Here goes "troublemaker Panchula" again hitting the "soap box" - however, I
am really lucky - I work with WONDERFUL supportive people - read on if you
have time...

this couple is a sweet spanish-speaking couple, have no legal papers, Dad
works and mom just had her baby.  Baby went in for 1st exam (5 days),
weight 8 lbs. (back to birth-weight) and seen by the midwife who pronounced
him lovely.  

Enter Family Practice MD, who says baby looks jaundiced and sends her for
blood tests.  Results the next day - 13.  He then orders mom to stop
breastfeeding for a week.  

Midwife hears this and quietly stops parents and explains that many doctors
don't agree with this, but parents are overwhelmed by the MD and decide to
follow his advice.  Midwife calls another MD, who calls the local
Neonatologist, they discuss the case and agree that baby should not be
weaned.  Mother is called by the spanish-speaking nurse and is also
reassured by the home health nurses that she can breastfeed, but she still
feels she must follow MD's advice.

Midwife offers a stack of reprints 1/2 inch high to the MD, he refuses to
read them.

Monday I get a call from WIC  - Mom is having trouble getting baby to latch
on (her breasts BEG her to feed her baby, so she has decided to breastfeed
despite MD's orders).  I make home visit, assist with attachment and
reassure breastfeeding is best for baby.  She must count wet diapers and
stools and tell me the next day how she's doing.  

Tuesday - baby wet 9 diapers and stooled with each one.  More blood tests,
bili at 12.  MD sees her breastfeeding the baby and tells her she must stop
immediately - and not breastfeed for 2 weeks.  Her baby has poison in his
system and only formula will flush it out.   He states categorically that
the midwife only has 2 years of education and he has had 20 and knows what
is best.

I make a home visit with the midwife, provide translation of the material
she shows them in relation to jaundice.  Parents overwhelmed, frightened
"what if the doctor refuses to see our baby for other health problems if we
don't follow his advice about this one?"  We arrange for an appointment
with another pediatrician for tomorrow.

I speak to my supervisor who goes to the head (GYN) of the department.  He
has asked me to compile research material so that he can write a letter to
the Family Practice MD.  Question - I have the article that came out in
Pediatrics in 1994, Lawrence's book of 1999 and Riordan and Auerbach 1999. 
What other resources should I offer?

Jeanette Panchula, BSW, RN, IBCLC, LLLL
Vacaville, CA
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