Advice VERSUS Information & Support

Many times over the years have I had my knickers in a knot over advice versus information and support. It was the great late Pam Lacey, chair of the Association of Breastfeeding Mothers that first really opened my eyes to this concept - and it's one I really wish more breastfeeding supporters would recognise..

So if you're a breastfeeding counsellor, peer supporter or anyone who works with mothers as a lactation worker - please read on!

Advice definition:

"Advice is a form of relating personal opinions, belief systems, personal values and recommendations about certain situations relayed in some context to another person, group or party often offered as a guide to action and/or conduct. ".

and

"Recommendations concerning future action, typically given by someone regarded as knowledgeable or authoritative.

We see advice in many forms: "What I would do if I were you", "you need to", "you must", "you should", right through to a blunt "do X".

The role of a breastfeeding counsellor is not to convey personal opinion or beliefs or to tell mothers what they should do; it is to support the mother and help her explore her options, to help her unpick any confusion she has surrounding a problem and empower her to reach a resolution she is happy with (regardless of whether this sits with your individual beliefs - this isn't your journey).

Good reasons not to give advice:

• To give advice assumes superiority, it presumes you know better than the person asking the question, it also makes you responsible for the outcome. If you give someone advice and they follow it - what if it doesn't work or worse still has a negative impact?

Here's an example of one I see regularly.
"My baby's poop is green, do I need to worry? What should I do?". 

Example of a typical "advice" giving reply: "This is caused by too much foremilk, you should start single side feeding - one breast per feed".

We know there are actually various reasons for green stools, one of which can be insufficient milk intake.  Limiting the baby to one breast could potentially create a more serious problem, particularly if the baby is very young.

And another 

"My baby is colicky and refluxy, won't settle, what should I do?"

Example of a typical "advice" giving reply: "You need to cut out all dairy ASAP".

We know there are actually numerous reasons for colic, one of which is dairy sensitivity - but what if that isn't the problem in this case and so doesn't improve or resolve things?  What if just being told to cut dairy without discussion, exploration or explanation sounds so drastic to the mum asking that she decides to formula feed instead, worried her milk is causing the problem?

• It doesn't empower anyone.  Often mums have already had numerous people give advice - how do they pick who to listen to?  If a counsellor gives advice and then a paediatrician gives conflicting advice, who would you listen to as a vulnerable new mum?  How do they tell good advice from bad?

• Giving advice can leave you open to mistakes.  A mum starts telling you about a situation, you think you have all the information, so you tell her she should do "X".  After hearing your suggestion the mum adds no she doesn't think that would work because of "Y" - a new bit of information the mum hadn't shared before.  Oh you say, then in that case I would do "Z".  The mums confidence is now faltering in you.....

• Longer term advice doesn't help.  What does the mum do next time she has a problem?  She again needs to contact someone for advice!  If the mum had been encouraged to help resolve her own problems with information and support, this empowers her with skills to apply to future issues.

• Advice involves making a "judgement" - offering a non judgemental ear can be very satisfying to the "talker", and help people to feel a weight has been lifted.  People can be reluctant to share what they feel the "listener" won't agree with if judgements are involved.

• Sometimes what people state initially as the problem, actually may not be the real issue - if you give advice rather than encouraging them to unpick their thoughts, this may not come to light.

Alternatives to advice:

Active Listening:
Don't consider problem solving, but listen (really listen) to the big picture. Ask open and closed questions to get all the relevant information so the mum can unload everything in a safe space.

Reflection:
Always clarify clarify and clarify again - "so it sounds like you're saying X, is that right?", sometimes reflection can literally just be echoing back what the person said - when the mum hears it back or summarised, it gives her chance to add things or realise X point isn't as significant as Y and so on.  It can help clarify things for mum too!

Give information:
There is often more than one way of resolving a situation; discussing various options with a mum so she can select what she feels works best for her situation.  Examples include "some mums find X works for them, whilst others prefer " - recommending that a mum with four other children to take her baby to bed and baby moon for a few days may simply not be feasible (particularly if baby is a few weeks old and partner is back at work)

You can still give firm "facts" without giving advice - eg "we know that to maintain a supply if baby isn't at the breast, mums need to express 8-12 times per day".

Outlining WHY often empowers mum to begin to recognise poor advice eg "your breasts know how much milk to make based upon how frequently and how effectively they're drained - therefore if baby isn't feeding directly at the breast, we know mums need to express 8-12 times per day in order to mimic this and protect supply".

Support mum to think things through:

"So you feel X is the biggest issue, what would be the absolute ideal outcome for you?" or "If X was resolved, do you feel that would resolve everything?". "Do you feel X would be practical for you or is Z something you feel more comfortable with", "could X be impacting on Y do you think?"

Mums who receive advice, often leave an encounter feeling more confused than before they arrived - especially if they have previously received conflicting information.  Mums who have received information and support often feel "lighter", as though they have offloaded.  Listening can in itself make a person feel valued.

Believe it or not the most valuable tool you have as a breastfeeding supporter is not your mouth, but your ears.