<< in some cases the doc could be thinking that this woman doesn't
look like a prime candidate for breastfeeding to him...
When he sees this unpromising soul before him, I think the train of
thought goes like this: poor-young-funky-looking mom - maybe she does
drugs or alcohol, certainly she smokes - shouldn't breastfeed - unsafe
for baby for her to even try - formula's easier ... >>

Usually in lurkdome, I find this post compelling.  A physician's
influence on whether or not a mother breastfeeds is very powerful
indeed. Many times, the decision about infant feeding is made without
the mother's input as the doctor's biased judgement and possibly false
impression of her ability to breastfeed replaces sound lactation
management.
                Case in point:
Mother of extremely premature twins, maintains milk supply,overcoming
hurdles in the NICU to have twins exclusively bf upon hospital
discharge.  Twins gaining 15 to 20 grams per week by the third week
post-discharge.  Doctor tells mother to start giving formula(not pumped
milk; babies had never received formula) because infants are not gaining
well. Mother abides by directives.  She fears that by not doing so will
result in twin's ill health. Mother already doubts her ability to bf
'cause mother in law is telling her she doesn't have enough milk for the
babies. Mother's supply decreases by the time she contacts the LC, who
has counseled her since twin's birth at 26 weeks gestation.

Upon mentioning this case by name to the peds,, the LC hears the
response, "Who? I don't remember...Oh THAT mother. She seemed too tired
and  she wasn't able to keep up ... she is going to get too stressed out
trying to feed twins so it's better if she feeds formula."

Maybe she was tired but as she formula feeds and starts weaning, her
dream to exclusively bf becomes just that...  a dream.

In the eyes of the doctor, she may be just another mother, nearly
forgotten about, amidst the masses in a busy pediatric practice.

As commonly stated in this forum,  the mother's wishes are often
ignored, as though the child 'belongs' to the primary health care
provider and not the parent!

Cathy Carnaby RNC, IBCLC
formerly NICU Lactation Consultant, currently in private practice