Katharine, I am glad that you wrote.  Your post was most enlightening.  We
all know that we shouldn't engage in globalizing our comments about any one
group. I understand your annoyance with Lactnetters who rant and complain
about those in your profession who are choosing to remain uninformed about
normal health for human infants. And I know that physicians like you and
some of the ones whom I work with are greatly aggrieved by those uninformed
physicians.

When a post like yours and Kathy B's reminds me to not generalize about
doctors, I will, for quite a while write more considerately.  Then I have a
day like two weeks ago and I want to tell others who will understand why I
am so angry. There must be a way for us to share our woes and frustrations
without offending. And much of the time we do.

So that it is not personally offensive to the beloved and appreciated MDs
on this list, maybe we could name in our posts the doctors that are
interfering with out clients' successfully feeding their babies. That way
there would be no doubt that we are writing singularly instead of globally.

[What feeling did that conjure up in all of you readers of Lactnet?  Did
you gasp? Would that take courage?  Or would it be worse than what we have
been doing?  Or would it be a certain route to expulsion from the list?]

Katharine, as I was reading your post a couple of times, some thoughts came
to mind.

One of the problems is that effective breastfeeding practice *is*
"alternative" to many of the physicians that I come in contact with [Note
that I'm doing better already]. Formula feeding is the norm and if a mother
wants to breastfeed she is choosing an alternative to the pharmaceutically
supported practice that a doctor is likely trained in. A mother who is
breastfeeding needs information that the doctor may not have.

And we remember that the return to breastfeeding, even at the level it is
now, was not led by the medical profession, but by those "extremists" that
came to your side when you needed breastfeeding support. Those extremists
who supported you were practiced at taking a stand against the "norm" in
our culture--often against their physicians.

I admit that some of us aren't very patient with the historically slow pace
that medicine has taken in embracing the health consequences of artificial
infant feeding. It is going to happen, but meanwhile we see one, then
another, infant denied her right to optimal health. Can you see why we get
so angry?

I'm sure that you grow in caring of your patients. What if you saw them and
knew what would be good for them, but had to send them to another physician
for treatment--a treatment that you felt strongly would harm your
patient--and your patient had to follow that physician's orders?

A major problem in this struggle to improve the health of our infants is an
inequality of power.  You have that power because you are a physician (and
you *don't* have to send your patients to another MD for treatment). I
don't have the authority to do what a physician does. Neither does the
mother of a baby who knows that she is better informed than her baby's
doctor (or hospital personnel) on a given issue. She can, of course, follow
her own judgement, and many do. That is one of the basic principles of
"alternative" health care.  The patient (or the parents) are ultimately
responsible for the health care of themselves and their families. And they
can't wait for the medical community to confirm (or disprove) what they
firmly believe is best.

What if I had believed my daughter's pediatrician 32 years ago when he told
me that I was selfish to be breastfeeding?  Formula had all of the
nutrition that my baby needed and who knew what was in my milk.
Breastfeeding was just not medically sound. I followed my own
judgement--with a lot of support.

The babies that I am working with this week will be 32 years old someday
and their infancy will be passed, and along with it the opportunity to
begin a path of good health for a lifetime. The mothers of these babies
must sometimes take a course of action "alternative" to that recommended by
their physicians.

A couple of weeks ago I wrote a post with a subject line "Do no harm."  I
had had a remarkable day of calls from mothers whose baby's doctors were
ill informed about breastfeeding, but who were in a position of power to
"order" certain practices.  I was angry because my clients call on me to
help them to succeed in breastfeeding their babies and the normal practices
of medicine are often the major obstacles.

So, to sum up:

Breastfeeding is "alternative health care" at this time in many physicians'
practices.

Leadership and change come from the "extremists"--those outside the norm.

Health care is best as a partnership.

We can learn a lot from e-mail lists, but we can also easily come over
unfavorably and rude. We subscribers on this list are on the same side. We
don't always agree, but we *are* on the same side.

I hope that I have been considerate in this reply.  I know that e-mail
doesn't lend itself to the subleties of voice communication and request for
clarification. But I have written, read, re-written this post for well over
an hour in an attempt to reflect Katharine's honest sharing with my own. It
is always good to see where another is coming from.

I have written with care--except for that part about naming names.  ;)

Pat Gima, IBCLC
Milwaukee, Wisconsin






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