My goal is to provide consistent information to moms and to have
collaborative relationships with physicians.  Although in many situations I
want to say, "I can't believe your physician told you that, or some other
negative comment," I usually say, "I wonder what your physician was
thinking. Let me call him and talk to him." And then after I assess the
mother's situation, I call him and ask him what his thinking was. There
have been times that he(she) knew something about the infant's medical
condition or about the mother that I did not know and that influenced
his(her) decision of what was said to the mother. Other times they admit
they had no rationale, but did not have the time to spend helping her with
breastfeeding or wanted to "cover themselves legally".  If they feel
adamate about something, I will ask them for references. Usually, they will
say that, that is what they were taught in medical school, or that is what
their patients tell them, or that is what they or their wife did, etc. So
then I offer to send them my supporting references. We usually end up with
a plan more beneficial to the mother and baby. Often, the physician will
admit he(she) really didn't have a good plan and will go along with mine.
One day I was visiting a friend whose baby was three days old. She had just
come from her peds office. He told her to supplement after each feeding.
This Mom's milk had come in and was extremely full, dripping milk, and the
baby had not lost much weight. I wanted to call the doc an idiot, but
called him(usually pretty supportive of bf) on the phone and asked him
"what was your thinking on this?" He said there was no thinking, he just
recommended formula because he wasn't there in the home and didn't know how
the baby was feeding, etc. He ended with," Of course, if the baby was
feeding fine and the mother's milk was in that she did not have to
supplement."

In general, I have found this method very effective. All the physicians who
know me in Albuquerque usually defer to my judgment.  I frequently hear
from Moms that their peds told them something and when they told them they
were seeing me, they said, "Oh whatever she says is what you should do. She
knows more than I do."

I don't think that we can be smug about our interventions with clients. Not
everything we do is based upon research and sound rationale. Often, we
counsel clients based upon clinical observations and personal experiences.
Although I really believe in positioning and prevention of sore nipples, do
we really have research to base our assertions? How about alternative
feeding practices?? How about use of breast shells and nipple shields???
Application of heat, cold?? Of course until we have that data, we must use
scientific rationale and what information we have to base our
interventions, but we need much reasearch. We need to use the model used by
Paula Meier to study the interventions we use to help mothers, so that in
the future we can base this new profession on a sound foundation.