Kathleen Kendall-Tackett, PhD, IBCLC, FAPA
When is help more harm than good?
I recently read an interesting book on poverty alleviation called When Helping Hurts: How to Alleviate Poverty without Hurting the Poor and Yourself. This book highlights a sensitive issue for any helping situation—namely, is our help, however well intentioned, doing more harm than good?
That’s a question we don’t usually want to ask ourselves. If we are going to be effective in any support we offer, we need to at least consider it.
Many of the principles the authors describe apply equally in any helping situation.
Here are a few ideas that seem particularly relevant to breastfeeding support.
- Community. Intervention programs should ensure the participation of the affected population in all aspects of their design. In other words, there should be community involvement and buy-in. Any program should be by the community, for the community. This happens brilliantly in peer counseling and mother-to-mother support programs, when mothers in a community reach out to other mothers like themselves. Peer supporters must be allowed to adapt breastfeeding programs to meet the particular needs of their own communities.
- Existing strengths. An approach the authors called “asset inventorying.” This just means identifying abilities and resources that exist in both individuals and communities. Once these are identified, helpers can facilitate links between existing individuals and groups, and determine the best ways to leverage these assets to solve problems and improve the overall health of communities. This can mean acknowledging mothers’ existing strengths and abilities, and helping to identify the sources of support that exist in their community.
- Avoiding paternalism. Helpers should not do things for people that they can do for themselves.
Knowledge paternalism occurs when we assume that we have the best ideas about how to do things. It’s tricky because often supporters actually do know more. But individuals have unique insights into their own situation and circumstances in a cultural context all of which need consideration. This principle applies in planning a community-wide program or talking with an individual mother.
Labor paternalism occurs when we do work for people that they can do for themselves. Labor paternalism undermines people’s talent and self-confidence, often creating dependency. Working with a new mother, for example, actively managing her baby’s latch or the mother’s positioning can undermine confidence. A mother may start to feel that she can only breastfeed with her counselor right there beside her—a situation most breastfeeding supporters will have encountered at one time or another.
A major paradigm shift in breastfeeding support has moved from a more interventionist and hands-on approach towards a recognition of the hardwired abilities that both mother and baby possess.
The mother-baby dyad is not a blank slate, ready for the supporter to write on. Rather, the helper can gently guide and support a new mother by showing her how competent she already is.
By keeping mothers and babies together and in skin-to-skin contact with each other, both mothers’ and babies’ hardwiring is triggered. By providing mothers with this sheltered space, many feeding difficulties can be avoided.
One of a supporter’s most effective interventions is, to quote Dr. Tina Smillie, simply to “ooze confidence” in the mother. Let her know that breastfeeding will work and that she can do it.
Health psychologists understand that the role of self-efficacy is one of the best predictors of health behavior. In some cases, high self-efficacy can literally mean the difference between life and death (for instance, when it relates to compliance with HIV or diabetes regimens). With regard to breastfeeding, mothers high in self-efficacy are more likely to achieve breastfeeding success.
So when supporting mothers to breastfeed, let’s aim to empower them by increasing their self-efficacy instead of giving instructions.
the helper can gently guide and support a new mother by showing her how competent she already is.
Corbett, S., & Fikkert, B. (2009). When Helping Hurts: How to alleviate poverty without hurting the poor or yourself. Chicago: Moody Press.