage family members to support a breastfeeding mother may be highly effective in one family or society, but not in another. Inviting the potential ally to attend a La Leche League meeting or to come to an appointment that the mother has with a lactation consultant may be effective in some situations but not others. Written materials are wonderful for people whose learning style is visual or whose cultural heritage emphasizes the written word, but conversation, audiocassettes, or videos may be better for those whose learning style is auditory or whose cultural heritage includes many oral traditions. If the mother is interacting with someone whose cultural heritage differs from hers, she may need expert help to successfully communicate what she needs. Every culture has traditions that form their style of negotiation (Woolf 1990; Triandis 1994) (See “Conflict Resolution Across Cultures” in sidebar).

Through La Leche League International, including the Professional Liaison Department, Leaders have access to many breastfeeding resources. There are also breastfeeding resources in public and academic libraries. The Internet also offers a wealth of information for Leaders who have access to it. The Web sites of many national and international organizations and online databases often include the full text of breastfeeding documents. However, since breastfeeding information obtained from sources other than LLL can be inconsistent and occasionally inaccurate, a Leader should always review it for accuracy. If the information is accurate and supports the goals of the mother, the Leader may suggest it as an optional resource for the mother to use.

The most effective information matches the perceptions of the intended recipient. For example, a person living in the United States may feel that breastfeeding information produced by a United States organization, such as the American Academy of Pediatrics (AAP), is most relevant. Professional affiliations should also be considered. If the potential ally is a nurse midwife, for example, information provided by a national or international organization of nurse midwives might be most respected. Professionals in medical or legal fields are likely to respect original research studies more than books that provide short descriptions of the original studies. It doesn’t matter whether the ally’s perception is accurate, just that the best match of information and perception is found.

In some cultures, both mothers and Leaders may be tempted to hand a stack of books or papers to the person with whom the mother is in conflict or to engage in a long lecture on the benefits of breastfeeding. But more information isn’t necessarily better. A small amount of the right information may be all that is needed. A large amount of information takes more time and energy to absorb. Change is a process. Small changes often lead naturally to larger ones over time (Fisch, Weakland, and Segal 1982). The task at hand is not to create an ally who is fully knowledgeable about and supportive of breastfeeding in all situations; it is to effectively invite someone to provide specific support in a particular mother’s life.

Conflict Resolution Across Cultures

Cultural values influence how people prefer to resolve conflicts. One important set of cultural values relates to social relationships.

"Social relationships exist in all societies, but are conceived of and structured differently. Relationships with other people may be approached in two basic ways: individualistically or collectivistically. In individualistic cultures (e.g., Western European, Anglo-American, African American), people tend to strive toward independence, uniqueness, self-expression, and the promotion of personal goals. In collectivistic cultures (e.g., African, Asian, Middle Eastern, Latino/a), people tend to strive to belong, to occupy their proper place, and to promote others’ goals (Hofstede 1980; Markus & Kitayama 1991; Triandis 1995). Though individualism and collectivism are not mutually exclusive, people generally prefer one approach over the other." (Good Mojab 2000).

Collectivistic cultures value the maintenance of harmony in social relationships within the in-group (the people with whom a person feels similar and with whom she feels she shares a “common fate”) more than individualistic cultures do (Triandis 1994). So collectivists tend to prefer bargaining and negotiation, “saving face” (avoiding embarrassment or loss of status) for the other person and for themselves, and indirect negotiation strategies like arbitration and mediation; individualists tend to prefer saving face only for themselves, autonomy, domination and control, and direct solutions to conflicts such as going to court (Triandis 1994; Leung 1988; Ting-Toomey 1988). Individualists are more likely to be actively self-assertive and to try to change their environment, while collectivists are more likely to be obedient to powerful affiliates and to try to change themselves to adjust to their environment (Triandis 1994). In most societies, women tend to be somewhat more collectivistic than men are (Triandis 1995).

Acknowledge Change

Creating—and becoming—a breastfeeding ally can be a difficult process. Even when successful, a mother may feel angry that change was not easier, faster, or greater. At a given moment, this frustration or anger may outweigh a mother’s sense of gratitude. But people still need and deserve appreciation for their efforts. The acknowledgment of change, though sometimes hard to do, can yield great benefits. When a potential ally feels that her efforts are appreciated, she may feel respected and be more likely to take yet another step toward change. Leaders can help mothers continue to work for change by talking about how it is a process for everyone—and that it can be a particularly complex and challenging one when cultural beliefs are involved (Good Mojab 2000). When a mother understands the sometimes difficult nature of change, she is more able to express genuine gratitude to her new breastfeeding ally.

Recognizing Success

When a mother learns the tools of breastfeeding advocacy and negotiation, she develops and uses skills that are important in other areas of parenting and life, regardless of her apparent success in a given situation. Sometimes, a mother’s best efforts are not enough to bring about the change she originally sought: a true disagreement may exist, change may take too long, directly attempting to change another person’s beliefs and actions may be inconsistent with her culturally based beliefs, or she may decide that her original goal is not worth her time and energy. In such cases, Leaders can help mothers explore other options. For example, a mother might ultimately decide to compromise or even to accept the situation as it is. Such decisions belong to the mother. Alternatively, a mother might decide to avoid an interpersonal problem that is undermining breastfeeding because she feels that she cannot directly cause change or she prefers an indirect approach. At first glance, the Leader might think that she was unable to help the mother find a real solution. However, some ways of avoiding a problem can create effective, positive solutions that indirectly result in change. For example, a mother may decide to change health care providers, seek a second medical opinion, reduce contact with a friend or relative, quit or change her job, patronize another business, or join a different religious community. By doing so, she sends a message that she will not tolerate a lack of support for breastfeeding—and she may find more breastfeeding support in the process. When verbal negotiation is ineffective, avoidance may encourage someone to provide better breastfeeding support in the future—perhaps for another mother. Regardless of outcome, Leaders can help mothers develop problem-solving and advocacy skills, as well as a better understanding of the process of change. And when someone does accept an invitation to become a breastfeeding ally, the Leader can take satisfaction in the fact that she was instrumental in helping build a world in which breastfeeding is more effectively supported and protected.

For More Information

Resources Regarding Breastfeeding and the Law

Mothers sometimes need help finding resources to help them deal with legal situations, such as family law cases, employment, breastfeeding in public, criminal and social service cases, jury duty, and civil cases. Specialized resources to help a mother create breastfeeding allies in the legal system or workplace are available at www.lalecheleague.org/LawMain.html or from your local Professional Liaison Leader.

Breastfeeding Resources Organizations

Many national and international organizations are involved in the protection, promotion, and support of breastfeeding. A list of organizations, complete with detailed contact information, policies, publications, products, and their Web sites (when available), is available in Breastfeeding Annual International 2001, “Breastfeeding Resource List” (Good Mojab 2001). Leaders can help mothers select accurate breastfeeding information from the sources that are most respected by a potential ally. The “Breastfeeding Resource List” also includes detailed information on many breastfeeding publications, non-print media, and Internet resources for parents, professionals, and advocates.

References:

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