Barbara Wilson-Clay, BSEd, IBCLC, FILCA, on why images matter in public health.
Almost 30 years ago I attended a conference in El Paso, Texas. Using the technology of the day, the speaker, Kittie Frantz, threaded a projector, and ran a Super 8 film. It was poorly lit, jerky, and lasted only a minute or two. The baby she had filmed was very thin. Her jaw excursions were short and choppy, and she lost suction every few seconds, crying soundlessly and flailing her arms while frantically struggling to latch back on. I had read about “dysfunctional sucking” and had tried to imagine from the verbal descriptions what that looked like, but being able to see it made it real at last.
Around that same time, I was beginning to teach others what I knew about assisting mothers and babies who experienced breastfeeding difficulties. Having been trained as a teacher, I was shocked to discover that there were virtually no teaching materials available to illustrate key points. We had cloth breasts and hand-drawn diagrams, most of which were wrong. In desperation, inspired by Kittie Frantz’s film and by the photos Chele Marmet (creator of the Marmet Technique for expressing breast milk) had employed so effectively in her lectures, I picked up a camera and began to document clinical cases. Kay Hoover had come to the same conclusion about the necessity of teaching images, and when we eventually met and became friends, the photos we used in our lectures became the basis for The Breastfeeding Atlas.
Fast forward to the present. Not long ago I had a phone call from a university professor with a background in public health who wanted to use some of my photographs to train her students. In the course of the conversation I gave her the same pep talk I give everyone who comes to me needing pictures, “Start taking photos of your own, and train your students in the importance of increasing the library of clinical images of breastfeeding.” Her response was revealing and in many ways very typical of the response I commonly get when I make this suggestion, “Oh,” she said, rather shocked, “I could never ask a breastfeeding mother for a photo!”
She admitted to feeling uncertain about how to approach asking for a photo, and even expressed the feeling that perhaps it was exploitative or violated the privacy of the mother. There is another way to look at this, I suggested. Consider, for example, how crucial photos are in training the next generation of health care professionals. How else can dermatology students identify suspicious moles, or pediatric residents learn to tell one childhood rash from another? From a public health standpoint, photos are vital to training, and constitute one of the big advances in our ability to educate clinicians. It isn’t different in breastfeeding medicine, and it is part of our job to increase the number and quality of teaching photos. Our hesitancy to ask for these photos implies that we still have taboos about the breast that handicap our ability to understand what we are looking at when we see problems in clinical practice that we’ve never before encountered.
So how do we approach this reluctance? It helps to know that mothers are typically very generous in giving consent to photograph providing certain parameters are made clear. The photo will not show their face, names will not be associated with the image, and the picture will be used only for educational purposes or to promote breastfeeding. These issues should be spelled out on a simple consent form that lactation consultants should routinely keep on hand. Hospitals have their own consent procedures, but many hospitals permit photographs of unusual cases in order to obtain training materials.
Over the years, many women have shared with me that it makes them feel better if their experience can help another mother. They know that a lot of health care professionals lack training in lactation support. Many of these women experienced delays in finding solutions because no one accurately assessed their situation. Helping to better educate those who serve mothers and infants gives these women the sense they have contributed to something good. It can ease any sense of exploitation to trade a photo for a free consultation, or free follow-up care. In some cases, a model fee can be offered. As always, communication and counseling skills are important. Occasionally a mother’s distress is so intense that asking for a photo might add to it. In those cases, the request should not be made.
In these days when everyone has a phone with a better camera in it than I ever had, and when digital photography is virtually free, it seems to me that there is no excuse that the library of clinical photos is still so small. I urge everyone to consider how they could meaningfully contribute to the field of lactation consulting by beginning to take photos.
A sample Consent to Photograph form is available in the Free Materials section of our website
Barbara Wilson-Clay maintained a busy private practice in Austin, Texas, U.S.A. for 27 years, seeing hundreds of clients annually. Many of these clients’ complex issues have been documented in published case studies or in The Breastfeeding Atlas, co-authored with Kay Hoover. Barbara served on many local, regional, national and international boards, helping to establish competency standards for the profession of lactation consulting, serving as an editorial reviewer, and helping to establish policies to support breastfeeding mothers and babies. She was instrumental in the passing of several pieces of legislation in Texas to protect the civil rights of breastfeeding mothers, helped found the non-profit Mothers Milk Bank at Austin, and assisted large companies such as Apple Computer and IBM to establish on-site support for breastfeeding employees.