I've been thinking about Gail's very astute observations about physicians and
their responsiveness (or lack thereof) to the importance of breastfeeding.
It hit home again yesterday.  I have a mom with low milk supply, and no
observable reason for it.  Baby is suckling well, though because of the low
supply, is quickly shutting down at the breast after just a couple of minutes
of sucking & swallowing -- transferring maybe a total of 1.5 to 2 ounces in a
40 to 60 minute period of time....Mom has been on fenugreek which hasn't
seemed to do much of anything, so it was suggested by the hospital LCs to get
some Reglan.  The mom's OB group absolutely FLATLY refused to order it
"because of the potential side effects" of which the mom was well aware, and
was willing to chance it anyway.  They gave no further help.  She went to an
internist yesterday to see if he would order it for her, and his response was
VERY interesting:

"My wife is a pediatrician, and we couldn't get either of our two babies to
latch on, so we just went to formula and they did just fine.  You've tried
the breastfeeding.  It isn't working.  Just go to formula."

He did a curbside consult w/ the endocrinologist in his office who then
ordered a prolactin level and thyroid screen.  So we'll see.  And he didn't
totally rule out ordering the Reglan -- not that it will do much if the
prolactin levels are normal, but at least he's on the right track.

Now WHY would he be so denigrating of breastfeeding?  And why wouldn't the OB
group help at all?  I think a couple of things -- when they have a negative
breastfeeding experience (and perhaps they didn't "try everything" they could
have), there is a tendency to assume that people should do what they did --
why sweat it?

The second thing is (and I was also thinking about nurses in this context),
when you are working in crisis management which is what physicians and nurses
are trained for, rather than health maintainence, then I think breastfeeding
seems to be a perk -- nice if you can do it, but not crucial in the bigger
scheme of things.  They simply can't put their energy into it, because it
isn't as important as making sure they know how to read fetal monitor strips
or treat DIC or PIH or 101 other acronyms that make up medicine and the
myriad crisis that plague pediatrician's offices, hospitals, OBs, and the
rest of them.   We've become so innured to the use of formula that in many
minds, while "breastfeeding is best" it's right up there with making sure you
stick with the food pyramid on a daily basis -- and that's way too hard -- no
one died from a periodic MacDonald's, so what's the fuss?  (Back to Diane
W.'s most excellent "watch your language" article).

Anyway, I don't have any answers, just more questions.  And this isn't to
excuse them -- it's just a thought as to why HCPs, physicians and nurses in
particular may not perceive bf as important.

It's just something nice to do that mothers like.

Jan Barger, RN, MA, IBCLC -- Wheaton IL
Lactation Education Consultants
www.lactationeducationconsultants.com

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