I am equally appalled at the level of knowledge of MDs. I saw a woman
yesterday who had been pumping for the past two weeks for her 9 week old
baby because of recurrent "mastitis". She has had 5 courses of antibiotics
starting at week one, and the doctor finally told her to stop nursing
because she was catching the germs from the baby.
It was a simple case of oversupply with recurrent plugged ducts and shallow
latch, but now mom has yeast overgrowth on her nipples and baby has been
bottle-fed for two weeks, and mom has been pumping both breasts every 3
hours (6-7 ounces each time) so her milk supply is revved up to about twice
what it should be. I will be amazed if this nursing relationship is saved.
They live an hour away, and mom is resigned to pumping and bottle-feeding,
but is tired of the "mastitis".
I feel very frustrated that all I can do is send a report to the MDs
involved, one case at a time.
To try and explain how it is "we" collectively are so ignorant about this
area, I can tell you from personal experience that I trained at a tertiary
care hospital in a large city. I got very good at caring for liver and bone
marrow transplant patients and itty-bitty premies in the NICU and dying
cystic fibrosis patients...because that is what I did the most of. My
outpatient experience was limited to an inner-city clinic a few hours a week
where I do not remember one single mom as breastfeeding. I finished a
pediatric residency in 1991, and had never witnessed a woman breastfeeding a
baby in any setting in my entire life. The first I saw was my own, when they
handed her to me in the hospital in 1992...and did not show me how to do it
even then.
I know there are medical schools who now include a little anatomy/physiology
of the breast (I had NONE) but I know it is not standard. And I am sure the
experience at residency programs is widely variable. We have a family
practice program in my city, and the residents have the opportunity to
follow me for up to 2 weeks (when they are not in their own clinic or at
lectures) but it is not mandatory. Some choose to come and others don't. I
do not know what the answer is. I have become very cynical about fellow
MDs' interest in learning about it. Those who are interested in becoming
more knowledgeable find a way to do so...many don't view it as important,
and a few are down-right hostile about any suggestion that breastfeeding is
preferable to formula.
6 years ago, when we were getting ready to open our clinic, I was certain
the MDs would be our major referral base. This has not been the case. Moms
refer each other to us, and I now feel it will be up to moms to demand that
the healthcare professionals become knowledgeable in this area of medicine.
Medicine is really becoming consumer-driven.
My two cents-
Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE
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