Against Medical Advice
Why are so many doctors ignorant about breastfeeding?
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 But it could be totally useless and outdated.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
Fortunately my kid’s pediatrician was incredibly knowledgeable about breastfeeding and was able to trouble-shoot issues with me during the first difficult month of nursing. I do wish, however, that lactation consultant fees were covered by insurance; yes, you see a consultant a couple of times before leaving the hospital, but as this article points out, many issues don’t crop up until well after you’ve left the hospital. I spent nearly a thousand dollars out of pocket on lactation consultant fees. I don’t begrudge it; it enabled me to nurse my kid, something that was incredibly important to me. For me, La Leche proved disappointing. I received really bad, and often judgmental, advice from the local volunteer I consulted. She had no experience with pumping – she thought that pumping was in fact “bad” because I should stay home with my baby nursing all the time and should never hand off bottle duty to daddy at night. (She was an attachment-parenting fanatic, something I really didn’t need in those fragile postpartum days.) She also told me I “couldn’t nurse properly” because I’d had a C-section. I eventually told her to piss off, then opened my wallet and hired a trained lactation consultant.I’m sure there are many excellent La Leche volunteers out there. But proceed with caution….
The above sounds familiar. After having a c-section I was bombarded with a very mean lactation consultant. Not only was she rough with me she was rough with my newborn. It was such a hard time. My DD and I are doing wonderfully now. I have been an exclusive pumper for 9 months and plan on continuing. I did this largely myself. There just is so little guidance out there. And so much of the info is outdated or plain wrong.
It doesn’t seem right that doctors aren’t properly educated on a function of the human body now does it? Weird.http://heyyourememberme.blogspot.com
Wow – I’m really amazed and sad by the experiences told here. I had my son in Seattle via c-section and had a pretty good experience with the hospital nurses and lactation consultants, and was lucky to have a fairly easy time nursing. However, I had a really hard time producing enough milk when pumping for my son when I went back to work at 3 months. I regret buying into the “your body will make as much as the baby needs” BS and regret that I resisted supplementing with formula till well after the first 6 months. I managed the exclusive nursing to 5 months, then started supplementing with rice cereal at 5-6, and I think formula when I finally gave up on unproductive pumping around month 7. I think what’s tough is that every woman’s nursing experience can be so different and there don’t seem to be many clearing houses besides La Leche for information. I also felt that once I delivered my OB totally lost any real interest after the obligatory 1-week “are you showing any signs of post partum depression?” visit.Anyway, I do think that forums like babble and other online rescources are a great improvement over the experience I had 5 years ago, and can help serve moms in more remote, or less nursing-friendly places. But how sad to have a La Leche volunteer make someone feel less-than, for not parenting exactly the way she had. That seems to be the problem with them – their mission is good, but just too extreme to be right for everyone. Oh and… how bizare that people made the previous 2 writers feel inadequate for having c-sections – unfortunately it seems we’re all doing that these days (though mine was a 10-pound 2-week late baby, so I have no regrets for my c-section).Dare I mention that an administration that doesn’t support a woman’s right to choose, right to insurance paid birth control, etc. seems unlikely to support insurance payments for doula support??Lastly, for any other Seattle moms reading, there is a really great support group called “First Weeks” in the Montlake neighborhood, run by 2 lactation consultants, drop in, bring / nurse / change your baby, pay what you will, that meets 2 days a week. It was a spectacular support option during the first few months of trying to figure things out and probably one of the reasons that things went so well for me.
OMG now i understand the connection between the “rich milk” theory and “Foremilk-hindmilk” theory. My mum and in-laws would piss me off asking to express some milk to check if it’s rich enough, while my doula said it’s BS just keep nursing. And the doctors wouldn’t say anything at all.
I received no breastfeeding support in the hospital because the one lactation consultant was at another location for the day and day after my delivery. Doctors and nurses were of little help. I had taken a class prior to delivery, so managed to do my best even though I had specifically asked for a lactation specialist upon my first breastfeeding. My daughter was 4 days old and I was out of the hospital (she was in the special care nursery) before I could even speak to the consultant, and we were both out of the hospital before we could meet with her. It would have been invaluable if I could have had that support within the first few hours, or even days. We are now doing well and just starting to wean, 10 months after. Not an easy road, but so rewarding and I’m so happy we stuck with it.
Same experience as described. Allegedly a lactation consultant existed in our hospital, but we only saw her once, about a day and a half after we requested to see her, when she popped into our room to say she couldn’t stay long because she was done for the day but could at least drop off a folder stuffed with completely worthless flyers containing random tidbits some of which I’d already gleaned from reading The Nursing Mother’s Companion before birth (and the rest was truly pointless). And thank goodness I did read that before she was born because the recovery nurses knew absolutely nothing about nursing but didn’t know they knew nothing. They wanted me to stop nursing the newborn because “there isn’t anything there and it’s wrong to make the baby use up calories working for nothing.” 1. It’s called colostrum, not nothing, and it’s exactly what she needed. 2. nursing now brings in the milk you’re babbling about. 3. nursing now is what’s helping my uterus firm up quickly (which they marveled at). At least I knew enough to ignore them and we did eventually get a lactation consultant around Day 5, at home, but God what an unnecessary ordeal and upsetting what they could’ve cost me if I hadn’t known better.