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IBLCE Study Tip #5: Counseling Don’ts–and Do

I like to think that I’m better at counseling real people than I am at answering test questions. Face-to-face, I’m listening, caring, and responding spontaneously with (what I hope to be) the right words for the situation. When taking the IBLCE exam, though, all of the “answers” can look good to me!

Over the years, though, I’ve helped other people to identify right or wrong answers, and I’ve found there are some definite red herrings. As you look at the responses, avoid anything that smacks of the following:

Judging: This comes along the lines of “That’s a dumb thing to do.” Well, the response is not quite that ugly! But variations might include: “No one else is doing that these days” or “That doesn’t seem very practical!” or “A pump would work better.”

Minimizing or Dismissing: This comes along the lines of “This is no big deal.” A response of this kind might be like: “Lots of mothers have gone through this and it resolves pretty quickly” or “You don’t need to worry about that at all.”

Re-focusing: Getting the attention away from what the mother is saying and focusing instead on another person, place, or topic is the trap of re-focusing. If the mother is crying her eyes out, saying “Would you like me to take you back to the nursery?” may at some point be useful, but the first response should be more like “Oh, this must be so difficult for you.”

Giving False Reassurance: Although most of us do want provide encouragement and support, we can’t get caught into the trap of false reassurance. “Don’t worry; your baby will be fine” and “She’ll recover. You’re giving her your milk and she’ll be better tomorrow” are examples of this.

Bossing: This is the trickiest of all! Most of us, thinking ourselves to be the experts, can fall into the trap of telling the mother what to do, because we honestly think our suggestion would be best. However, anything that smacks of ordering the mother is not the right answer for the test. Similarly, “fixing” the problem is another example of telling the mother what to do.

Generally, pick the answer that puts you in the role of facilitating the mother’s decision, rather than deciding or implementing a decision. While “fixing” may sometimes be appropriate, it is often not the appropriate first response. Wait until the mother has been “heard” and is “on board” with any suggestions you might make.

IBLCE Study Tip #6: Medications
IBLCE Study Tip #4: Counseling

5 Comments

  1. Jessica Sattler

    Love this post! I too, feel like I am pretty good with my patients- and am not often at a loss for what to say, but seem to get counselling questions wrong! This is a great way to break down the subtleties of the “bad counselling” responses.

    Thanks Marie!

  2. Melody Ward

    Hi Marie,

    Thanks for doing all you do to help us prepare for “the exam”! Even though it’ll be my 3rd time taking it, I always learn new things by studying…and…reading through your blog is a great refresher for test taking strategies!!

    This is totally off topic, but something I’d like some clarification on. Even if it doesn’t come up on the exam, it would still be good for all of us to know. Realizing there is a difference between “providing information” and “recommending”….is it ethical/legal for an IBCLC (in private practice or not) to sell herbs, as well as recommend dosages?

    If an IBCLC is not qualified to recommend a medication or herb, as this can be viewed as “prescibing”, it seems that selling herbs and recommending dosages is out of our scope of practice. Or is this just a very gray area that is open for interpretation?

    Thanks, Marie!!!

  3. Marie

    Melody, thank you for your very good question about the lactation consultant’s role in herbs.

    First, the lactation consultant–unless she has a credential in medicine, pharmacy, naturopathy, or some related discipline–is absolutely not qualified to “recommend” or “prescribe” herbs. I willingly acknowledge that some of my colleagues have deemed my stance on this as “too conservative” but I have had this discussion with staff at IBLCE, and I am quite confident that I am correct in saying that it is not in the IBCLC’s scope of practice.

    Put another way, anything that sounds like “this herb would be a good thing for you to take” is not within the IBCLC’s scope of practice. Don’t choose that as the answer on the IBLCE exam, and don’t do that in real-life practice! Most definitely “recommending” a dose is clearly outside of the scope of practice.

    In my opinion, selling herbal preparations is different. Let me tell you why I say that. I buy nearly all of my herbal and other natural products at a Lori’s Natural Foods, http://lorisnatural.com/ a wonderful store where I’ve been buying products since it first opened its doors in 1981. The co-owner, who calls himself the “Fossil,” is among the most knowledgeable people I have ever met where it comes to herbs. However, even when I assert myself as a long-time customer, address him by name, and assure him that I will not tell anyone if he makes a “recommendation,” he never recommends anything. He simply arms me with literature written by recognized experts. He urges me to read it all carefully and make up my own mind. I think this is great role-modeling for how the rest of us should behave, too.

  4. Yanet

    I really like the calnader idea Thanks!Childcare providers have excellent guidance for caring for the breastfed infant in Caring for Our Children: National Health and Safety Standards, 3rd Edition. You can find this entire text on line; chapter 4 (Nutrition) covers breastmilk storage,handling, and feeding. Some US States have more or less guidance in their formal regulations. Providers may also follow more detailed guidance/requirements if they are participating in the US Federal Child and Adult Care Food Program (CACFP), since that will give reimbursement to providers feeding meals containing breastmilk. Mothers can look up both of these documents to learn the standards the childcare provider should be following. It is also excellent guidance for a babysitter or smaller, unregulated childcare provider. FWIW, in neither of these documents does it address how long to keep breastmilk leftovers.’ So, since there is no evidence giving a safe’ window, mothers may want to consider providing smaller servings rather than having to judge whether leftover breastmilk is safe’ to re-feed at a later feeding. Childcare providers may err on the side of caution and be unwilling to offer leftovers since they do not want to be liable if the infant develops food poisoning/GI issues.

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