Chaos and the theories around it fascinate me. In my early days at college, a friend introduced me to fractals, and the thought that the flap of the wings of a butterfly could cause a storm. While my understanding of the surrounding theory and the mathematical underpinning has waned in the years, I still find myself attracted to making sense out of chaotic situations. I find it both beautiful (like the image of a fractal on the left) and overwhelming.
This week I attended an Agile meetup where Don Gray presented. Without going into too many details about the actual meeting, we explored a problem, why it existed, and how to fix it. At the end of this discussion, Don shared a slide of the cynefin framework. (I highly recommend clicking on the link to see the graphical representation, which I hesitate to include due to copyright issues.) In essence, the cynefin framework breaks down a problem into 5 categories - simple, complicated, complex, chaotic and disordered. When looking at the problem from this framework, it was obvious that the problem we had been pondering fell into the chaotic realm.
What does chaotic realm mean? Basically that you cannot directly correlate cause and effect. Like the butterfly wings causing a storm, the ripple effects of a small action cannot be followed, or predicted. When several variables exist, trying to make sense out of a chaotic problem often has people running from one proverbial fire to another, and making no progress. When faced with chaos, the best choice is to control what is controllable and to move forward with consistent action.
To extrapolate this theory to its application to world of lactation is not lost on me. I was most fascinated in the chaotic nature of the lactation world and why it is so appealing to my problem-solving nature. It also helped me to see why the current model of evidence-based solutions is inadequate and does not always lead to best practices in our field.
Here is my breakdown on the cynefin framework with respect to the lactation world.
Simple: If you do X, Y happens. A good example is a manual breast pump. Put the pump together, following the instructions, it will operate as expected.
Complicated: If you do X, Y happens or if you do A , B happens, but expertise is needed to decide X or A. Problems in this realm are ones where there are many right answers. An example would be the treatment of mastitis. Usually antibiotics are prescribed by a doctor which is a solution. Their expertise comes in prescribing a specific one. There are also home remedies, and herbal products. If a mom uses antibiotics, she may end up with thrush. If she uses home remedies, it may take longer or require more active participation. However, in the end, whichever route she choses, the results of relieving the mastitis are similar.
Complex: No longer can a cause/effect be easily seen, except in retrospect. I would say a good amount of lactation work exists in this realm. Looking back at a week of activities, it may be easy for an IBCLC to see the "root cause" of mastitis. A busy schedule, going back to work, baby with a cold, oversupply - all of these could be a trigger for mastitis, however, each mom/baby dyad is unique and we cannot say that with absolute certainty that every mother who has returned to work will end up with mastitis. Some women will never get mastitis, and others will be plagued with it.
Chaotic: Cause and effect are unknown. Making sense out of chaos is where the role of a lactation consultant becomes invaluable. In attempting to answer the question "why", IBCLCs can get caught in a chaotic loop. Chaos is not predictable and therefore answering why is counter-productive. A great example of a chaotic lactation problem is low milk supply. There is no one solution, and even in retrospect, when it is fixed, we can't say for sure why in all cases. In a chaotic problem, we grab hold of what we can control, to hopefully move forward into the complex realm. With low milk supply, we may collect data (weight gain, number of poopy diapers), propose dietary changes, advocate for the use of galactogogues, introduce pumping, suggest an evaluation for tongue tie, among others. Each step along the way, we re-evaluate for positive changes. In the end, we probably won't be able to answer why mom had low milk supply, however, by controlling those aspects that can be controlled, we move towards the end goal of increased milk supply.
Disorder: Regardless of how the framework defines this category, I feel that most parents can identify the disorder that exists beyond the chaos. The more children that exist in a household, the more disorder is apparent. Newborns insert a certain level of disorder by their very existence. Colic is an example which easily crosses into disorder and becomes an issue of survival rather than solution.
Out of a tech meeting, I gleaned an amazing insight into the lactation profession. Working in a chaotic environment requires perseverance, intelligence and a certain amount of guts. People are unpredictable and the ripples of action or inaction have long reaching effects whether that cause can be identified. Making sense out of chaos is an under-recognized skill in lactation and instead of beating the drum of evidence-based solutions, we need to embrace the chaos.