Dear Dr Eliot Nelson:  I read in the Burlington Free Press an article in
which you were quoted as saying, "I encourage moms to keep going, but
recognize that some may feel anxious or uncertain about breastfeeding,"
and, "I try to not to make them feel bad about that decision." 

The statement, if correctly quoted, misses the point.  It is the
physician's job to help alleviate fear and uncertainty by providing
correct information. Lack of information, and worse, misinformation,
fuel anxiety and indecision. 

On the other hand, making a decision which one knows is not in one's
best interest can be reasonably expected to cause some discomfort.
Feeling anxiety about making poor decisions is a self-protective
mechanism which serves us well over time. No one wishes to take this
protection away.

Health care providers and educators frequently find that patients are
confused, fearful, or reluctant to act in their own best interests, or
those of their children.  I have had several women explain to me that
they do not use seatbelts, nor do they secure their children, because of
their fear of being trapped, particularly underwater, in case of
accident. I do not belittle their fear, but neither do I try to make
them feel good about their fear-based decision.  I take the time to
explain the relative risks of the different potential outcomes. 

Respecting people as individuals, and acknowledging their right to make
decisions, does not mean one has to give professional support to every
decision one's patient makes.  Nor should a doctor conclude that a
mother's expression of uncertainty means that there is no longer any
reason to give her correct information. A doctor who is respectful and
demonstrably caring should not have to fear making patients feel bad by
giving the best information available.

At times I believe it is the physician who feels uncertain, and needs to
improve his or her knowledge base in the physiologic role of
breastfeeding, in order to have more confidence when supporting this
important phase of reproduction.

Arly Helm, MS, IBCLC

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