I visited a specialist at Texas Children's Hospital in Houston recently who
examined my youngest for chronic knee pain.  He dismissed some
mis-information I had received from the pediatrician by saying: " We forget
some of the things we learned in medical school unless we work with the
conditions every day."   This honesty explains, of course, part of the
problem with some of the breastfeeding related issues WE deal with on a
daily basis.  While they are the main part of OUR practice, they are a small
part of most medical practices, hence, unfamiliar.  I don't know about you,
but personal discomfort with the unfamiliar makes me wish certain problems
would just go away.  I think that is human nature. I try to fight that
impulse, but boy I bet it's tough in a managed care environment with 5 min.
per patient.  Not an excuse, just part of the issue.  There isn't a lot out
there in the med. lit about breast yeast.  There is controversy about it,
and we don't know near enough about it.  Doesn't mean we shouldn't find out.

 Add to this the problem that many MDs and nurses are not formally educated
on lactation to begin with.  So part of our challenge is to cont. to
advocate for inclusion of lactation science into those curricula.

I have a doctor who refers a lot of babies to me.  He doesn't "believe" in
sucking problems, etc.    Here's what I do.  I write reports (brief, one
page -- never more than 2 paragraphs)  that describe what I see rather than
provide a diagnosis -- which is, after all, his perogative.  Then, if I know
it is a controversial subject that he is likely to dismiss because I am not
his peer, I attach the cover (abstract) page of the newest, best, most
respectable scientific study I have available.  I just faxed him over the
Messner study on ankyloglossia yest. attached to a report about a
tongue-tied 6 day old who is not growing and whose mother has full breasts
and split nipples.  Their insurance requires a ref. from the pedi. so they
can get coverage for the frenotomy, so I'd like for them to stay in the
system, and these reports are a way to courteously educate.  Last time I did
this was for a baby who had the most asymetrical jaw I've ever seen in a
human being.  The doc didn't think it could be the reason the baby couldn't
feed at breast.  I sent a page out of Wolf and Glass describing jaw
stability as the platform for normal feeding function.  The next morning the
nurse practioner called me to say they were looking for a PT for the baby.
So I know this approach works-- at least most of the time.  When it doesn't,
I suggest a second medical opinion and send patients to other OBs or
pedis -- or to the proper specialist in the community for another look.

 WE have to work harder because some of the supportive lit. for a lot of
what we do is all over the place in sources pediatricians and OBs don't
typically access.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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