In this instance, I did not even know the doctor told her to wean until  
after I told her what normal stools look like.  She called with a simple  
question:.."Hello, can you tell me what normal stools look like in a  breastfed baby". 
 Me :"Are you concerned about your baby's stooling?"   Her "I am just curious 
that my baby is stooling normally". I described the  range of normal for a 2 
week old, what it looks like, etc.  Then she told  me what her doctor said.  
EEKS. Thought I.  Now I have done it,  contradicted a doctor without even 
knowing it!   Yes, I will send  the doctor a tear off of baby stools and hopefully 
another mom will not have to  deal with this.  This was not a client I was 
seeing, just a simple question  on the phone. I have not reached the place in my 
practice that I refuse to  answer basic questions without charging for a 
consult.  And, I do not send  a report to a hcp because a mom asked how long to 
store her milk or how to  introduce a bottle to her baby because she is returning 
to work. I  answer the questions, and then refer them to the support groups 
in the  community.  Actually, I do not think a report to a doctor or other hcp  
is necessary for every single contact an LC has with clients.   Not every 
contact is a medical issue.  Also, I get plenty of questions as  an LLL Leader 
that I never report to a hcp because that is not my role at all as  a LLL 
Leader.  The firm stools was an LLL question.  I did not tell  her 'your doctor is 
wrong'.  What I said was your doctor may not be aware  you are breastfeeding.  
Please be sure to tell him at your next visit so he  knows.  It is normal for 
breastfeeding babies to have stools that are soft  and yellow and seedy at 5 
weeks.  It is actually a good thing and sign your  baby is getting enough to 
eat."     
 
 Honestly, I was shocked to hear a doctor did not know such a basic  thing. I 
totally understand a brain surgeon not knowing or a cardiologist...but  a 
pediatrician?  Sorry, but knowing what stools look like does not seem to  be the 
kind of thing a pediatrician should be unaware of.  Not every  mom calls and 
says "My doctor says" they simply ask a question.  I know I  do the same thing 
when looking for opinions that are not clouded by the opinion  of others.  I 
never say "I saw Dr. G and he suggested I have xyz.   Actually, I private pay, 
go to a doctor and act as though it is my first time  with the issue at hand 
and then compare their diagnosis. I do not want the  diagnosis influenced by 
another physician's opinion.  It also prevents the  doctor from ever worrying 
he/she is stepping on another doctor's toes by  disagreeing. I am a consumer, no 
one owns my medical care but me. I  completely understand calling and asking 
a question without sharing that another  answer has already been provided. I 
get the same thing when they have seen other  LCs and do not want me to know.  
The bottom line is there is a level of  knowledge we should be able to expect 
from a health care provider for  infants. 
 
I am all for providing information, but I don't know that I find all  doctors 
to be open to correction however gently and humbly provided. I  guess my own 
misconception is that if they wanted to know they would read  what I read in 
their medical journals and I would not need to inform  them. Sometimes when I 
am on Lactnet reading I want to collect all the  fabulous doctors here and take 
them to my own area!  I am lucky though, and  much luckier than some.  I 
really do have more than a handful of marvelous  doctors practicing in the area 
and it is really wonderful to work knowing they  are the doctor caring for the 
baby.  When a mom tells me her doctor said  something very unsupportive of 
breastfeeding, I pass out names and  numbers.  I do not think it is all telephone 
game and if it is, there needs  to be some way to ensure the information is 
being correctly heard because this  is a health issue.  It is important that 
information is heard correctly. 
 
For the most part, I really do not expect doctors to know everything about  
breastfeeding. Perhaps because I do not view breastfeeding as a medical  event 
doctors need to know about and be able to manage. I would like their  
education to be more geared to the breastfeeding as the norm for medical  care, but I 
know the education is about pathology, illness, disease.   I want my doctor to 
be a great diagnostician and to recognize and be able to  treat everything 
that can possibly be wrong.  They do not need to know  everything about 
breastfeeding, just enough to not mess up  normal.  They should know the basics of 
what normal looks like and  they should be current in their knowledge if what 
they do not know would mean a  mom uses formula unnecessarily. .Telling a mother 
to use formula needs to  be seen as a risk benefit issue and it is mostly seen 
as a choice  between two feeding methods that are close enough to the same to 
not matter  much.   If this was any other field of medicine I think there 
would an  outcry that docs are not up to date and not following the latest 
practice  guidelines.  We expect this for cancer treatment, we expect this for heart 
 disease, etc.  But, women and children can be treated based on opinion and  
outdated research and no one cares. 
 
Yes, there are great doctors who are passionate about their work and follow  
the research closely and alter practice accordingly. But,  considering  the 
work load and the constant influx of information, it makes sense they cannot  
stay current on everything. I just think there are far too many babies  being 
weaned to formula due to inaccurate medical advice and as long as no one  
considers formula a risk, it will continue.  For the most part, very few  really 
understand that they are making a drastic medical call when they tell a  mom to 
stop breastfeeding.  Two people are being hurt, and they are not  even aware 
they hurt one!  They do not see breastfeeding as that much  different and think 
nothing of adding formula, switching to formula just to see,  etc.  
 
Other than pediatricians and obstetricians what other medical practices  
expect to be informed by someone the mom contacted on her own for care.   For 
instance, if a mom went to a massage therapist would the massage therapist  have 
to report that visit to a health care provider?  Do non-licensed  practitioners 
report to doctors and share information that is contrary to their  advice or 
questions the order they have given for their patient?  If this  is common 
place, I would feel more comfortable about sharing information  with a doctor 
about something as basic as stooling in the newborn or as serious  as weaning to 
formula for reflux. I am not comfortable contradicting a doctor,  but I am 
very comfortable giving mother information that offers her another  viewpoint and 
letting her make her own decisions and encouraging her to share  what she 
wants to do with her doctor.  Or change doctors to one who will  respect what she 
wants to do.
 
 I do not think this was a telephone game situation. I asked her  to repeat 
exactly what the doctor said to her.  I asked if she questioned  the doctor to 
be sure she understood correctly, etc.  I think it is  possible in some 
instances that what a mom hears and what was said don't mesh,  but I am not sure 
that happens as much as we would like to believe. I think the  information they 
say they received is what they were told.  And, if it is  true that many 
mothers are not taking the information properly, this is  serious.  Think of all the 
other things that may be 'misunderstood' and  could cause serious harm to the 
baby.  It seems to me that health care  providers should be very sure they 
are being clear and being heard.  
 
I too am very open to being educated about the best way to share  information 
with doctors that will protect a professional relationship and show  respect 
for their position. I think it would be especially helpful coming from  the 
doctors here because they are also passionate about breastfeeding.  I  am also a 
woman and a mother and I have my own stories as a patient of doctors  telling 
me things that are inaccurate, treating me with a condescending  attitude 
when I dared to question their advice so I do believe what moms tell me  because 
I have experienced it as a patient myself. I am all for informing, but  I do 
not want to set myself up for a confrontation.  A written report  makes for no 
confrontation.  I like the written reports for that  reason. I second the 
request for the doctors here to share what they think  would be the best way to 
share the information in a non-confrontational  way.  For now, I send reports 
and if they have questions, they can call me  and I'll provide more information. 
 I am willing to learn and try new  ways that will further the mission of 
brestfeeding as the normal and expected  way of feeding babies in the medical 
community.
 

Best,
Pam MazzellaDiBosco, IBCLC,  RLC

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