. I am supposed to write an open letter to the physicians of our
hospital (pediatricians and obstetricians) emphasizing our need to be
advocates for one another and the need to work as a team when it comes to
our
breastfeeding mothers.  I inadvertantly upset two of our obstetricians when
I
gave them research based information on breastfeeding that contraindicated
what their doctors had told them.  Now the docs see me as the "bad guy" and
I
could lose my job if I let that happen again.  It has been suggested that I
come up with a top ten list of issues that breastfeeding women present to me
that come in conflict with what the doctors recommend.  For instance "Only
breastfeeding 10 minutes on each side.  A baby can get all the milk they
need
in 10 minutes."  Or, "Don't feed a baby any closer than two hours, even if
they are crying until they are blue in the face, do not pick them up and
feed
them".  One doctor told me not to tell his patients about fluconazole.  He
doesn't believe that thrush really exists.  So, how do I do this job well
and
not alienate the doctors?

I wonder if it would help to describe your situation and dilemma to the
doctors. Begin by explaining that you are an IBCLC and what that means: the
many hours you have had to spend with mothers, the reading and research you
had to do, the exam, the continuing education, etc., that has built your
expertise in breastfeeding. And tell them that, like them, you are required
to follow a code of ethics when you are working in this field.

Perhaps you can even describe for them a couple of cases where your
expertise has made the difference - where you were able to help a mother
increase her milk supply or deal with difficult problems (problems you
suspect the doctors wouldn't know what to do about). Share how pleased  you
were to be able to help these mothers, and if possible how you worked with
the doctors as a team (if you have examples of that).

Then share with them the dilemma you are facing when the doctor's advice is
different from the research-based information you have (thanks to your
extensive training and continuing education). Ask them how they would like
you to handle these situations, since you have an ethical obligation to pass
on the accurate and up-to-date information. Would they like you to pass on
the research information to them, so they can see what you are teaching
their clients as well? Would it help if you offered some in-service sessions
for them? Would they prefer that you simply presented the information to the
clients, acknowledging that this is different from the doctor's opinion, and
let the client make up her own mind?

I like the idea of a list of "top ten" potential conflicts, where you can
list some of the studies and references that support your approaches. You
might tell the doctors that you would be very pleased to see the research
that supports their ideas (for example, nursing only after two hours) as you
believe it is very important to keep up-to-date in the field.

Maybe you'll find some ideas in this that you can use.

Teresa Pitman
Guelph, Ontario

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