At 08:51 AM 11/16/03, you wrote:
> >> My impression is that... docs who aren't routinely
> >> involved in breastfeeding are generally... receptive...
> >> while peds and OBs generally are not.  Reasons?

I had another thought of this topic.  I am not making apology for what we
are facing in infant care in the US, but merely reflecting on why someone
who works with infants hourly and daily would be less receptive to
breastfeeding information than one who is not responsible for infant health.

Since feeding a baby is considered a health issue, parents expect a
Pediatrician to know about this aspect of health.  They also expect the
Pediatrician to know the answers to breastfeeding questions and how to
resolve any problems. How many times have you had a client ask, "Why does
my Pediatrician now know that?"

Medical school training does not prepare a Ped for these parental
expectations.  At best, they learn that breastfeeding (or breastmilk) is
"best."  But knowledge beyond that about infant feeding is based on formula
feeding and resolving the problems related to this method of feeding. And
out in practice they are bombarded with what Dr. Gail Hertz identified as
"inservice " by the formula companies and "carefully worded misinformation."

Consider how much time and focus we put into learning about breastfeeding.
And we practice what we know enough times to "get it right" (at least for
this year) and to fine-tune anything that doesn't seem to fit. We are not
coming to this knowledge from years of "doing it wrong," at least not in
principle.

It does not feel good to the baby doctor to say, "I don't know the answer
to your question about medications in your breastmilk." Or "I did not study
anything about breastfeeding in my training so I am unable to advise you on
feeding your baby this way." Or, "I hear the same information that you do
that breastfed babies are healthier but I don't know how to help you. All I
can do is recommend formula."

Infants come to the doctor every month in the U.S. and their mothers call
the Ped's office about breastfeeding problems.  And the doctors do not know
the answers. They are faced with sick babies all through their day and
handling breastfeeding issues is threatening.  If all one knows is to
recommend a treatment that makes babies sick, she would not want to keep
hearing that her treatment makes babies sick.

No one likes be continually reminded of aspects of her job that she is not
knowledgeable about. We wish that these reminders would just go away. "If I
hear one more time that a mother does not want to give formula to her baby
when the baby is not gaining enough (or is fussy, or is feeding all of the
time...) because she heard that formula will make her baby sick, I am going
to scream!" "I am tired of mothers asking me and my staff questions about
this crazy breastfeeding thing!"  "And here is that LC on the phone again
telling me something that I don't know." (Made up statements.)

Being reminded of our inadequacies makes us angry. Just think of how angry
we Lactnetters get when someone writes, "Any LC who is worthy of her
certification would never consider doing what you are doing." We seldom
write any more about how we are handling a problem for fear that we will be
chastised for not knowing enough or for doing something wrong.

The National Breastfeeding Awareness Campaign is not going to make practice
any easier for Peds. Whenever a Pediatrician who is not knowledgeable about
breastfeeding reads about the need for babies to breastfeed they are faced
once again with their inadequacy in this area.  They are not ready to
believe that they cannot bring a baby to optimal health.

Diane wants our discussion on this topic to give clues as to how to address
the issue. Dr. Mimi has one solution--go through the parents.  This is the
"grassroots" approach, which affects most true change. The American Academy
of Breastfeeding Medicine does their best to approach it from "the top" but
this doesn't work well enough or fast enough. So I guess we are left, as
always, of one baby and mother at a time until we reach the "critical mass"
or the Hundredth Monkey.

I have addressed the Pediatrician's plight in this post and neglected the
Obstetrician. Many of the same emotional responses are present in
OBs.  With less skill and practice in normal deliveries, and with medicated
deliveries as the cultural expectancy, and with fears of litigation (based
on a false sense of "safe"), and with a focus on problems related to the
deliveries that they do perform, they have very little interest in a
woman's breastfeeding issues. "If medicated deliveries impact
breastfeeding, so what? I don't have the time or inclination to go into how
a woman feeds her baby." "Yeast in the breast?  Whatever does that mean?
Why is she calling me?  I have no idea how to treat such." "Just give formula."

So breastfeeding is a pseudo medical issue looking for a home. And WE have
a home to offer. Please hear us.

Patricia Gima, IBCLC
Milwaukee, Wisconcin
Mailto:[log in to unmask]

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