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Against Medical Advice

Why don’t pediatricians, and OB-GYNs for that matter, get educated about breastfeeding?! Mine promote the heck out of it, congratulate me for keeping up with it, and were quick to criticize me at the mere mention of weaning before my daughter turns one, yet can’t hold an intelligent conversation about it, let alone answer questions. And I was shocked by the question you ran a couple of weeks ago about a doctor who criticized the “richness” of a mother’s milk. Is there any movement within the medical community to get doctors up to speed? I thank my lucky stars that my community has an amazing lactation consultant who provides her services at no charge. But she’d have a lot more free time if there’d been someone in the hospital after delivery to give me some proper training. – 4 Out of 5 Doctors Don’t Have a Clue!

Dear 4 Out of 5,

The waiting room walls are plastered with breastfeeding promotional material. You get a nod of approval and a check on the clipboard when you answer “Yes, I’m breastfeeding” at that one-week pediatrician appointment. But when your nipples crack or your breasts are streaky or your baby can’t seem to get a good latch, who you gonna call? Your doctor, of course. But which one? It seems somehow out of your OB/Gyn’s jurisdiction. Besides, she’s moved on to another batch of pregnant women, and doesn’t plan on seeing you again until your six-week appointment. And your pediatrician? Well. You might get some advice. And, if you do, it might be right. But it could be totally useless and outdated. Or flat-out wrong, and possibly harmful. We ourselves were flummoxed by this glaring knowledge gap in the medical trenches. When we were researching our book we spoke with Nancy Wight, the President of the Academy of Breastfeeding Medicine, about the inconsistent message. Here’s what we learned:

Doctors want to encourage breastfeeding, but they don’t always know enough about it, largely because it hasn’t been a priority on the education level. Breastfeeding training is not required for medical school, and although there are advocacy groups working to make breastfeeding a larger presence in medical education – increasing, for example, questions about breastfeeding on exams – there is stiff competition for med students’ time and attention. A movement is at work to help doctors understand the issues that breastfeeding mothers face, but change is likely to be slow.

Some doctors are obviously WAY better than others on the topic of breastfeeding. Some may have breastfed themselves or care enough to have done the research on their own. Like anything else, the way people think about breastfeeding has a lot to do with when and how they learned about it, and the prevailing beliefs of the time. Knowledge about breastfeeding has expanded tremendously in recent years, and recommendations have changed accordingly, but not everyone keeps up with the research.

An older doctor may have gone through the effort of formally re-educating herself, but the chances are better that she’s walking around with the breastfeeding information she learned twenty-five years ago, augmented by what she’s gleaned from whatever’s come across her path since. This is not laziness or close-mindeness on the doctor’s part. Breastfeeding is just one of the many areas a pediatrician needs to keep, ahem, abreast of, most or all of which can have serious ramifications for children’s health. This one often does not get top priority. Why not? Maybe it’s a kind of unconscious medical misogyny, or an affinity for the cold hard, countable ounces of bottle feeding versus the symbiotic, immeasurable nature of nursing. Maybe there really are things that are more pressing.

Many hospitals do make the effort to employ a lactation consultant and some offer breastfeeding support groups. But your experience with little on-staff support is not uncommon: the lactation consultant may not be available. Or spread too thin. Or is doing double duty as a nurse. Also, only some of the breastfeeding questions and/or problems occur within the first few days of breastfeeding. For many women, breastfeeding questions continue for months! If it’s not engorgement, it’s pumping, or dietary restrictions, or thrush, or weaning . . .

Midwives, postpartum doulas and childbirth educators tend to know more about breastfeeding than physicians. But most of these professionals are not covered by insurance. If doctors can’t handle breastfeeding issues, shouldn’t insurance cover a visit to someone who does? The fact is, most moms, and most doctors, turn to La Leche League for their expertise and accessible research. And, though it’s remarkable that an entire breastfeeding support infrastructure exists purely based on volunteers – talk about community organizing – we can’t help but wonder how many more women would breastfeed if support was offered through a more familiar source: the family doctor.

It sounds like you had great support, which is fantastic. For readers who may suspect their doctor is offering outdated or incorrect information, try contacting a Lactation Consultant, La Leche League, or another breastfeeding support group for a second opinion. It can be stressful to challenge a doctor’s advice, but when it comes to breastfeeding, your doctor may not be the most authoritative voice. Once you know you have the facts, you can make an educated choice for yourself and your baby.

Have a question? Email beingpregnant@babble.com

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