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Subject:
From:
"G. Hertz" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 31 Jan 2001 22:47:51 -0800
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This isn't to defend the slanted view of breastfeeding that some docs have
about breastfeeding, but more to give you an idea how it has come about and
is perpetuated [and how you can go about changing it].

Doctors learn their trade 6 ways.

1.  Med school and Residency:
Breastfeeding is not well taught or taught at all in many programs. This is
more true for years past, especially those years when breastfeeding was what
moms did when they weren't going to formula feed. Fortunately, this is
starting to change and the docs coming out of residency this year are much
more likely to have had some constructive exposure to breastfeeding than
their peers who graduated 5 years earlier.

2. Personal experience:
Residency programs are not supportive of breastfeeding. Time off is limited.
Time on (36 hour shifts and long work weeks) make it hard to mantain a good
milk supply. Female physicians have fewer children than their male
counterparts. Formula reps go out of their way to supply docs with formula
for personal use. Some docs may be less  likely to seek help if they are
having problems with breastfeeding.

3. Scientific journals:
Until recently, most of the breastfeeding articles were in journals that
were unlikely to be picked up by your average doc who probably reads JAMA,
BMJ, NEJM, Lancet, JPeds, Pediatrics.  Also, without a good grasp of
breastfeeding basics, they have trouble picking apart a study to evaluate
whether it's valid or not.

4. Mentors and Peers:
Most docs have not had formal training in breastfeeding - especially the
older docs. When misinformation gets passed down through generations of
mentors it takes on a life of its own.

5. Patients:
This is probably the most important because "seeing is believing". So what
do docs see?  They see increased jaundice in breastfeeding babies [because
of the hospital policies, labor meds, etc.] and failure to thrive - that
they are powerless to fix aside from giving formula because that's all they
were ever taught to do and they don't have a working understanding of
breastfeeding.
They give bad advice and never know it  because moms don't admit that they
didn't follow it.  They see the breastfeeding problems but not the
successes - those babies only come for well checks unlike the formula fed
babies who come for so many sick visits.
Docs think a year is a long time because the moms that wean early are the
ones that they hear about. The moms who are nursing toddlers don't mention
it, for fear of being told to stop, etc.

6. Formula Reps:
This is where docs get the majority of their breastfeeding / infant feeding
info from. There's handy handouts for patients and printed materials for
docs which reinforce the "don't make them feel guilty formula is just as
good breastfeeding is hard" routine.


This is why you run into such slanted views and incredibly off-base
information from docs who think they are being supportive of breastfeeding.

Gail Hertz, MD, IBCLC - who last week had a mom tell her that she breastfed
her daughter for 4 1/2 years!!!

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