Since JE has shared our topic with you - I shall share my posts with you as
well - with the names changed to numbers.  As you will note, I am a bit
more vocal off Lactnet [can you believe THAT, Dr. Jack!?!]  Since I
represent both sides of the issue - I've got a LOT to say.

Gail
Gail Hertz, MD, IBCLC
Pediatric Resident
author of the little green breastfeeding book - disclaimer: owner of Pocket
Publications

Dr. 1  writes:
>  More to =
> > Harriet's point, would the proposed intervention (lactation consultant
=
> > visits during the first week or two of life) had affected the rate of =
> > breast feeding at six months and the rate of hospitalization?
>
> Good question, Dr. 1
> I suspect the answer lies in who  is going to be  helping these moms &
> babies otherwise.
> Given that we Docs get little or no formal training in med school on
> breastfeeding - that 30 minute physiology lecture that mentioned
prolactin
> does not count - and that the "handed-down" doc to doc info that
comprises
> much of our residency is again often from someone without formal training
-
> this does not leave physicians in very good position to be providing
GOOD
> information to  moms  nor do we have the time to  spend doing it  in the
> current state of medicine.
>
> A favorite study of mine compared the knowledge of residents and
attendings
> regarding Breastfeeding management - the scores were not good - not even
> 50% of correct answers. The difference between the residents and the
> attendings?  The residents were not at all confident about their ability
to
> manage Breastfeeding issues  - The attendings were quite confident in
their
> abilities.  The difference in their scores?  No difference.
>
> I dealt with a patient tonight who had left a previous doc's practice
-for
> several reasons - one  because the doc had said she couldn't breastfeed
as
> frequent as q 3 hrs because her breasts wouldn't fill up again in that
> short a time ( where do people come up with  these ideas?!??)
>
> The majority  of women who don't breastfeed up to 6 months stop for
reasons
>  that involve misinformation  (I don't have enough milk?)  or simple
> problems (sore nipples, I need to return to work)  or  unintentional
> mismangement on the part of the healthcare system (bottles of water,
> formula supplementation when not medically indicated, you have to wean
> because I'm putting you on Amoxicillin or  because you need  minor
surgery,
> or you can only breastfeed for 10 minutes q4 hours because the baby needs
> to stay under the bili light, etc....)   not because  they have sheehans
> syndrome or need to have chemotherapy.
>
> LC's can and do take the time to remedy or head off these problems.
>
> As to the hospitalization part - There's a study from BMJ 1990 Jan
> 6;300(6716):11-6 with 750 babies that showed a protective effect of 13
> weeks of breastfeeding from a GI illness standpoint - and with the
> protective effect came a reduction in hospitalizations for the breastfed
> babies - even after breastfeeding was terminated.
>
> The majority of the studies I have in front of me deal with the reduction
> in sick visits  - let's see - what's that buzzword.... capitation......
>
> Actually, physician education regarding breastfeeding is a favorite
subject
> of mine - what has your experience been regarding such?
>
> Gail S. Hertz, MD, IBCLC
> Pediatric Resident (R-2, halfway through)
>
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> Lactatoinn