The enemy of knowledge is not ignorance; it is the illusion of knowledge

I’ve been following this conversation started by the Grammar Girl:

“I was a guest on a podcast where kids asked two people questions to decide who was the fake and who was the real expert.

The host said that early on, the kids thought the fake was the expert every time because the actors answered every question confidently, and the experts would hedge or even sometimes say, ‘I don’t know.’

They eventually told the fakes to be less confident so the kids would have a chance of picking the expert sometimes.”

The Grammar Girl’s post was making a point specifically about ChatGPT, but the sentiment can be applied more generally, and in our case to the field of lactation and other perinatal care providers.

Some of my favorite comments on the Grammar Girl’s post include:

Never trust an expert who isn’t willing to admit that they don’t know.

Experts know that there are sometimes variables or gray areas, thus they don’t answer in terms of absolutes.

That makes me think of how an intelligent person (possibly an expert in something) is still curious and open minded enough to not always be sure of everything. 

Those who are experts, look before they leap, stop before they comment, ask for help and do their research. Saying ‘I do not know’ is a strength.

It reminds me of the quote: ‘The enemy of knowledge is not ignorance, it is the illusion of knowledge.’ 

Individuals on the perinatal care team can get stuck in a rut where humility is absent, and this can become dangerous for their patients. 

Debra Bingham of PQI, in a recent newsletter, reminds us of physiologic humility.

Bingham writes:

“Perinatal health professionals work tirelessly to provide the best care they can. Unfortunately, sometimes we get stuck performing “strong but wrong” routines. For example, we have centuries of evidence to tell us that physiologic birth practices are key to having the best outcomes. Yet, too often we do not practice what I like to call physiologic humility. Humility that the physiology of a woman’s body before, during, and after giving birth is complex and typically works well on its own. Thus, we should proceed with physiologic humility because there are so many limitations in our knowledge of the complex physiologic processes related to birth …

As perinatal health professionals it is our responsibility to do everything possible to ensure that women in our care get to experience Mother’s Day. Especially this month, may we all continue to keep that in mind and as a top priority.”

In all fields of care, cultural humility must also be maintained. As defined by the National Association of County & City Health Officials (NACCHO), cultural humility (CH) is “a lifelong process of self-reflection, used to better understand the multi-dimensional identities of clients in order to establish and maintain respectful, healthy, and productive relationships.” NACCHO’s Shifting the Care Paradigm Fact Sheet describes how lactation care providers can partner with families and their community to understand individual patients’ cultural background, experience and personal challenges, and specific goals. 

In the U.S., perinatal care is often siloed; however, this trend seems to be evolving as care becomes more collaborative. Collaboration requires all care providers to exercise a level of humility, offering their expertise while respecting and hearing out other members of the care team. Most importantly though, care team members must work together to respect their patient’s wishes and facilitate informed decision making.

“Absolute certainty leaves little room for shared decision-making,” the author of  Humility and the practice of medicine: tasting humble pie points out.

The author later concludes that “the cultivation of humility is often painful and requires a high level of self-awareness and reflective practice.”

A challenge indeed, but worth the effort. Consider “taking a bite” of “humble pie.” [Chochinov, 2010]

VA Maternity Care Coordinator (MCC) program facilitates specialized care for military Veteran parents

For new families, healthy, evidence-based infant feeding education and support can be hard to come by, but among this often barren landscape of support, the VA Maternity Care Coordinator (MCC) program provides an oasis for military Veteran mothers.  

Retired USAF Lt Col Tammy Tenace BSN, MS, APRN-BC, now Women Veteran Education, Outreach and Research Coordinator  for James A. Haley Veterans Hospital in Tampa, Fla. says that the VA understands that pregnancy and parenthood often requires specialized care.

About a decade ago, as care providers started to notice that lactation and breastfeeding support was severely limited in civilian communities, they established the MCC role. MCCs maintain contact with Veteran families throughout the perinatal period, facilitating care that meets their specific needs. 

Because the VA does not provide obstetric care, the MCC acts as a liaison between the VA and the community obstetrical provider. MCCs follow Veterans through pregnancy and postpartum at one and six weeks postpartum. [https://link.springer.com/article/10.1007/s11606-019-04974-z]  The VA supplies Veterans with lactation supplies like breast pumps, nursing bras, nursing pads, storage bags, etc.

The MCC role has been established at every VA medical center, and Tenace has served as MCC at her hospital since 2016.  

Photo by George Pak : https://www.pexels.com/photo/family-sitting-on-sofa-beside-house-plant-near-the-windows-7983863/

Throughout the COVID-19 pandemic, what little perinatal support existed in civilian spaces, dwindled to almost nothing, Tenace points out. 

Hospital breastfeeding support groups, while only meeting a couple of times a week, stopped meeting altogether. Women weren’t allowed support people or their partners at appointments, and they began to feel isolated. 

“I realized I needed to do something; I couldn’t depend on the community,” Tenace says.  

Working through the Office on Women’s Health as a subject matter expert, VA National Consultant for Lactation Ashley M. Lauria, MA, RD, LDN, IBCLC helps establish standards of care in lactation programs at VA facilities nationwide. 

Tenace and Lauria both comment that among the hundreds of parents they have cared for, it is truly a rarity for an individual to express disinterest in lactation. Their experience reflects national numbers, where most dyads start out breastfeeding. 

Women Veterans are the fastest growing group among the Veteran population. In fact,  “by 2040, VA estimates they will comprise 18% of the Veteran population, versus just 4% in 2000,” according to a VA Pittsburgh press release.

In order to keep up with this demand, Tenace and her colleagues are in the process of curating a Certified Lactation Counselor (CLC) program. Made possible through funding from the Women’s Health Innovations and Staffing Enhancements (WHISE), ten of their staff members are completing the Lactation Counselor Training Course (LCTC), including Tenace, physicians, a health coach, advanced practice nurses, among others. 

“The most up-to-date information is really important,” Tenace begins. “[We are all] unlearning the things we thought we knew. The course has been instrumental to helping us feel like we are actually helping women, instead of relying on the knowledge that we thought we had. The course is detailed and professional, yet practical. The practicalness is what’s to our advantage. It’s how we actually help women breastfeed.”

Photo by Timothy Meinberg on Unsplash

Tenace and Lauria go on to explain that their efforts are Veteran-led. That is, their facilities host quarterly focus groups where they can learn about Veterans’ requests. 

“We want to know from women: what do they want?” Tenace comments. 

Because Veteran women often prefer support groups comprised of other Veterans, Lauria offers virtual lactation support groups that also act as social circles and a place for comradery. 

As James A. Haley Veterans’ Hospital designs new facilities, Tenace has been invited to offer input on the creation of lactation space for both employees and patients. Tenace applauds their leadership for focusing on improvement for the patient and employee experience. She also highlights that the newly designed main entrance will host a lactation pod. 

“I can’t think of a better way to show commitment,” she adds.  

Tenace and Lauria have embodied a passion for birth and lactation since their youth. Their work with the VA allows them to continue their mission to celebrate parents and their families and position themselves as life-long learners, evolving with the needs of Veteran mothers. 

 

Photo by Brianna Lisa Photography: https://www.pexels.com/photo/mother-breastfeeding-her-child-in-park-11620457/

For more on VA maternity care services visit https://www.womenshealth.va.gov/docs/WomensHealthReproductiveHealthBrochure508.pdf

More on Veteran Health https://www.commonwealthfund.org/blog/2021/birth-equity-Veterans-and-servicemembers  

Regulations and resources for all military branches https://www.mom2momglobal.org/bficb 

Coverage for pregnancy and lactation care in the military health system https://www.military.com/daily-news/2021/11/01/tricare-cover-doulas-lactation-consultants-some-starting-jan-1.html