Episode 7 - 5 Great Questions: A Lactation Care Provider's Guide
Welcome to the Lactation Training Lab podcast, a show created to inspire, inform, and engage everyone who works with pregnant people and new parents. So glad you’re here! I’m Christine, an IBCLC and trained childbirth educator based in the U.S. After years of practicing clinical lactation care and providing professional lactation training to other healthcare providers, I created the Lactation Training Lab to serve as a resource for learning and connecting overall things lactation related. Whether you’re seasoned or studying, I hope this show will make you think and inspire you to act. Here we go!
Welcome back to the Lactation Training lab Podcast. Today I wanted to spend a little bit of time going through one of my most popular free resources. A lot of people enjoy this resource, have downloaded it, and have given me feedback about this, and they’re saying that it’s really helpful and it’s made them think about how they speak with their clients in a different way. This particular resource is called “5 Better Questions To Ask Your Lactation Clients.” There are 5 plus an extra bonus one that I added at the end. We’ll go through each one and I’ll give you a little bit of insight and background to what these questions lead to, how they made things better, and then you can always go to my website christinestaricka.com or www.lactationtraininglab.com in order to download this free resource right from the tab that says “Free.” We’ll jump right in here.
The very first one, number one, instead of asking “How often does your baby feed” I suggest you ask “How do you know when your baby is hungry?” This gives you a lot of insight into what this parent knows about feeding cues. Particularly in those first few days and weeks of feeding, this is really important to hone in on this particular part of what parents know about how feeding is supposed to happen. It helps you identify when people are using incorrect or inappropriate cues for feeding or if they’re scheduling feedings. It helps you identify those things that you need to know in order to be able to give them good information about how to move forward. Whatever they are doing is going to come out when you ask this question about how they know when it’s time for the baby to eat.
Regardless of how the baby is being fed, it’s important that we hear this information so that we can make a plan for going forward. Whether that’s something that requires additional education because this is a baby who is feeding at the breast or chest, or if this is a baby who is being fed with the bottle or another device, but there’s more information that they could use about how to appropriately feed their baby on the cues rather than when the clock says that it’s time. It also encourages parents to share the basic timeline of how their feedings are happening. When you start talking about this, it takes the emphasis off of what time does your time does your baby eat, how often do they eat - it takes away that time clock part of it and reminds subtly that we need to focus on the baby and what they’re telling us, communicating, in order to know when it’s time for them to eat.
Similarly, the next question, number two, instead of asking “How long does your baby normally feed?” I suggest that you ask “How can you tell when your baby is finished at the breast or the chest?” How do you know when the baby is finished? Again, this helps identify those places where cues are not being read correctly because possibly parents weren’t given this information, or there’s scheduled feedings going on, or there’s a certain amount from a bottle or other device that’s being given without any cause, or reason for that, maybe just because that’s how much the parents thought they were supposed to have, and it could be incorrect. We really need to get this information so that we can have this plan, start to move forward and start to make changes based on any problems. It really gives you that opportunity to hear the parents talk about how the baby is acting while they’re feeding. It lets you know what they’ve observed, if they’ve observed much, or if things are sort of just happening and that’s working out just fine because things are just working. It really gives you those opportunities to identify places where there can be more education or information given to them or more guidance given to help them get towards the goals that they’re looking for. It gives you a lot of ways, things that you can hear through the answers to those two particular questions that are going to give you a good sense of what is the way that feedings are starting, how are feedings going, and then how are they ending beyond the simple or the questions basically that the parent comes to you to ask.
These are also good questions actually even if you’re working with somebody in the hospital where you don’t know if there’s a problem yet, like when this isn't somebody who has called you on the phone or come into your clinic and said “I’m having this specific problem with breastfeeding and here’s what’s happening.” No, this could also be used in a situation where you are encountering the person, you have no idea how they feel like it's going, and you could be getting a completely positive story out of this. Those two questions work really well for both kinds of situations.
Another one that works for that, if you know that the person is expressing milk, instead of asking “How is pumping going for you” or “how is hand expressing going for you” or “How is breast/chestfeeding going for you” you can ask instead “How do your breasts or chest feel after you’ve pumped/hand expressed/fed the baby?” Again, this takes the emphasis off of the process and helps people refocus on the body and how the body is working. We want to encourage people to notice the changes, especially again in the earliest days, weeks of feeding and lactation, we really want them to notice how things are changing with each of these processes. So whichever processes they’re using, whether it's one of those or all of those or however they’re proceeding through lactation, there’s a really good opportunity to make sure that they understand they’re supposed to notice, and it really does matter if they are experiencing excessive fullness. That’s something that would come out of that conversation.
This conversation starter here can be used again if you’re approached by somebody who says “I have a problem,” if you’re encountering someone and you have literally no idea what’s going on, again perhaps encountering somebody whose baby is in the NICU, they’re still hospitalized or maybe they’ve been discharged and their baby is still in the NICU. You could be talking to them about this. I find that this question brings out way more information because the question “how is pumping going for you” or “how is breastfeeding going for you,” it gives you a short answer and it’s almost like a yes or no. It’s like “it’s going fine” or “it’s terrible,” “it’s hard but I can do it,” those are good to know, but it’s certainly not enough for what I need to be able to do in order to be able to help them if they’re needing help. I find it’s a much better conversation starter and so perhaps you can think of all of these as better conversation starters.
Number four, How often is your baby feeding during the night? Well, instead of asking that, instead of again turning our attention back to the clock/time/hours/how many hours pass in between, and all of those things, I suggest that you ask “Please tell me how your nights are going with this baby.” This is another question that can be used in any situation, no matter what’s going on, no matter what processes are being used, whether there’s feeding from the body, whether there’s bottles and devices, pumping, hand expression, anything that they’re doing - we need to know how the nights are going. We really need to know a description, a story of what’s happening in the night. They can tell us the story of how their baby acts during the night, so again we’re listening for the cues that they understand or maybe are not seeing and we think that they should be seeing. We can hear from them where their baby is sleeping. We’re going to get information that tells us where there's a gap in information, if there’s more safety information that they need to have, if there’s more guidance or advice on how to manage the nighttimes. We can hear about where they’re sleeping in relation to their primary caregiver, whether that’s in the same room or a different room, and we can find and identify those places where we can give information that could help with the continuation of lactation or which would be useful to know about how that works.
We can find out from this conversation about whether nighttime feedings look really different than daytime feedings. What is life like in their house in the nighttime? What is happening? How is the baby acting during the night? Are they getting help from other people at night, perhaps their partner, significant other, if they’re helping or if they’re not available to help, if they have a partner or don’t have one that’s there during the nighttimes. There’s other needs that happen during the night like their other children have needs during the night, perhaps they’re young or have special needs. There’s lots of reasons that parents can have multiple responsibilities during the night. All of these important details can give us more of the entire picture of baby’s feedings. In a simpler way, we also get to hear about a little bit more of that picture because I often find that when I ask somebody about feedings, they tend to focus on the feedings that happen during the daylight hours, not so much in the nighttimes. And we know in lactation care that if we don’t talk about the nighttime, we’re not getting the full picture because what could be happening is that most of the feedings are happening during the day but at night there’s some sort of a large gap where there’s no feeding happening or feedings are happening poorly due to a multitude of reasons. Or we could have a situation where feedings at nighttime are scheduled whereas feedings during the day are responsive. We need to provide information that’s going to help meld those things together and provide more understanding about how lactation works.
There’s so much opportunity with this question about how the nighttimes are going that can really give us a much better picture of the entire feeding story of this baby and the parents so that we can help them move forward.
Number five, instead of asking “How often are you hand expressing or how often are you pumping,” I suggest you ask “When was the last time that you expressed milk?” This question comes from my experience working with parents who have babies in the NICU who are exclusively pumping. During the time that I was working with this population of parents pretty much exclusively, I really found that if I asked how often, their answer was very much whatever they thought or had heard or had been told was “the right answer.” And we know there’s some variation in how those things are taught, we know there’s a basic framework into which it needs to fit like at least 8 times in 24 hours, but we know that those frameworks get stretched, they get compressed, they get changed. So the parents will often give the answer that they believe is going to be the right answer - they don’t want to be wrong, they don’t want to say that they don’t know what we told them or that they weren’t listening. They want us to know that they’re paying attention and have been educated on this, that they have sought information about how to make this work best. And sometimes it's simply the easiest way to describe how they are generally thinking about when it’s time to express milk. So even though that doesn’t always happen exactly by the clock they know that generally when 3 hours pass that they have usually been pumping. But if we ask “when was the last time,” this encourages them to actually think back and say “Okay, well, right now it’s 2:00, the last time I pumped was right before lunch and I ate lunch at 11:30 so that means it’s almost time to pump.” That’s a much better description than saying “I pump every 3 hours.” That’s great, but if you are sitting here right now, and here’s how this played out for me in the NICU quite a bit: if I saw a parent in the morning, we talked about pumping and they would say every 2 or 3 hours or whatever answer they were giving, it might sounds like it would totally fit - except that if we didn’t talk about “when was the last time you pumped” which was 5 or 6 or 7 hours ago, then it sounded like we were pumping enough but we weren’t really.
It really gives the opportunity to hear the actual story of what has been happening. It gives you the opportunity to hear the details that sometimes are the actual thing that is interfering with the intentions of this parent. Here’s an example of how this would play out. It would be 9:00 in the morning and we would be talking about when was the last time that you pumped and so they would say “I get up at 5 so I can pump and I got my other kids ready for school and ate breakfast, dropped my kids off at school, came here to the NICU, by the time I got here it was like 8:30 and now it’s 9:00.” So now it’s been 4 hours and I’m sitting here talking to you and thinking “why aren’t you pumping, where is the pump, why is the pump not out? So that’s an opportunity for me to hear and observe what’s going on and say this is a really busy time of the day for this person so there other responsibilities are sometimes interfering in how they feel they’re going to be able to schedule their pumpings in - so let’s talk about how to make this particular gap now be the big gap, make that be the time where we have to rush around and do a bunch of other things where we’re planning on not being able to pump for 4 hours at this point. Having that knowledge allows us to use the flexibility that we know is there and use those details to build out a better picture/story of what’s happening and help them get around those other kinds of obstacles.
It’s great to think everybody is going to perfectly be able to pump 8 times every 24 and hours and it’s going to be evenly spaced out, no they’re not, that’s not realistic. What we have to do is help hear the story, think about their other needs, help them think through where those problem areas are and work out solutions that are going to work around obstacles that they have.
Similarly, here’s the bonus question for you, number six, instead of asking “How long do you usually pump or hand express” I would ask “How long does it take you to get the milk out when you pump or hand express?” How long does it take you to get the milk out? Because that again takes the focus off “I pump for this many minutes” and it puts the focus on “wait a minute, I’m supposed to notice how my breasts feel after I’ve pumped or hand express, oh yeah, this is about me and my body, this is how my body works.” And it gives the opportunity to be able to share additional information about techniques that can make things go faster or work better, it gives the opportunity to identify where maybe there’s excessive fullness that’s not being relieved, or an observation that “I just don’t really see any changes and now we’re on day 5 and I’m not observing any changes in how my chest feels after I’ve pumped.”
We have to be able to ask the right questions in order to get all the details and answers and information we need to be able to help somebody get through and make their plan better if it needs to be made better. I really like using this myself and I really have gotten a lot of good feedback on this.
You can get this from the website under the “Free” tab. Go to lactationtraininglab.com and then click on “Free.” You can get this “5 Better Questions to Ask Your Lactation Clients.” I feel like this will really help you feel like your consults are more conversations that give you better pictures and stories to work with than just having basically short answers that are yes or no or very short or very number-based. It really seems like with these questions you can get a lot more descriptions, narrations, and details about all of the external factors that are impacting what’s happening in the lactation story of this client and their baby. Thanks for joining me and I’ll see you next time on the Lactation Training Lab Podcast!
Listen to Episode 7 here!