I've tried.  Believe me, I've tried. I've tried to be gentle with the mds
that my clients have to deal with.  I've tried to understand their sense of
responsibility and fear of lawsuits coupled with their ignorance of
breastfeeding.  I've tried to see that they are acting on the basis of their
training and their text books and the shiny brochures that come from the
pharmaceutical companies professing partnership with these mds in preserving
the health of our nation.

But... I've had it this week!

1) young mom wanted to breastfeed, hemoraged at the birth, low hemo. count,
low supply, ped said supplement with abm.  Mom says she will supplement but
still wants to breastfeed. Ped says he doesn'n know how to help her with her
milk supply; call a lactation specialist.(good)  I come on the scene, with
good pump, fenugreek, and my other effective assistants.  Two weeks later,
after much hard work by mom, baby is totally breastfed and mom and dad are
so happy.  Eight soaked wet diapers a day, 4-5 stools, perfect consistency,
baby happy too, filling out beautifully.  BUT she is not at the
weight-for-age that the doc's references say is necessary.  He doesn't even
see the baby (nurse weighs her and reports) and he orders returning to
supplementing 1-2 oz of abm at every feeding. Mom argues, but is brushed off
and ordered to give supplement and return in 1 week, when baby should be up
to what the chart says she should be. When she calls me it is clear that
even though the doc said he doesn't know about b'feeding, he calls the
shots.  He has absolute veto power over anything the LC says or mom and dad see.

2) Mom presents with beginning yeast infection on nipples.  Goes to ped and
asks for treatment for yeast in her and baby.  Doc looks in baby's mouth,
says no thrush, won't treat.  He doesn't believe that she has yeast
overgrowth on nipples. She can get some lotrimin and apply 3x day if she
wants.  I give her my recommendations for non-prescription treatments, but
nipple pain persists and breast burning begins, along with some vaginal
itching.  Baby is gassy and not nursing as well as he was.  But doc says it
is not yeast and won't treat.  Mom is reluctant to go to a doc I refer to
who will treat yeast.  She knows that it is yeast and I know that it is
yeast, but doc has absolute veto power over anything the LC says or the mom
knows.

3) Mom has low milk supply, having to supplement premie.  She is still
bleeding red after 5 weeks.  She increases her supply with heroics.  She
suggests to her doc that perhaps there is a retained placental fragment. He
says no, and retained placenta would have no effect on milk supply anyway.
She suddenly begins a heavy flow and he concludes that it is an infection
(no fever for this 5 weeks) and prescribes an industrial strength antibiotic
which (you guessed it) can't be used with breastfeeding. Baby will have to
be totally abm fed for the 7 days of the treatment and 2 more days after.
Mom objects, doc says he could give her a weaker abx but it would just
stretch out the healing.  Mom goes with doc's plan.

After the week, bleeding resumes. Doc says a D&C is needed; there might, in
fact be some fragment. Mom felt early on that there was retained placental
fragment, so did LC, but doc has absolute veto power over anything the LC
says or the mom knows.

We are going to try to prevent a yeast overgrowth after this "hot off the
presses" antibiotic that killed every bacteria in its path. But if she gets
a yeast infection, we will just try to get some doc to treat her and her
baby for it.  But the docs will not believe that it is yeast, and will
exercise their absolute power...

I know that these mds don't really have absolute power; parents just offer
it to them and they willingly accept it.  Fear is the culprit here, and
abdication of parental responsibility. But I may as well be peddling
glow-in-the-dark shoe laces to these parents.  They know, and they know that
I know, but it counts for nothing.

The AAP has come out with a statement encouraging breastfeeding and these
docs may read the recommendation, but with their power, mixed with their
lack of knowledge, we just have chaos and many dejected mothers. They still
see abm as the standard.  If a mom wants to try breastfeeding she can go
ahead, but her baby had better "measure up" to the standards of abm-fed
babies, or it's no go.

I'll admit that there are two family docs here who know that healthy human
babies come in all sizes and to whom I can refer for a second opinion.  They
also appreciate the seriousness of yeast overgrowth, and they certainly know
that a retained placental fragment affects milk supply.  And they listen to
parents when they tell what they feel may be wrong with their children.
They are in a partnership with the parents for the good health of their
children.

But most of my clients go to mds who interfere with breastfeeding at every
turn. The moms call me upset and feeling helpless to do what they want for
their babies. And people wonder why American women can't breastfeed their
babies.

ARRRGGGGGHHHH!!!

Sorry about the ranting. This week has just been too much.

Patricia Gima, IBCLC
Milwaukee


mailto:[log in to unmask]