Dr. Jaclyn Wells’ article, “Just Follow the (Ten) Steps: Breastfeeding Education in Baby-Friendly Hospitals” was recently published in Issue 7.2 of Rhetoric of Health and Medicine. In this interview, Assistant Editor Amy Reed, asked Dr. Wells about her personal experiences with her research subject matter, her expert opinion on patient education materials, and more.
AR: At the start of your article, you share your personal story of giving birth at a baby friendly hospital, and indicate that you came to this topic via your own experiences. Can you talk a little bit more about how your personal experiences helped you approach this research? For example, in what ways did having these experiences help you craft research questions or make recommendations? Alternatively, were there any ways in which your personal experiences served as a barrier to researching this topic?
JW: Thank you for asking! In the article, I only describe my hospital experiences right after birth. Readers may wonder what infant feeding looked like for my daughter and me after we went home. These later experiences certainly shaped my research, so I appreciate the chance to share more.
In a nutshell, I never successfully breastfed my daughter. Instead, I exclusively pumped and combo fed, but what’s funny is that I didn’t even know those were “real” feeding methods until I started looking for more info and support online, including on social media. I was like the student who thinks they’re cheating the system by writing their outline after they write the paper until they learn that reverse outlining is a legit thing people do.
When I started researching for this project, I read Jessica McCaughey’s fantastic TCQ article, “The Rhetoric of Online Exclusive Pumping Communities: Tactical Technical Communication as Eschewing Judgment” and had such an aha! moment. McCaughey writes about exclusive pumpers turning to each other in online forums–which I did!–because formal institutions like hospitals provide little, if any, information and support about exclusive pumping. Before I read McCaughey’s article, I didn’t think of myself as an “exclusive pumper,” because I didn’t think that such a thing was common enough to merit a name. When asked how I fed my baby, I might have said something like, “Well, you know, I was going to breastfeed, but then it didn’t work well for us, so now I pump the milk and give it to her in a bottle and…” I was the same way with combination feeding: If asked whether I breastfed or used formula, I would have offered a long, circuitous explanation instead of saying I combo fed, only because I didn’t know combo feeding was legitimate or common enough to have a name.
As a parent, I would have benefited so much from prenatal education that explained all the feeding options, including their advantages and disadvantages, so I could make informed choices and have lots of alternatives if my original plans didn’t work. My sense is that breastfeeding educators don’t discuss options like exclusive pumping and combination feeding because they’re worried about discouraging breastfeeding parents and giving them an offramp for when things get hard. But, breastfeeding is hard, and preparing parents for the challenges by educating them about alternatives just seems reasonable to me. In my research, I have been thinking about how materials may encourage breastfeeding without making parents feel like they have failed if they use alternative methods. That’s what I needed as a new parent.
AR: It was fascinating to read the quotes from the patient education materials, and to note the jargon, assumptions, and incongruities that would potentially make them difficult for patients to decipher. It made me think, immediately, of the now ubiquitous “summary of your visit” packets that patients are provided with after a medical appointment. Often, those are equally confounding! Are all patient education materials this poorly written, or have you collected examples of helpful materials as well?
JW: Ever since I started this research, I cannot help but analyze every pamphlet I get at the doctor and every flier I see at the hospital. It reminds me of my first-year writing student who joked during our visual analysis unit that she couldn’t even go to a restaurant anymore without examining the colors, images, and fonts used in the menu.
I have collected some examples of helpful materials—they’re not all bad! One memorable piece of writing helped me think about how rhetoric and writing researchers could support physician training, and specifically, how doctors are trained to write for patients and their families.
After my dad’s stroke a couple of years ago, my family was thrown into baffling, heart-wrenching circumstances. I know many readers with aging parents will relate. We had so much to figure out regarding the cognitive effects of my dad’s stroke and his care moving forward. We didn’t have power of attorney or guardianship prior to the stroke, so we were wading into confusing legal territory in addition to medical. Plus, my dad was a Vietnam veteran using VA healthcare and benefits. Add military lingo to the medical and legal jargon and you can imagine how confused we were, on top of being exhausted and heartbroken about our dad’s health.
A couple of weeks into my dad’s hospital stay, one of his doctors wrote a three-page report for us to use in any situations in which we needed to advocate for him, like when trying to get guardianship so we could help make medical decisions and when applying for additional VA benefits to pay for his care. The report was detailed, organized, and remarkably easy for a layperson to understand. There was some medical jargon, sure, but the doctor was careful to avoid it when he could and explain terms when he couldn’t. The report’s immediate audience wasn’t necessarily me or my family, but the writing was so clear and easy to understand that we found the document useful for understanding my dad’s condition in addition to advocating for him. The doctor had been clear and kind in speaking with us as well but having a written document that we could read on our own time, when we had the clear mind to process the information, was invaluable.
When I thanked the doctor for the helpful report, he admitted that he had always enjoyed writing. I got the impression he was “one of us” already—someone who appreciated and took seriously writing and communication, I mean—but I wondered what could be done in physician training to make all doctors aware of how important and useful their writing can be to patients and their families, especially in crisis situations like when a family member is hospitalized.
AR: Ultimately, you argue that infant feeding materials need to offer parents critical access rather than just functional access to information about breastfeeding and formula. Can you speculate on how medical professionals might themselves foster this critical access, in combination with better patient education materials?
JW: Yes, definitely! I think the key is really to consider the parents’ circumstances instead of giving blanket advice or making them feel like only one choice is acceptable. With infant feeding, that often looks like discussing the options instead of presenting breastfeeding and formula feeding as either/or.
I recently interviewed parents who had delivered in and/or gotten prenatal education in a Baby-Friendly hospital. One mom I’ll call Diana praised a lactation consultant she saw while in the hospital after delivering her second baby. Diana wanted to breastfeed, but her milk hadn’t come in yet. She had also had a very difficult delivery, so she and her partner were even more exhausted than the norm (and the norm, if there is one, is already plenty exhausted). The consultant provided Diana some strategies and showed her how to pump to stimulate milk production, but she also said, “Just do what you can. We’ve got formula if you need it.” This was very different from Diana’s experience with her first child, when a lactation consultant pressured her to avoid formula entirely and to pump as frequently as possible regardless of how desperately she needed rest. Diana pumped regularly and ended up breastfeeding more successfully than with her first child. She talked to me about how relaxed the lactation consultant made her feel by simply presenting the options, reminding her to rest, and encouraging her to not beat herself up if things didn’t go exactly as planned.
I think that empathetic support can really help new parents make decisions that are good for them and the baby. That support can be especially helpful when combined with clear educational materials that parents can reference later on, perhaps after they’ve had at least a little rest. My dad’s stroke was obviously a very different experience, but my family got that combination from the doctor who wrote the letter—kind, reassuring support in the moment followed up by clear, accessible writing we could reference later. Parents learning to feed their infants will benefit from that same combination.
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