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Q & A: Counseling the mother of a preterm or ill baby

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Question: THINK ABOUT IT: When a mother who intends to breastfeed changes her mind because her baby is ill or preterm, which of the following strategies would BEST encourage breastfeeding?

A. Provide her with a list of all of the benefits of breastfeeding a preterm or critically ill infant.
B. Generate a list of the hazards that are associated with artificial feedings for preterm infants.
C. Convince her that pumping and feeding her milk from a bottle is a good compromise in this case.
D. Invite her to revisit her original reasons for breastfeeding and explore these within this context.

Answer: The best answer is (D). This is not the only possible strategy, but of the options listed it is likely to be the most effective. The mother is already “on board” with the idea of breastfeeding, but helping her to revisit the decision—and tailoring the discussion to the premature/ill baby situation—is most likely to encourage her to breastfeed.
(A) is not best because the mother already expressed an intention to breastfeed; it is unlikely that listing the benefits will change her mind now that her circumstances are different than she expected.
(B) is a tempting option, isn’t it? But it is unlikely to be the BEST option in this case. Her original intention was to breastfeed, so giving her more info on the risk/benefit is unlikely to help her at this point. While not a bad strategy, this is not the BEST strategy.
(C), too, is a tempting option but it is unlikely to be the BEST strategy. “Convincing” the mother contradicts the principles of good counseling techniques—namely, helping the person to come to her own conclusions.

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