who to trust or not?

[mothercat]

In the mood for a professional philosophical discussion? The let's talk about trust.

In the last two weeks I seem to have had the same conversation with several clients and friends. As birth professionals we spend a lot of time trying to convince moms that they know their body and their baby. We reinforce all the healthy things that are happening with their pregnancy and what good parents they are.

Yet, all it takes is one visit with a doubting friend or a visit with an uninformed HCP to undo all our hard work in confidence building.

For me this mostly seems related to breastfeeding issues. A baby may be gaining slowly but is obviously nursing well and is healthy, but the HCP is worried the baby isn't gaining fast enough. Or, there is a very active toddler who has lost a bit of weight and the HCP tells the mom she needs to quite nursing and put the child on real food. I provide the mom with the correct info, but she isn't sure who to trust. Of course, she should trust me because I am giving her the correct info, and I am telling her to trust what she knows about her baby.

But there is a flip side to this. Why should she trust me any more than she trusts the HCP who is obviously giving the wrong info? I don't want her to trust me to the point where she also doesn't believe in the little voice telling her something is wrong, just because I am the midwife and she likes me.

Any thoughts?
Linda

[mamallama]

Well, you could give her the information, source it, and trust her to evaluate it's veracity for herself.

I doubt her other HCP is sharing his/her source. Doubting friends generally have dubious sources.

All you have to do is present a credible source. Her critical thinking skills will back up the intuitive confidence building you've been working on.

[MsBlack]

This is a good question--and it has come up for me very recently in the very area you mention--breastfeeding, tho I have seen it come up other times over the years w/respect to pregnancy and/or birth.

I, too, want to trust women, and hope to inspire their trust in themselves--in their observations and general sense of things/intuition, as well as in their critical thinking skills.

However--I have found that even without (and really, MOST OFTEN without) any kind of sourced information provided, the family member or care provider who speaks with certainty/bossiness is the one believed, at least to begin with! HCPs...and in my case, legal and certified ones like Drs and CNMs as opposed to my uncertified DEM status...live in people's minds as 'authorities'. Clients have been conditioned to trust 'experts'--and it takes a lot to undo that trust enough to get crit. thinking skills engaged independently. Most people also trust their mom, auntie, cousin, who has advice on pg, birth and bf; the emotional attachment to the person creates a loyalty issue as far as the giving/receiving advice goes. Very frustrating at times, when either/both HCP or family members are giving decidedly bad, UNinformed advice that comes with either/both conventional respect for authority or the loyalty born of emotional attachment. And in these cases, a woman's critical thinking skills are not something she readily reaches for, or will trust in herself as much as she trusts her enculturated impulse to respect authority and/or emotional attachments.

So I have this mom....I knew she was heading for yeast/thrush issues since I met her at 30 wks. Since then I have tried to inform her and provide her with support in making good choices to change this trend. All to no avail--mainly because she simply did not want to believe me in spite of the evidence. Now, at 10wks pp, she is only pumping and bottle feeding due to horribly painful breasts--and now, she finally believes that she has yeast overgrowth (now confirmed by med. HCP and family!) and is considering stopping even the pumping because even that hurts so much AND, many of the yeast cures are not rec'd to be undertaken before a baby is 6mos if you're bfing. Blessedly, her baby thrives and is quite a happy fellow.

Anyway, not to go into the whole gory story, but it has been a quite intense example of what you mention, mothercat, concerning trust. It has me thinking, but I can't say I've come to any helpful conclusions for future ref!

[mothercat]

Now, I'm glad I asked. I never thought about the emotional attachment thing.

One of the moms I'm dealing with keeps waiting for the other shoe to drop. The pregnancy went well, the birth went well, baby is gaining and healthy, even if the weight gain is a little slow, but still back to birth weight at 2 weeks.
I think she is having a hard time believing she deserves to have things go well.

Sheesh, who said that midwives aren't qualified to counsel clients (old, long thread on another board).

[happyartmama]

This is a good topic; I face the same sort of uncertainty, sometimes even before the birth! I'll be discussing breastfeeding info. and tips with mom to be, and she already sometimes doubts her ability, or names how many friends had trouble and gave up within a couple weeks, or that her mom couldn't BF her, so there may be something genetic, etc. etc.

So since there seems to be consensus on the helpfulness of providing sources for information, does anyone have links to solid articles/info. on the facts about BF? Most of my info. is pulled from so many books; I have a feeling moms-to-be might be more likely to read one or two succinct sources.

[SublimeBirthGirl]

I don't care if my students trust me or not. It's actually more fun when they doubt me. That leads them to do their own research and come to their own conclusion (that I was right all along! LOL). I want them to trust themselves above everyone else. Some just aren't capable of it for some reason.

[Ironica]

There's also the issue of who is telling moms what they want to hear.

If the pediatrician says "Your baby only needs to nurse every 3 hours; give him a pacifier in between" and the LC or midwife or family friend or whoever says "Watch your baby, not the clock; he needs to nurse as often as he says he does"... well, exhausted mama WANTS to believe that she gets a 3-hour break!

With birth, an excited mama who wants to meet her baby and is SICK of being pregnant is all too willing to believe that it's best to get induced at 40+5 or whenever.

And so it goes. I do honestly believe that one of the biggest challenges to evidence-based medicine in the US is market-based medicine, where the practitioner that tells you "Here, try this cream" is going to make more money than the one that says "Hey, you're allergic to your favorite food." The conflict isn't always between HCPs and doulas/midwives... but even when it's not, how many of these advice-giving family members are quoting their own HCPs? Quite a few, I bet.

[Ironica]

Originally Posted by happyartmama

So since there seems to be consensus on the helpfulness of providing sources for information, does anyone have links to solid articles/info. on the facts about BF? Most of my info. is pulled from so many books; I have a feeling moms-to-be might be more likely to read one or two succinct sources.

The Pump Station in Los Angeles has some great handouts. Most of them were written by Cynthia Epps, a local LC, who's apparently the LC to the stars or whatever ;-) (she's been a friend of my husband's family for years... she came to see us at the hospital the day after our son was born, and was sooo helpful in correcting some minor latch issues and reassuring us about nursing him all the freakin' time ;-). You might search around and see if you can get permission to reproduce some or all of those handouts; I know that some of them got distributed in my birthing class, which was no connection to the Pump Station at all.

Oh, on that note (who to trust, getting good BF info, etc.) one effort that I know Cynthia has been involved in is a Breastfeeding Task Force. She and some other LCs in the area have been going to hospitals and providing in-services for PP nursing staff, to give them up-to-date info on how to promote and support breastfeeding. When we were in the hospital with our son for 72 hours after birth, that means we went through six nursing shifts... and had ONE nurse who knew anything about nursing, latch, etc. So I think it's a very valuable service.

[mothercat]

Originally Posted by SublimeBirthGirl

I don't care if my students trust me or not. It's actually more fun when they doubt me. That leads them to do their own research and come to their own conclusion (that I was right all along! LOL). I want them to trust themselves above everyone else. Some just aren't capable of it for some reason.

This is probably the subset I'm talking about, those who can't trust themselves.
This probably is related to trust issues that occurred much earlier in life. They really, really believed they could trust someone and then that person betrayed them. I could see where abuse of any sort could lead to this.

I don't want them to trust me completely either, but some are like windflowers, every little thing that comes along changes their mind. It makes it hard to know sometimes what they will do, because they seem set on a plan and the next time you see them, things are going in the opposite direction.

[Malga]

This is an interesting topic that I have also pondered. I have to say that I don't know if I always buy the women trusting themselves issue : let me explain why (just want to propose some different thoughts). Women generally go to midwives, doctors, etc because they do want an "expert" opinion. In fact, I want an expert opinion sometimes too. For example, I started having some heart palpitations awhile ago and I went to a cardiologist-- an "expert" on hearts to get it looked over and a "professional opinion." I dont' want to learn everything there is to learn about hearts-- I'm not that interested in it. Of course I wouldn't go along with anything that felt very wrong... But, what is the point of midwives if it isn't sometimes their expertise?

[SublimeBirthGirl]

Originally Posted by Malga

This is an interesting topic that I have also pondered. I have to say that I don't know if I always buy the women trusting themselves issue : let me explain why (just want to propose some different thoughts). Women generally go to midwives, doctors, etc because they do want an "expert" opinion. In fact, I want an expert opinion sometimes too. For example, I started having some heart palpitations awhile ago and I went to a cardiologist-- an "expert" on hearts to get it looked over and a "professional opinion." I dont' want to learn everything there is to learn about hearts-- I'm not that interested in it. Of course I wouldn't go along with anything that felt very wrong... But, what is the point of midwives if it isn't sometimes their expertise?

The difference, in my mind, is a medical condition compared to a normal state of being in a woman's life. If I had something wrong, I'd go to the doctor. If I'm healthy, I don't. I'm that way with just about all health issues, not just pregnancy, though. I don't do well baby visits, don't do well-woman visits anymore, etc. I will probably get a pap again eventually...

[JanetF]

I think women are socialised to believe their bodies are faulty, that other people always know more and better than them, that breasts probably don't work and bodies don't really work for birth either. Thus it only takes one dolt to pass uninformed judgement for the whole inner core of a woman to be exposed and she stops believing anyone who tells her otherwise. Most of us graft a thin veneer of trusting birth, trusting babies, trusting breasts etc over the top of our deep conditioning which just lurks around there waiting to be uncovered. All manner of things can uncover it, like longer labours, anyone's small thoughtless comment, a paed, a family member, whatever. It's like the inner core of conditioning rises up, breathes a sigh of relief and women get back to feeling comfy again with their inner knowledge that their bodies don't work. It's inculcated in us from birth, through puberty, menarche, then into the pregnancies most of us have with Experts in charge and constant doubts about our capabilities being played on. Undoing that conditioning is hard work and most of us seem to find it really painful and challenging and seem to feel it's easier to live with the devastating results of it than fixing it so we no longer have to live with that pain. Those are the things I observe in supporting women healing from birth trauma and I see it occurring with monotonous regularity in all areas to do with our bodies. We don't need a birth revolution, we need a feminist revolution, then the birth stuff would be fixed anyway.

[courtenay_e]

Originally Posted by happyartmama

This is a good topic; I face the same sort of uncertainty, sometimes even before the birth! I'll be discussing breastfeeding info. and tips with mom to be, and she already sometimes doubts her ability, or names how many friends had trouble and gave up within a couple weeks, or that her mom couldn't BF her, so there may be something genetic, etc. etc.

So since there seems to be consensus on the helpfulness of providing sources for information, does anyone have links to solid articles/info. on the facts about BF? Most of my info. is pulled from so many books; I have a feeling moms-to-be might be more likely to read one or two succinct sources.

I send them to LLL, who is THE trusted source for information and breastfeeding standards for WHO, UNICEF, AND the AAP. Generally, if I tell my clients that, and link them to cited articles, as well as tell them about the Health Care Provider Breastfeeding Seminar I went to...where out of FOUR HUNDRED Doctors and Nurses in the room ONE, yes O-N-E had had the NON-required class on breastfeeding, and it was FOUR HOURS long... that HCP's are NOT required to take classes on breastfeeding or nutrition, and so most of the information they have is anecdotal, from mothers, sister, aunts--most of whom have incorrect information themselves, because we are a bottle feeding society! Then, I go back to the fact that LLL is looked to by those major organizations for studies and standards, and then link them to info or give them the pamphlets/tear-off sheets that correspond to their problems (a good way to get these would be to make friends with your local LLL Leader...).

So, basically, I go with, they may be WONderful HCP's, but the fact is, they were not required in their studies to know about this problem. Here is information from one source who is trusted by many major organizations to get the info correct. That way, they're not trusting ME. They're reading the info for themself, well cited and supported data, and making their own choice.

Kellymom also has great articles, which are often well cited and also quite "readable."

[mamallama]

Originally Posted by mothercat

This is probably the subset I'm talking about, those who can't trust themselves.
This probably is related to trust issues that occurred much earlier in life. They really, really believed they could trust someone and then that person betrayed them. I could see where abuse of any sort could lead to this.

I don't want them to trust me completely either, but some are like windflowers, every little thing that comes along changes their mind. It makes it hard to know sometimes what they will do, because they seem set on a plan and the next time you see them, things are going in the opposite direction.

I think a lot of times the primary need of this subset of women is approval. Yours, the doc's, the mother-in-law's. Or maybe the need for approval is secondary to the childbearing issue, but approval seeking is an unconscious behaviour that impedes their critical thinking.

[Malga]

Thus it only takes one dolt to pass uninformed judgement for the whole inner core of a woman to be exposed and she stops believing anyone who tells her otherwise.

I think this may be underestimating women.

My only point is that sometimes I do go to experts in other fields for their knowledge. For instance, I have a friend who is a vet tech and I ask her information about my dog. I ask a naturopath about my health and preventative help measures. I don't think its unreasonable for women to ask midwives or doctors for support, information, opinions, etc. And as I said before in my example, most women can descrimate between what is helpful information to receive.

[JanetF]

If most women would apply critical faculties to birth and breastfeeding our rates of both would be significantly better, wouldn't they? What I do and what I observe in the vast bulk of women are very different so it's best to not overlay my experience on what I see is a clear majority. Asking for an opinion then doing what your own research proves to be best is different from how most of us operate.

[Malga]

One more question... why are we "birth professionals" if there really isn't a need for this type of work?

[Malga]

If I had something wrong, I'd go to the doctor. If I'm healthy, I don't

This is definitely an issue in the West. People only go to get help after something is wrong. Preventative help is the key-- thats one of the things I love about midwifery, massage, naturopathy, even PAP smears ;-). I agree one difference in my example was going to a doctor for a problem versus health. I could give another example of going for chiropractic even though I feel wonderful because they are experts in that field and it helps me to stay feeling great.

[Ironica]

Originally Posted by JanetF

If most women would apply critical faculties to birth and breastfeeding our rates of both would be significantly better, wouldn't they?

There's a confluence, though, of applying those critical faculties and having good information to apply them on. There's a lot of conflicting info out there... studies that outright contradict each other; philosophical differences on various things (who should I trust on nutrition, a vegan or a WAPer?) and generalizations that may not hold for a particular situation.

A friend of a friend lost her milk by 8 months because she'd been using a nipple shield all that time. My friend tells me, "No one told her that that could happen!" I responded, "I did." When I first met her, at my friend's baby shower, and her baby was four months old, I had mentioned that it's a good idea to wean off the shields as soon as possible, as they can cause problems with nursing. I also talked about various ways I'd heard of for weaning off of them.

Of course, I'm not her pediatrician, or any other professional she consulted. I'm just a mom, who was still nursing a 2-year-old at the time, and happened to go to a lot of LLL meetings. ;-) Maybe she would have given my information more weight if I had been an LLL Leader or something, I dunno.

So, it does still come down to knowing who to trust. Should she have trusted me? Well, yeah! ;-) But did she have any way of knowing that? Hm. My friend who I know this woman through has a habit of calling me after every appointment (pediatrician, allergist, prenatal, whatever ;-) and bouncing what they said off of me for what I think of it. Obviously, she trusts me. She knows me better, but I don't have any credentials. Should she trust me? I dunno. I mean, I think she should ;-), but in the sense of this thread, I don't know if she "should."

[mothercat]

Originally Posted by mamallama

I think a lot of times the primary need of this subset of women is approval. Yours, the doc's, the mother-in-law's. Or maybe the need for approval is secondary to the childbearing issue, but approval seeking is an unconscious behavior that impedes their critical thinking.

This is the part I'm trying to understand. So, what you're saying is the cognitive abilities are there but that their need for approval, from whomever they are talking to, overrides their ability to think things through and stay focused on the best info they have been given or found on their own. They believe some of the stupidest bluffs and misinformation because of perceived approval.

This is where it gets hard for me as a midwife. I am a very rational person and it seems that the truth should also be so obvious. It should be obvious when it is referenced and cited in multiple ways. But, knowledge doesn't always win out over emotions.

Just having trouble wrapping my rational mind around an emotional issue. It's really frustrating when I see someone lied to, and they can't see it. You provide them with proof they have been lied to and they still don't believe it. They probably do see it but tuck it away as an anomaly, because their emotional needs take precedence.

Then we throw in some of the other societal messages that our bodies as women are broken (thanks JanetF for your perspective).

Does it make any one else really angry for the damage that was done to this person in the past, and to know that that damage will continue to impact their lives and choices for years to come?

Thanks to those that are contributing to this thread. I wish we had a forum for a Socrates cafe on MDC.