I liked  Dr. John DiMichele's post on MDs, drugs and breastfeeding very
much. My problem is that as one of the few MDs knowledgable in bf in this
country I often get contacted by mothers (many referred by LCs) whom I
don't know, and who live far away. LCs or LLLL don't tell a mother that
their doc is wrong, but suggest that they contact me to get a second opinion.

One of the worst was last week. I got a call at 10:30 pm from a woman who
heard about me from a nurse who was at a lecture of mine. This woman's
sister had a baby by C/S 10 days ago. 4th baby, bf well, previous child
severe milk allergy to this day. She went to see a doctor (OB/GYN) for
lower abdominal pains and fever (not her regular doc - she was staying at
her mom's). This doc thaught of UTI, or maybe an infection in th C/S
incicion, and prescribed amoxycillin (which isn't the drug of choice for
either of these conditions), and told her to pump and dump for 5 days. He
explained that the drug gets into milk, and there is no reason a healthy
baby should get an antibiotic. Mom explained about milk allergy, asked for
a bf compatible drug - but doc didn't change his mind. She asked about
pumping, and doc told her just to get a manual pump in a drugstore and
pump. At the time they called me mom was crying - had severe engorgement
(of course no milk could be pumped with the pump), baby had gotten one
bottle of formula and was fussy, and they were at a loss what to do.

How can I react to such a case? I had to tell mom to disregard docs orders
and go ahead and nurse. I also told her to see another doc in the morning
if she doesn't feel better.

This doc sees bf as a means to get food into a baby, and this can be done
just as well by formula in a bottle, without the risks of an
antibiotic...HE never tried pumping 10 days post-partum with a manual pump.
I don't think that he understands the importance of bf for the baby and
mother, and I doubt he would if I tried to explain.

I get calls like this all the time - mastitis treated with amoxycillin and
mom told not to nurse, jaundice of 10 at three weeks - mom told not to
nurse, moms with classic symptoms of breast thrush told they have a low
pain threshold, and psychologically don't really want to nurse, and all the
rest which you all know too well.

I talk to and see all these moms on a voluntary basis because I don't do
private practice, and I just feel sorry for them - they have no-one to turn
to. Most are phone consults, but I try to see as many as possible, and then
I give a detailed letter for their own docs - but I don't know if they give
it to him, or if he learns anything.

I often feel very frustrated, and reading Lactnet has helped me a lot in
recognizing that this is a universal problem, and not just here. We have a
long way to go...

Mira Leibovich, MD, IBCLC
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