I've forgotten the fun of being in memo attack mode during the 20+ years in
international public health and have started to remember how good it feels
when you have time and patience on your side.

I'm remembering how time and patience won out over our battle with vitamin
A deficiency in Niger where it was contributing to a 30+% increase in child
mortality and exceptionally high blindness rates due to xeropthalmia (the
form of the deficiency that literally melts the eyeballs).  It took from
1986 to 1993 to win out over a lot of resistent private voluntary
organizations and Ministry of Heath officials but it finally turned around.

So, I can do it with one measly recalcitrant pediatrician who hates
lactation consultants.  I found out from a client (and had it confirmed
from other LCs) that this pediatrician actively dissuades her clients from
seeking our services and she has bullied her partners into not referring to
lactation consultants.  She had the nerve yesterday to interupt a
consultation I was just about to begin, by saying "let me start this since
I have 30 years experience in pediatrics".

She has her standard straddle position that she uses to cure all latching
problems.  I have had two clients for whom this failed.

One client said the straddle position worked for a few days, but whose
primary problem was low supply and turned out to have exceptionally low
prolactin levels.  I actually did a pre and postfeeding weight check in the
straddle and the transition position and milk transfer was EXACTLY the
same. Ultimately, the woman went on domperidone (after her poor baby was
hungry and not gaining for the three weeks she was in denial that she had
low supply).  Her supply responded promptly to the domperidone.
Subsequently, I noticed that the other pediatricians in the practice
actually started prescribing domperidone.

The other client had a baby with macroglossia, was told by the NICU and
this pediatrician to NOT pump.  The pediatrician spent 10 minutes using the
straddle position to latch the baby and it didn't work.  The pediatrician
insisted it would work and the poor woman struggled for two solid days on
her own before she found a position that would work and got her baby onto
the breast.  He did terrific when I saw her with the smallest of the SNS
tubes and went from 0.3 ounces of milk transfer in > 1/2 hour to 1.5 ounces
in 10 minutes FROM THE BREAST with the small tube SNS.

So, in this current situation where this particular pediatrician totally
dissed me in front of the clients, I had the good fortune to be in a room
crowded with health care practitioners, including the obstetrician.  We
introduced ourselves to each other and I mentioned I was board certified
and he laughed and said he wasn't (he has an excellent reputation) and I
name dropped shamelessly.  When I told him about my international nutrition
days, he said I must know the Dean of the School of Public Heath at
Columbia and said, I didn't but had heard of him.  I then told him about my
connections with the Dean of Public Health at Hopkins because of his work
on vitamin A deficiency and my MHS there.  We then got onto Bill Gates and
how much money he's dropping into schools of public health and how he
certainly could afford to do so.  So, while we were making chummy chummy
(in a way that I really could never do for social purposes) the
pediatrician failed in her attempts to get the baby onto the breast and
left me to my own devices.  Really, I have to say that it was pure luck
that the Aussie latch (thank you Rebecca Glover) worked like a charm and I
was able to latch the baby on.

I feel decadently evil, but I couldn't help myself.  I sent the report to
the pediatrician today and I'm going to follow up with a chummy letter
about how wonderful it is that she is so supportive of breastfeeding and
let her know about all the breastfeeding conferences I can think of in our
area saying how much I think she might enjoy the new information presented
given her dedication to breastfeeding.

I have patience, I will endure, I'm not leaving this woman alone until she
finally admits that we LCs have something to offer.  Polite, friendly,
persistently cheerful letters that won't ever stop until she caves and at
the very least allows her partners to refer to us.  She has become my
personal project.

On a much larger scale than my current microbattle - Ditto the formula
companies.

I could never ever manage this when it comes to the social dysfunction of
my son's private Manhattan nursery school which is making me want to move
back to Africa or home school (which given my son's energy level would
probably exhaust me in about a month).  I cannot tell you how resentful I
am of these overacheiving moms who have 2-3 nannies, don't work, and don't
really spend much time with their kids except to polish their four-year
olds resumes for private kindergartens.

Best, Susan Burger, MHS, PhD, IBCLC

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