I'd like to add some ideas to what's already been suggested as the reasons
for the resistance of so many doctors to breastfeeding.  Although I am
sure there are physicians for whom money is the main motivator, I
don't believe that is the main reason for most of what we're seeing.  Lack
of training and experience play a part, as I'm sure does the fact that the
majority of mother/baby dyads seen by physicians in this country are
bottle-feeding (either exclusively from birth -- about 40%; or mixed with
breastfeeding leading to exclusive abm-feeding in about 80% by 6 months of
age), and possibly a lack of readily available resources for referral.

However, there is an element to this which smacks of irrational, i.e.
emotional, reactions.  Many (but definitely not all) physicians accept new
research and change their practice accordingly.  So why if faced with such
compelling ovjective data of the superiority of breastfeeding, do so many
simply refuse to see it?  I believe that for a lot of them it's a
personal, emotional issue.  Take the case of a female physician.  If she
hasn't had children, it's hard to say how she would respond.  If she has,
it's likely (the statistics bear it out) that she either didn't breastfeed
or did so for a very short while.  How will a physician who herself chose
abm or felt she had to switch within weeks to abm, reconcile her own
feelings of guilt, loss, etc, with the enthusiastic promotion of exclusive
breastfeeding for 6 months and continued breastfeeding for at least a
year?  I would imagine it's not much different for a male physician.  If
he hasn't had children, his response would be hard to predict.  But if
his spouse chose to abm-feed or stopped breastfeeding early due to
problems (which maybe he felt helpless about, and possibly conflicted
about because of his own belief that breastfeeding was best for his
child), how enthusiastic would he now be?  Obviously, there are physicians
who, themselves, or their spouses, breastfed very happily, optimally and
successfully.  But, just like our general society, they are few and far
between.  These physicians (again, as shown in studies) are more likely to
be supportive of breastfeeding, although they may not necessarily be any
better at helping mothers with problems than their non-breastfeeding
counterparts.

As someone recently pointed out, physicians are human beings.  As such, we
are prone to all the same emotional responses, including denial,
transference, etc.  We live and grow up in a bottle-feeding society.
IMHO, it's not surprising that so many react to breastfeeding issues the
way they do.  As health care professionals, physicians are expected to
keep their emotional reactions largely to themselves, but don't always
succeed.  I believe that our greatest hope lies with the next generation
of physicians (although I'll keep working on the older ones).  Regards,
Alicia Dermer, MD, IBCLC.

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