In a message dated 10/29/00 7:36:52 AM Pacific Standard Time, [log in to unmask]
writes:

<< I need help.  Anyone who has had to work as a LC in the hospital setting,
 please feel free to respond to my private email address.  I have an
 assignment. I am supposed to write an open letter to the physicians of our
 hospital (pediatricians and obstetricians) emphasizing our need to be
 advocates for one another and the need to work as a team when it comes to our
 breastfeeding mothers.  I inadvertantly upset two of our obstetricians when I
 gave them research based information on breastfeeding that contraindicated
 what their doctors had told them.  Now the docs see me as the "bad guy" and I
 could lose my job if I let that happen again.  It has been suggested that I
 come up with a top ten list of issues that breastfeeding women present to me
 that come in conflict with what the doctors recommend.  For instance "Only
 breastfeeding 10 minutes on each side.  A baby can get all the milk they need
 in 10 minutes."  Or, "Don't feed a baby any closer than two hours, even if
 they are crying until they are blue in the face, do not pick them up and feed
 them".  One doctor told me not to tell his patients about fluconazole.  He
 doesn't believe that thrush really exists.  So, how do I do this job well and
 not alienate the doctors?  I am sure I can't be the only one this has
 happened to.  How can I get the doctors image of me as the "nipple nazi" to
 change?  This is quite serious as my job depends on it.  TIA.  Loni Denman,
 RN, IBCLC
  >>
It is a very delicate situation when information is being put out by the
health care team members that are trusted to know about breastfeeding, when
their info is laced with inaccuracies.  Saving face is a part of this
situation that needs to be address.  We need to come from sharing "new"
evidence-based - buzz phrase of the 2Ks - even if its not that new.  When
discussing these 'differences of opinion' it is helpful to state the facts
then give examples that support the "new statements". Things that help are to
talk about, " even tho a newborn's stomach capacity is only 7 cc, since baby
is still learning how to extract milk from mother's breast and he may not be
very efficient about it yet.  In addition, babies also need non-nutritive
sucking which can also be done at the breast..." Referring to the supply line
of the umbilical cord and how that was a constant feed situation and how
babies need to eat frequently to adjust to the new oral feeding method they
are trying to learn is another illustrative example.  While it may be true
that most older established babies can get most all the milk they need in 10
minutes, that isn't likely the case for someone new to learning to
breastfeed.  It takes all of us more time while learning a new task than it
does when we've had some practice at it for a while.  We need to give babies
the opportunity to learn a bit first before we raise the marker on their
efficiency expectations.
As for the doc who doesn't believe in thrush, I'd hate to be driving near him
- what if he doesn't believe in stop lights either?  This is such arrogance!
Hear it all the time from HCPs who "don't believe in - nipple confusion - or
whatever.  Like this is related to a belief system!  Don't know what to say
to those folks.  Facts is facts, and water is still wet even if you don't
believe it!  Coming from a gentle sharing perspective tends to be a better
means for advocating change.  Going head to head rarely fosters
understanding.  But when you can share along the lines of I just found out
(maybe 10 years ago, but who cares) that babies who are attended to with 90
seconds of their beginning to cry actually cry less frequently.  Or any other
factoid you wish to share.  Attitude is such a huge factor in allowing and
creating a safe space to change points of view and exchange info.  Be gentle.
 For many this is very new and totally contradictory info from what they were
originally taught.  It may well be very different from their personal
experience too.  Good luck, and rest assured you are not alone in this
battle.  We are all doing what we can to chip away at the "altar of
ignorance" Dr. Jack has so aptly referred to.

Gretchen Andrews, BA, IBCLC
The Lactation Connection
private practice, So. Calif, USA

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