Monday, November 11, 2013

Help Me To Help You: The Promise and Pitfalls of Peer Support in Social Media

Macierzyństwo, 1905 by Stanisław Wyspiański

This is quite the time to be a new breastfeeding mom. Support for breastfeeding has never been more abundantly available, especially when it comes to social media forms of it. There are multitudes of message boards, there are blog followings with regular, lively discussions, there are lactation support websites with many different specialties - and then there's the juggernaut (you see what I did there) that is Facebook, of course. Breastfeeding discussions come up regularly on fan pages for various bloggers and organizations, but the liveliest action by far is in the groups, whether open, closed, or secret. I have no idea if anyone has ever tried to get a ballpark idea of how many Facebook breastfeeding-related groups there are, but there have to be hundreds if not thousands.

So this is great, right? It's what we've always strived for, yes? Nursing moms helping one another, spreading positive promotion of breastfeeding, cheering each other on by the dozens, this is living the dream. In many, many ways, absolutely yes! But in some other ways, well . . . it gets complicated.

I'm part of quite a number of different groups and boards, some of them breastfeeding specific, others more about parenting in general. I witness and sometimes participate in breastfeeding-related threads on a daily basis, and have been doing so for years. You know that saying "The more you know, the more you realize you don't know?" The deeper I've gotten into my lactation science program at school, the quieter I've gotten on those threads. Note my long period of radio silence on this very blog; it's definitely related. Partly due to being absurdly overcommitted, fer sher, but part of it is also due to a growing realization of my own limits.

In the boards and the groups and the pages, within any given breastfeeding thread, there's an ever-variable mixture of totally great advice, utterly terrible advice, and advice that could maybe, possibly, perhaps be good - IF we had a hell of a lot more information about the mother and baby at hand. All this comes with a liberal serving of emotional support- never something to be discounted; at times it is what the mother needs more than anything.  And ALL OF IT IS MEANT TO HELP. But when it comes to even the seemingly-simplest of nursing issues, how can moms possibly sort this all out? Sometimes they'll get lucky and go with advice that happens to be sound, and all is smoothly resolved. But sometimes, not.

Let me see if I can illustrate this with an example. In my Advanced Case Studies class a few terms ago, one of our texts was the excellent book "Case Studies in Breastfeeding: Problem-Solving Skills and Strategies" by Karin Cadwell and Cynthia Turner-Maffei. In it was an table that sums the social media support dilemma up perfectly.

As part of learning the Eight-Level Lactation Consulting Process, a chart was laid out with six different dyads, labeled A through F. Eight columns listed the various steps: 1) History, 2) Assessment, 3) Symptoms, 4) Problem Formulation, and so on.  The interesting part: Column three was identical in every case. "Mother describes hard breast with shiny skin; breast larger than normal and warm to the touch; breast pain."

Every single mother presented with the exact same symptoms. And EVERY SINGLE ONE OF THEM had a totally different underlying cause, with a different strategy devised to address their issue.

But in (totally well-intended!) online situations, many sympathetic moms will read the presenting symptom and only know their own individual, unique experience of that symptom. That experience might be relevant to the mother at hand - and it also very well might not. And sometimes moms simply want to share their own stories in return, which is also a very valid need - but conflating that with offering advice is treading into very tricky territory. This was an insight shared with me by Jennifer Tow, and I think about it frequently when following such conversations. It can be so hard for both storyteller and advice-seeker to know whether the shared story has any practical relevance to the situation at hand.

Case in point: Fenugreek might very well have helped your supply, but it is absolutely not appropriate for every woman, nor is it a panacea for supply issues in general, which can range from simply turning around some poor management in the early postpartum period to very complex physiological conditions.

Lactation pros are sometimes present on such threads - and it is worthwhile to note that they are often the ones offering the LEAST advice of all. This may be partly for financial reasons, partly for liability concerns, but primarily because they know full well just how individual each case really is. Without a maternal health history, information about the birth itself, a feeding assessment, an oral evaluation, and any number of other relevant pieces, the full situation is incomplete - and that's not even getting into the options for how to actually address the issue (once it is actually identified) with a comprehensive care plan. The variables are endless and the details always, always matter.

I think lactation professionals have been reluctant to bring this matter up because seriously, the good intentions of everyone ARE so deeply felt and appreciated, and who wants to be the Scoldsy McBuzzkill who rains on the peer support parade? Honestly, where would we even BE without peer support? The progress we as a society have made in reclaiming breastfeeding has everything to do with it, and we owe an immense debt of gratitude to the founders of La Leche League, the most famous breastfeeding peer support group of all time. LLL began as peer support, continues as such, and is AWESOME for it . . . but there's a fourth L in that organization that makes all the difference in the world. Every meeting is facilitated by a Leader. Some meetings need more active guidance, in others the mothers need very little input, but that guidance is there for a reason.

For the most part, I write this post not because I have solutions to propose, and certainly not because I think lactation consultants should be the only persons allowed to speak about breastfeeding (because how paternalistic would that be?), but because I want to open this up for discussion. Let's talk about this. IBCLCs, moms, other perinatal professionals, breastfeeding peer counselors. I truly believe that unless the formula companies have become so devious that they're willing to plant undercover undermining minions on message boards ( . . . actually, let's not rule that out altogether), every mother posting in groups and boards is doing so mainly because they genuinely want to help. This is not an easy topic to discuss, but I think it's time.

How can we best help each other to help each other?


  1. This is a really great post! I find myself in a similar situation. Sometimes, there is just so much I could possibly say that I just don't say anything. Often, I end up addressing the incorrect/bad/incomplete advice given more than I address the original poster. Mostly, I don't get involved and hope that someone who is more tenacious than I will be able to cut through the bad advice and deliver good stuff to whoever is posting.

    I remember clearly when I took my CLC training, and realized how much I had to unlearn, and how much of the advice I had been seeing from other moms had been not so great. It became hard to hang around my usual breastfeeding forums after that.

  2. I'm trying to articulate a point here, so I hope this makes sense. I don't really think there is such a thing as 'bad' advice when it comes to peer support. Every decision we make as mothers is based upon our personal experiences and choices as well as the information we find. If one person's advice is to wean, and the mother agrees with that advice, that's her business. If a problem is medical in nature. a qualified professional should be consulted, not peer support. Peer support is for the day-to-day situations that arise, and there often is no 'right' answer. If the baby is biting, or going through a nursing strike, or not sleeping well at night, etc, then the answer depends not only on information but also on personal preference. Peer support is not medical advice, and I don't think most women see it that way. Medical advice, on the other hand, must be fact-based and consistent while also being supportive. I really feel for doulas and other 'in-betweeners.' What you say may be taken as official medical advice or just peer advice, depending on the woman hearing it. It's a complicated issue.

  3. the lactating lawyerNovember 13, 2013 at 5:51 AM

    I created a group to support african-american mothers in breastfeeding. the goal is primarily to cheer one another on. The group has grown through referrals from friends of friends and is made up of educated women, mostly lawyers. Most people are into evidence-based support and we always make it a point to encourage women to see a lactation consultant when they are facing particular issues. The challenge is, there is the lactation community is not that diverse and many black moms have had trouble building a satisfying relationship with the lactation consultant. Great post!

  4. I have seen many dangerous posts, such as putting foods into bottles for newborns, letting them cry it out for several hours, one bottle of formula won't hurt, or just try soy! There are many seemingly innocent statements on forums where you know the adviser is being supportive, but I often feel like Scoldsy McBuzzkill, because I know better and am compelled to say something. I have seen babies hurt by following that advice. As many of you experienced, I had to take a step back from unregulated forums because of the numerous trolls lurking and because I don't want to be a buzzkill. I am torn on how to feel, because if all the educated women step back, then is rumor going to get worse? Or if we all pitch in, is it going to eliminate peers and leave only "authority" figures? I already disagree with how IBCLC is causing women with loads of experience to be sifted out of the field because they can't afford some aspect of the lengthy certification process, and I don't want to run off moms from forums because I'm interrupting the happy-go-lucky circle of love going on. I feel it's a fine line. Great post- this is an excellent conversation starter.

  5. Thank you! I've been a La Leche League Leader in Canada and China for 20 years and have noticed that mamas are much less eager to attend meetings than they used to be. They would often rather stay home and check online instead. It's sad! There is so much wonderful helping and support that goes on at a meeting. Cheers from Ruth in Victoria BC Canada

  6. Good lord everyone! Sorry for my absence here - my email settings for comment notifications had changed thanks to Gmail's new filtering function (I think), and I didn't see the new comments until now! Thanks very much for the thoughtful discussion, all.