Theresa
These are common scenarios and frustrating for the LC and mom. However try 
to remember the physician is doing what he/she feels best for the patient 
based on his training. It is your job to run interference, so to speak, if 
you can, to remedy the situation to preserve bf if possible, educate the 
physician, while not alienating the physician in the process.
1. year old infant w/ bronchitis - I would say something like some 
physicians beleive milk will thicken mucus secretiions, while others don't; 
breastmilk is not a dairy product-milk; and it is not formula. let her know 
many physicians are not familiar w/ the differences. You may be able to find 
some refs abiout the mucus debate. If you have a book like Jack Newman you 
can share that one. Personally I would rarely outright say to ignore the 
dr's advice and do something else, but I rather let the mom come to her own 
conclusion. Let her know there are differences of opinion, esp. that he's an 
ER doc.
2. mom w/ appendectomy - The anesthesiologist is probably very unfamiliar w/ 
breastfeeding medicine. You can share the Hale info w/ mom or the Dr. Newman 
type info w/ her. You can perhaps involve the pediatrician if he/she would 
be more knowledgeable. You can let her know that the anesthesia is not at 
work since she is awake and alert now and therefore it is 
metabolized/metabolizing. Again, let her draw her own conclusions. Do not 
force any of these issues, it can get you into alot of trouble, even the mom 
may report back to the MD, esp if the baby happens to throw up or something 
and it gets blamed on untimely bf.
3. slow gainer at 11 wks. - go back to square one with this dyad. Do a good 
history. My guess is that she needs to nurse more - have the baby  in close 
proximity whenever she can; be faithful to her pumping, use a good quality 
pump. the amts she is pumping (4 oz)and the amt the baby consumed at one 
feeding (2 oz) don't sound esp. worrisome to me. I think it might be the 
total time bf/pumping that is the problem. Other questions to ask: any other 
foods, water, pacifiers, mom's meds, birth control meds; any health 
problems; etc

Laurie Wheeler, IBCLC, MN, RN
Tupelo Mississippi, s.e. USA

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