Breastfeeding Medicine

Physicians blogging about breastfeeding

Discussions with Doctors

with 19 comments

I went to San Francisco, because I never been there, in 1999 to attend an AAP meeting so that I could get some needed continuing medical education credits. One of the speakers, ABM member Dr. Nancy Wight, spoke on breastfeeding. Almost every word was news to me. Medical school, residency, chief residency and part of a neonatology fellowship and I did not know about any of the content she was presenting. One of the other speakers lectured on lice- that I knew something about. But breastfeeding? Nope. How did Dr. Wight know this stuff when I didn’t? Who taught her yet set me loose on an unsuspecting patient population armed only with my personal 7-week breastfeeding experience?

I went back home after that conference and talked my hospital’s IBCLC and asked her why she had let me get away with being so, so…wrong. I’ve learned so much since then, thanks to my colleagues at the ABM, AAP and that very patient lactation consultant.

The point is most physicians don’t ruin breastfeeding intentionally.

Sometimes, as a lactation professional (or as an informed breastfeeding mom) you have to deal with a physician who is not knowledgeable about breastfeeding. It’s a hard task if that physician isn’t receptive to your ideas, evidence-based as they may be. Those of us who are members of the ABM are often having some of the same discussions you are, and we share your frustrations.

Most physicians are “under-educated” about breastfeeding. But it’s important to know how we are educated if you are going to make a difference in how that physician responds to your attempts during teachable moments. My brother is a lawyer and often complained about the tactics of the Socratic method employed in law school where you are randomly picked to answer a question and have the potential, if you don’t know the answer, to look like an idiot in front of your classmates. Now take that Socratic method and put your client in the room, so that person, who has hired you, sees you look like an idiot too and you pretty much get the idea of medical bedside rounds. That’s how we learn. Potential public humiliation. We don’t like that.

In fact, we get very good at avoiding it. We are the doctors, taught from our first day that we are the final end point. Not knowing something is simply not acceptable. We study hard but when the answer to the question isn’t in our head, then we have to have alternate strategies. The first response is generally activation of the fight or flight response (or as in my favorite episode of “Scrubs,” the doctor with antlers strapped to his head looking into the oncoming headlights of a truck). So, we are given a topic about which we know very little and we react as if we are ready for a fight. And we weren’t taught about breastfeeding. We might be ready for a fight.

Then, we need to sound confident about whatever answer we give. (I had a friend who answered a question on rounds with “antibodies to the ovum of a sperm whale” but said the ridiculous answer with such confidence that even my attending physician, who had to know my friend was making it up, paused to think about the potential correctness of the answer.)

If we have no answer, or confident witty retort, then we start poking holes in the question or statement, asking for literature and pointing out flaws, real or perceived, in what has been presented. And we can counter every one of your stories with one of our own experiences. Starting to sound familiar? And please, never, ever underestimate the role of potential medical malpractice plays in all of this. You may be sure you are right, but the threat of legal action because of a high bilirubin or a low blood sugar that went untreated is very real. Meaning, your goals may not match those of the physician.

And, while you’re doing all that, here’s something else to think about, too: maybe you aren’t right. On my first day of medical school my Dean welcomed us by saying “Fifty percent of what we are teaching you is wrong. We just don’t know which fifty percent.”

I know it’s worth the effort, even if it’s one physician at a time. I’m not the only member of the Academy of Breastfeeding Medicine who needed the right message at the right time to hear you.

Interested in programs that work to teach physicians?

Pennsylvania EPIC-BEST program (pages 7-8)

Georgia EPIC program

Connecticut Teleconference series

American Academy of Pediatrics Breastfeeding Residency Curriculum

ABM “What Every Physician Needs to Know About Breastfeeding



Dr. Jennifer Thomas is a pediatrician in Wisconsin and is Chief of the America Academy of Pediatrics Chapter Breastfeeding Coordinator Leadership Team. She shares her expert advice on breastfeeding and pediatric care at DrJen4kids.com.

Written by drjen4kids

May 1, 2010 at 11:26 am

19 Responses

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  1. Thanks, Jenny, for writing about such an important and valid topic. Like you, I never received any BF training…and only got involved when I went searching for help and information after I had major problems breastfeeding my 1st child. Luckily now, things are changing in many training programs. AAP SOBr and ABM are such wonderful resources–I hope every physician takes advantage of everything these 2 wonderful organizations have to offer. Great post :-)

    NKSriraman

    May 1, 2010 at 11:51 am

  2. Dr. Jen,
    I finished reading your post with mixed feelings: somehow soothed by your story of learning about breastfeeding, but…the frustration and sadness seep back in.
    Just 10 days ago I learned that a mom I had been working with gave up on breastfeeding and pumping. This couple was so motivated to breastfeed their child. She pumped day and night for 3 solid weeks, only getting drops. Their management and her breast physiology were all one could hope for. All I asked was that their doctor do a blood test for a progesterone level.

    The mom had had an emergency c-section. Her doctor said: no, she was not the one who did the c-section. “Progesterone has nothing to do with lactation so there is no blood test warranted.” Would not talk to me, the lactation consultant.

    I understand ego is involved. And probably that doctor wouldn’t have wanted to talk to the doctor who did the c-section. But where are the ethics in that kind of closed-mindedness?

    The new training is great and hopefully things will change so my granddaughter will have good support when it is her time to breastfeed. But I’ll be retired; and this baby I saw three weeks ago, now formula feeding, will be in high school.

    Sue

    Sue Petracek IBCLC

    May 1, 2010 at 12:39 pm

  3. If all docs would just refer breastfeeding problems to a lactation consultant, things could be so much better all around; for the mom, the baby, the pediatrician and the community in general. It’s always okay not to be an expert at something and if we put our collective heads together it’s usually a win-win for all. Sue’s story above is a good example of when a lactation consultant might have been able to be of some assistance.

    Betsy Riedel RNC, IBCLC

    May 1, 2010 at 2:02 pm

    • Unfortunately, that’s not always an option either. Many areas don’t have an IBCLC and often the people who are the “lactation consultants” for hospitals aren’t well educated either. Then you have the costs- while breastfeeding is (or should be the goal) many insurance companies won’t cover the consult to an IBCLC or the IBCLC doesn’t take insurance directly, so you have to come up with the money and wait for reimbursement. Still less than switching to formula though.

      Rebecca

      May 5, 2010 at 1:54 pm

      • Rebecca that’s no longer true. Breastfeeding is now supposed to be covered by the insurance companies under the Affordable Care Act

        Susan Burger, MHS, PhD, IBCLC

        February 25, 2013 at 9:23 am

  4. Dr Jen : Thanks for your comments about how we can change the under-educated” about breastfeeding I am teacher at the Medicine School of Universidad Nacional del Litoral Santa fe Argentina Iam neonatology and I work with newborns at the Alassia Children Hospital in the same city. I am also interested in how I can improve my classes of breadfeedings so I am preparing my tesis in this topic improving since the ” pregrado” and investigating if the students are competeted in holding breadfeeding.
    I apologize for my poor english
    sincerely
    Gabriela Arribas

    gabriela arribas

    May 1, 2010 at 3:53 pm

  5. it is very sad that if you look at the fack you more chance to fail breastfeeding if you talk to your doctor….
    hope thing can change

    tanou

    May 1, 2010 at 4:26 pm

  6. The problem is Lactation Consultants can’t prescribe, at least not in my area. When I had thrush,the LC diagnosed it but couldn’t prescribe the meds.

    When I called the OB, they though I had a vaginal yeast infection. Oy. Medical mess.

    I’m going to write a post on my blog about this post and link back.

    M

    Pissed Off Patient

    May 1, 2010 at 5:50 pm

  7. I couldn’t have said it better myself! Until I started BF my twins I never realized how many moms I steered wrong because I thought I knew what I was talking about. I think rather than complain about peds not being BF friendly we need to advocate for more education at the med school and resident level. Many peds don’t even know they should refer to a LC or what websites to refer moms to, and many of us have been taught by people we respect and thus think we are giving the right advice.

    kidsmd04

    May 1, 2010 at 6:32 pm

  8. Why can’t pediatricians offices just employ IBCLCs, or a CLC or some other similar certification? For the really small offices, ask an LPN to seek certification. Seems to me like a an easy fix.

    Katie

    May 2, 2010 at 3:52 pm

    • I agree!

      M

      Pissed Off Patient

      May 2, 2010 at 9:48 pm

      • I appreciate all the comments. And I agree that having an IBCLC is a great idea. I am very proud that I have my IBCLC so I can incorporate breastfeeding guidance and help at every appointment.

        The idea about the curriculum addition is something we all hope will happen.

        In defense of my profession, if I may step into dangerous waters, we don’t take care of breastfeeding mothers all day. It’s a bigger percentage of my practice, but working with breastfeeding mothers is only a small percentage of what I need to know to function in my profession. As I mention, I don’t think any doctor I have worked with wants to ruin breastfeeding intentionally. We all try to do our best. Maybe we think we are doing the right thing. I wish that the anger and passion generated through discussions about breastfeeding would be used to collaborate, rather than be a source of confrontation.

        Also, and maybe I should have mentioned this about our education as well: we had to learn to collaborate. We have been fighting to be at the top of our class in high school to get into a good college. Then need to get great grades in college to even get into med school. We fight for good grades to get into a residency of our choosing in a location we need or want and then the same for a fellowship if we chose. Then we get into the real world and have to realize that we aren’t fighting against each other anymore. I graduated in 1993 and I’m ok with saying “I don’t know” now and have collaborated lots. That wasn’t an easy transition.

        Best of luck in all you do.

        drjen4kids

        May 2, 2010 at 10:04 pm

  9. I was stunned in 1996 when I conducted a Lactation Course by correspondence and practicum at a Melbourne Victoria Australia University for Midwives. As an IBCLC Midwife and University Lecturer I invited the then Chief Paediatrician of the Royal Childrens Hospital to speak. He announced that up until this point breastfeeding was never included in the doctors curriculum at least in Asutralia. Ian Campbell introduced feeding breast milk to sick babies and those having major surgery – great results. Stunned the staff who of course were sceptical at first?! Also that breast milk by the baby’s own mother suited the maturity of the specific baby better than pooled breastmilk.

    Beverley Walker

    May 2, 2010 at 7:55 pm

  10. [...] your doctor knows about breastfeeding because s/he graduated from med school? Think again! One of the speakers, ABM member Dr. Nancy Wight, spoke on breastfeeding. Almost every word was news [...]

  11. [...] hospitals, clinics, and teaching institutions.   As Dr. Thomas mentioned in her previous blog: Discussions with Doctors, many health providers receive minimal training about the health risks of formula feeding, and thus [...]

  12. I completely agree with referring breastfeeding moms to lactation consultants or other breastfeeding specialists. As an example, when a patient comes in with a strange looking skin condition the doctor will refer them to a dermatologist, the person specializing in that area of medicine. The same should go for breastfeeding. Is it because they view lactation specialists as lay people? I know many people who deal with helping mothers breastfeed don’t have medical backgrounds but as a mother who has breastfed 3 children(including twins), dedicated herself to researching breastfeeding, has her CLC, working towards her IBCLC, works everyday with breastfeeding moms as a breastfeeding peer counselor and hears their stories day in and day out it is extremely hard to try to empathize with a doctors plight when they can easily educate themselve or refer to someone who has.
    I fail to see the difference in giving bad breastfeeding advice to try to save face and malpractice. Yes, they may not have a horrific outcome with the end of breastfeeding, but it can be tremendously crushing for a mother who was heartset on breastfeeding who switches to formula on bad advice only to find later that she had never needed to do so.

    Dayna

    May 9, 2010 at 12:59 pm

  13. It’s funny that I stumble across this. I’ve been fighting thrush in my breasts for two months – and I’ve been to three doctors that have seemed completely clueless to the issues that I have. They don’t believe that I can still have yeast but my breasts still hurt. So I’m left without medication and the pain is getting worse again. So I’ve been looking for a doctor that actually is educated on this subject in my area (San Francisco). Any advice on how I can find a doctor that is knowledgeable on this subject.

    Cynthia Rodriguez

    June 13, 2010 at 8:39 pm

    • Hi Cynthia,
      I am an IBCLC in Oakland. I work at Dayone Center in Walnut Creek. I can’t prescribe, but I can help you get the help you need. Email me, if you would like.
      Carrie

      Carrie

      June 15, 2010 at 4:34 pm

  14. [...] where’s the return on the investment of educating medical students about human lactation?  Doctors know painfully little about breastfeeding yet they’re on the front lines when mothers and babies have the most trouble.  Have you ever [...]


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