Hello everybody,
I read Wendy's and Stephanie's notes about MD's who are completely
unsupportive of bf, and make the poor mothers miserable, and I felt like
I've been there..I run into this kind of problem all the time, and I am an
MD myself! It happens all the time - I see babies and toddlers and ask
about their nursing histories (if they are new to my practice), and many,
if not most, of the times I hear that they nursed only for a short time -
the baby was hungry, didn't gain enough, didn't sleep through the night, or
whatever, and they were told to supplement, and of course stopped nursing
shortly thereafter. Usualy I don't see them at the crucial time when I
could have helped, and I try not to make the mothers feel bad about it. I
tell them to ask me if, and when, they have their next baby.
In the past I tried to tell doctors and nurses about bf, as we know it, but
their response was too often like the one Wendy got, so I stopped. I feel
bad about this, but somehow lost the energy to fight this battle. I help
every bf mother, even not in my regular practice, I do this on a voluntary
basis, at any time, but I don't confront their doctors. I'm sure I should
do more to spread bf information, but I had some really unpleasant
experiences, even though I alwas do my best to respectful and gentle. I can
completely identify with Wendy, and my only advice is - help the mothers as
much as possible, find a bf supportive doctor, but don't get into arguments
with unsupportive doctors. I found bf a little like religion or politics -
its a very emotional subject, and poeple, including doctors, usualy have
fixed ideas about this.
Of course there are cases when doctors simply don't know enough about bf,
and are happy to learn, and you can know this after one sentence.

I hope I don't sound too pessimistic - I am a basically optimistic person,
but sometimes I must vent my darker side...

Mira Leibovich, MD
>
>Yes, truly I am feeling homicidal!! Today I had a call from a mom I had
>helped while in the hospital. She started by telling me how everything
>was going with breastfeeding.  Her daughter is now 1 week old, is
>nursing every 2 - 2 1/2 hours, is a little fussy at night if she's in
>her crib alone, so she brings her to bed with her and they sleep much
>better. Birth weight 7#9 oz., at home visit on day three - 7#0, today in
>the ped office 7# 14 oz. Lots of wet diapers and yellow stools and baby
>is satisfied between feedings, no engorgement, no sore nipples, baby
>latches on well. She then asked me how I thought bf was going.  I told
>her that if everyone did as wonderful as she was doing, I would not have
>a job!
>To my dismay, she began to SOB!!! She had just come from the ped office
>where between the Dr. and his nurse they had spent 30 minutes telling
>her everything she was doing WRONG!!  She was informed that the baby had
>not gained enough weight, and if she didn't gain the right amount by
>next week, she would have to supplement. (They didn't tell her how much
>was enough, just that 5 oz over birth weight at 1 week old wasn't
>enough!!!) They told her that she was nursing entirely too much and she
>must wait four hours between each feeding. If she nurses at two hours
>the breast is EMPTY, at four hours, she will have enough.  Also if she
>has to supplement next week, that will actually improve her supply as
>her breasts will have time to become engorged!!  And she is NOT ALLOWED
>to ever sleep with her baby again.  If she cries in her crib, don't even
>enter the room for four hours, as she will become spoiled!
>I am appalled!  This ped has been in town for approx 1 year and I am
>aware that he certainly does not support bf'ing from his orders in the
>hospital, but this is the first time I have heard this info.  I have to
>assume every other mom that was given this advice listened and failed at
>bf.  This particular mom is knowledgeable and well read about bf and
>knew enough to question this advice.  We talked about bf management and
>I believe this mom will be running, not walking to another Ped.
>I immediately went to this physician, and nicely requested to provide a
>lunch and learn session to his staff, reviewing the latest AAP
>guidelines, at no charge to him. I thought I could get in the office and
>provide the latest info on bf management.  He adamantly refused, stating
>he doesn't agree with babies ever nursing more frequently than every 3 -
>4 hours as they spit up too much! He stated his staff provides the bf
>info he wants parents to follow and they don't need any education!
>Next, I went to the chief of peds and asked for his help in reviewing
>the AAP guidlines in the next ped meeting and encouraging them.  He will
>do this but states that in the office, a doctor is "king" and he has no
>say over what is done.
>So, now I'm back to square one.  We have been working very hard in the
>past few years to become more bf friendly and have definitely begun to
>improve bf rates upon discharge.  Any suggestions on where to go from
>here??? (short of homicide!!)  TIA  Sorry this is so long.
>Wendy Krzanowski
>RNC  IBCLC  CCE
>Hello Lantnetters
>I have a problem that I'm looking for a little help with.  I am a
>hospital-based LC (the only one in town) and our pediatricians have just
>started ordering supplements-a lot.  Baby who loses 8-9% - comp after
>nursing.  Babies who are 36-37 weeks and still learning to suck - comp
>them.  Jaundiced babies... I think you can see a trend here.  They are
>not very supportive of my services (neither is the staff at mey hospital
>- but that's another whole issue).  I need to address this with them.  I
>have been very non-threatening to them thus far.  I've been nice and
>very subtle in my attempts to discuss other things with them. The old
>"here's an article I thought you might like about treating both mom and
>baby for thrush." and then I highlight the important stuff.  I left them
>copies of the AAP guidelines this week.  I've had 3 moms in the past
>week who have supplemented because the "doctor said I should" and 2 of
>the 3 stopped nursing all together.  The other one is nursing a couple
>of times a day.I just got a call to see a c-section mom day 3 who they
>ordered supplements for.  Mom called me and wants to figure out how "not
>to do this" She had a difficult time BF the first time and this time has
>tried so hard.  I've seen mom twice during her hospitalization, but the
>peds didn't even consult me before ordering supplements.
>I guess my question is - how do I tactfully discuss this with the
>pediatricians and try to earn some respect for my position at the same
>time?  I know I'm not the first LC to have faced this problem and I know
>I won't be the last. BTW, both of these pediatricians are female and
>have young children who were breast fed. I am looking in the archives as
>well but i could use any advise that you may have.
>TIA
>Stephanie RN IBCLC
>