LASS-E: a helpful mnemonic trick for effective breastfeeding counseling sessions

When counseling a breastfeeding mother, it is a temptation for eager counselors to launch right into their recently studied list of possible helps for the mother's difficulties, forgetting that one of the most important ways to not only HELP a mother, leave her feeling truly supported and, most importantly, to build her confidence in her own capabilities as a mother, is to ACTIVELY LISTEN to her and to AFFIRM all the things she is doing right (and she WILL be doing lots of things "right.")  LASS-E to the rescue!

"LASS-E" is a simple mnemonic--memory device--for counselors.  Not meant to conjure up the dog of old TV episodes, think of it as the Irish word for a female, "lassie."  The acronym breaks down this way:

The first thing to do in a counseling situation is to Listen.  Active listening is conveyed with attentive body language, interested eye contact, and a restful body (not fidgeting or glancing at your watch--or phone).  It means asking questions and really listening to the answers.  Making attentive sounds, like "mmm-hmmm" or a quiet "yeah"--and nodding--let the mother know she has your full attention.  Reflective listening also means repeating back what you have heard the mother say about her feelings about the situation, as well as what you heard her say about her problem, and checking in that you heard her correctly.  If you didn't understand her quite correctly, keep trying until you are sure she is satisfied that you understand.

L=Listen
A=Affirm
S=Suggest
S=Summarize...
​E=Evaluate

The very next step in the LASS-E counseling technique is to Affirm.  As mentioned above, there is no doubt MUCH that the mother is doing well, not least of which is trying to give her child her very self.  Don't neglect to tell her so, because there may not be anyone else in her life who has taken the time to thank her for what she is doing for her baby.  However, do not bother with insincere flattery; she will see right through that, at least on a subconscious level.  Look for things about her situation that you honestly admire and choose your words wisely to build her up.  If she blows off your words or even completely disagrees, still, the fact that you took the time to build her up with your words does matter and at a deeper level, encourages her to begin to believe that she IS doing many things right.

If delivered in a spirit of genuine help, not rushed, or with condescension, she will likely take your Suggestions exactly for what they are--possible helps for her difficulty, not a sign that she is or has been doing something "wrong."  This is especially true if you give her the tools to solve her own problems.  "Let's see what happens when you hold him skin to skin" or "Sometimes it helps if mothers try relaxing and lying back a little bit with baby lying on top--would you like to see if that works for you two?"  A supportive tone of voice, genuine humility and honest care for her go very far with helping her feel not judged or shamed, but to view your counseling as what it actually should be--brainstorming possible solutions for real problems.  View yourself not as a lactation magician with an impressive bag of tricks, but as a kindly older sister or aunt who's been there and has some ideas that might help.  The humble counselor does not need to pull out all the ideas she possesses to prove herself worthy of the name, but realizes that a few powerful ideas that work for the mother may be all that is necessary for her to get herself and her baby back on track toward the mother's breastfeeding goals.

View yourself not as a lactation magician with a bag of tricks, but as a kindly older sister or aunt who's been there and has some ideas that might help.

Once you and the mother have decided on a path to try, Summarize what she decided.  "So you are going to ask your cousin to come by tonight to watch the other children so that you can concentrate on just nursing.  Is there anything else you think might help?"  And then you're right back to Listening and Affirming (LASS-E need not be a technique that only goes in one direction.)  But once you sense that the counseling session has ended, make sure you both have a clear sense of what was decided by summarizing what YOU heard, and asking her if she agrees that the course of action is a good place to start in solving her problem.

The last step in the counseling session is to plan to connect again in some way to determine if the plan of action worked.  There is no need to plan a return visit for every problem; a phone call in a few days or a week might be all that is needed.  Do make some sort of plan for how you will follow up to make sure that the mother and baby are back on track.  Then make sure you follow through and Evaluate how the mother and baby are doing.  Depending on the situation, it might be within the day, or the next day, a few days later, a week later, a couple weeks later, or even the next month.  Part of being a good counselor is keeping your word, so DO follow up.  This will help reinforce to the mother that she matters, and that helping her to breastfeed matters, something that may not be a message she is getting from anyone else in her life.