It is very difficult to manage the ill breastfed baby when you have a 
pediatrician that won't listen to you. Whether they are admitted with poor 
feeding/gaining/dehydration or they are just sick with something like RSV. I 
have seen babies put on formula because they are dehydrated d/t poor intake 
of breast milk. I have argued with the pediatricians about this. When I 
suggested IV hydration, the doctor looked at me like I was out of my mind 
and just said, "no, we are going to supplement with formula."  I thought we 
could hydrate this lethargic dehydrated baby and work on improving 
breastfeeding; however, that being said, the majority of the pediatricians I 
work with are breastfeeding friendly and willing to have mom work with me or 
the LC. It is just that handful that makes you want to scream. Good thing 
is, the next pedi to come on will just change the orders. I still work 
diligently to improve and save the breastfeeding relationship if this is 
what the mother wants.

Elisabeth Coble, RN, CPN, CLC
IBCLC (c) July 2014

-----Original Message----- 
From: Ingrid Tilstra
Sent: Monday, April 07, 2014 9:51 AM
To: [log in to unmask]
Subject: Re: Breastfeeding unfriendly doctors

I'm afraid I can't think of any other area of medicine where "I don't 
understand how to meet best practice standards in this area so I'm just 
going to do what I'm comfortable with regardless of health outcomes" would 
even be on the table.

Ingrid Tilstra
La Leche League Canada Leader
International Board Certified Lactation Consultant


On Apr 06, 2014, at 09:56 PM, Gail Hertz <[log in to unmask]> wrote:

> One of the formula prescription responses stuck with me all weekend. It 
> was the one that mentioned Breastfeeding unfriendly doctors. The first 
> thing I want to say is that doctors are certainly getting better at 
> Breastfeeding management from what I've seen. It used to be that nobody 
> knew what to do( on the doctors list serve I belong to) and now they know 
> to have mom nurse through a mastitis and where to look up medications for 
> Breastfeeding moms. Progress has been made over all.
>
> To give you some idea what it is like for a doctor to give advice to have 
> a baby exclusively bf without supplementing with formula, compare it to 
> taking a trip. You've gone the old way so many times. You are used to it. 
> You know the landmarks. The trip has gone safely( by current standards). 
> You know how long it will take. Now there is talk of going a NEW way. 
> Through a bunch of neighborhoods that you haven't been to before. With 
> different landmarks. And there's hazards. Like hypoglycemia. And jaundice. 
> And slow weight gain. And you've got to get the baby safely to the 
> destination. Well, why should a doctor take the baby on the new route, 
> when the old route got the babies safely to the destination before?
>
> Ok, we know that the old way wasn't so safe, but is is familiar. It gives 
> doctors something to tell moms to do when they say " My baby doesn't seem 
> satisfied" . It IS a lot quicker to tell mom to top the baby off with 
> formula, especially if that was what you were taught to tell them because 
> you can just do that over the phone and everyone is happy-for now. If they 
> don't know how breasts really work, they won't know that putting the baby 
> back to the breast(the 3rd breast I call it) will help with supply. And 
> they don't know how supplementing with formula instead of expressed 
> breastmilk can hurt supply. Getting a weight on a baby and knowing what to 
> do with 6.3% down depending on what gestation and how many hours old the 
> baby is can be the difference between being in familiar territory or 
> feeling like you're lost.
>
> I'm not making excuses for these docs, I'm trying to let you know WHY they 
> are taking the old familiar route. It is a lot less scary. And the formula 
> reps endorse it. And the moms want to feel like they are doing the right 
> thing for their baby. If they knew what to expect they wouldn't put so 
> much pressure on the docs, and if the docs knew what to expect they could 
> tell the moms and know when it is appropriate to supplement and maybe feel 
> a bit more comfortable taking the new route.
>
>
>
> Gail Hertz, MD, IBCLC, FABM
> Author of The Little Green Book of Breastfeeding Management
> [log in to unmask]
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