I really liked Margaret Wills' approach to addressing doctors.  Stressing
the positive things they can say and do, and how important their input is,
rather than seeming to be too critical.  A few critical examples might be
used for humour, but focusing on the feel-good stuff might be more
productive.

I used to practise in Harare, where most of my work/referrals came from
paediatricians and family doctors.  As Margaret says, doctors don't have
time in a 15 minute slot to fix a breastfeeding problem.  But when they
have someone to refer the breastfeeding problems to, then I got the
overwhelming impression that they became much more positive about
breastfeeding a)they could unload the technical problems on to me and b)
they could then afford to be more glowing about the good things for the
babies with continued breastfeeding rather than formula-feeding.  It was a
win-win situation.  It also gives IBCLC a great chance to be part of the
healthcare team caring for a particular dyad - good liaison, good reports,
good trust;  the doctor monitors the baby's health and the IBCLC fixes the
breastfeeding.

Stressing the positive input that doctors can provide and stressing the
crucial role they play in influencing their patients - and hence the health
of the babies - would seem like the most beneficial slant to your talk.
Good luck!

Pamela Morrison IBCLC
now in Rustington, England (a very different country with a different take
on breastfeeding).

-------------
Date:    Thu, 23 Feb 2017 17:33:34 -0500
From:    Margaret Sabo Wills <[log in to unmask]>
Subject: soliciting input -- my second query

You can congratulate them on the great position paper on breastfeeding by
their very own AAFP (someone told me one of the authors was married to an
LLLL)
http://www.aafp.org/about/policies/all/breastfeeding-support.html

Good luck with your talk.  The doctor's support is so important to keeping
families in the breastfeeding game.  Whatever I say in the consult can be
instantly thrown overboard if the doctor says something different (sigh…).
In fact, you might make headway with this group with the opposite angle --
not how easily they discourage parents who are overreacting to their
well-intentioned words, but by playing up the power of the doctors' words
if they say something even remotely positive about breastfeeding.

They need to convey to their patients that breastfeeding is important.  If
they ask "Are you breastfeeding or formula feeding" -- parents hear that as
two equal choices -- no big deal.  If they ask, "Do you have any concerns
about feeding?" it leaves the door open for discussion.

If family practice doctors/pediatricians take breastfeeding seriously -- as
a basic survival function, an ordinary thing that babies should be able to
do -- parents feel this is worth working on.  If a baby isn't
breastfeeding, let's feed the baby somehow, but recognize that something
needs to be fixed -- this functional difficulty deserves investigation. Not
just the milk, but the physical act of breastfeeding is part of the baby's
development.  If a child was having difficulty breathing or walking --
sure, we'd supply a respirator or a wheelchair, but we wouldn't leave the
situation there.  Just because a baby can take a bottle, it doesn't mean
that all is well.

Breastfeeding is instinctive, but it's even more a learned behavior for a
mother.  In places where everybody breastfeeds, women grow up observing
breastfeeding,  and busybody grandmas and sisters and aunts help her learn
hands-on (and feed her and fold her laundry).
 If a doctor says "Some women have a lot of difficulty breastfeeding" the
mother automatically assumes she is one of those unlucky mothers who can't
do this.  If the doctor can sympathetically say to the distressed parent,
"You're right -- all mothers have to learn how to breastfeed -- you're
working hard on this, and here are some resources to get help if you need
it," -- so she doesn't feel like a freak/failure because she is having
learning curve difficulties.  She's on common ground, and she has resources
to work through to her goal.

Doctors need to recognize they can't work through a breastfeeding problem
in 15 minutes while addressing all sorts of other vital body systems.  They
can ask -- "How do you feel breastfeeding is going?  "is feeding reasonably
comfortable" and "is the baby swallowing?" and of course everyone is
watching the weight gain.  And they have to be quick to refer out to
mothers' support groups and IBCLCs if a mother needs to address a
breastfeeding problem in more depth.

Sometimes it seems that doctors feel that the are "lifting a burden" off of
the family by discounting the importance of breastfeeding (at least that is
the positive motive I ascribe to it when mothers tell me what the doctor
said).

Thanks for your work on this.

Margaret Wills, IBCLC, Maryland, USA

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