Gloria wrote:
"The AAP is constantly being exposed for what it is---first and foremost, a profit-centered club. If they cared about children's health or children's rights, we would be seeing passionate support of breastfeeding, a moratorium on vaccines and an end to male genital mutilation. Until we see those moves from the AAP, we will know they are a fraudulent, unscientific bunch of money grubbers."
Suzanne Berman responded:
“Should it be any surprise that pediatricians are hesitant to refer patients to lactation consultants when comments like these are floating around on Lactnet?”
Really? So, b/c LCs (this statement came from a PCP-a midwife, not an LC) are calling the AAP on their “wimpiness”, peds are justified in withholding adequate care for their patients? So, if the local pediatric cardiologist didn’t like your practice, would you withhold a referral for a baby with a heart defect? Besides, this really is a straw man argument b/c the reason LCs don’t like certain practices is b/c they undermine and even destroy breastfeeding!!! If they were making referrals, they would be acting on behalf of breastfeeding, not in opposition to it.
“When a child is learning to walk, and takes tiny steps, we smile and encourage. In the process, the child is clumsy and falls; we still try to encourage the positive movement as steps in the right direction.”
Children learn to walk b/c they are internally motivated to do so. Yes, we encourage them, but th
ey would do it anyway, unless we chained them to their beds. So, why is there no internal drive on the part of so many peds to “learn to walk”? No one has chained them down.
“If you feel the AAP is not doing enough to promote breastfeeding (and please don't paint all AAP members with the same brush!), come share your wealth of knowledge and experience with a pediatrician -- encourage -- smile -- teach.”
I honestly don’t think anyone painted anyone with any brush. All comments were directed at the AAP. OTOH, as has been pointed out through Nancy’s post of AAP policy, it is the vast majority of individual peds who are choosing NOT to follow their own Academy guidelines. So, again, I ask—why do they have no interest in “learning to walk”?
I had to go into court once to testify for a mother in a divorce proceeding b/c the father was arguing that the 8 mos old did not need to continue to bf and could spend overnights with him. The ped came in and stated—under oath—that there was no benefit to human milk after 4 mos!!!! My job was easy—I just quoted the AAP’s own documents. He looked pretty stupid—and should have—and the mom won the case. But tell me, why was her own ped not on her side? How many other mothers in his practice have been undermined in overt or subtle ways by his irresponsible ignorance? Now, multiply this times all the other peds out there who think the very same=2
0things about bf’ing. I am pretty sure that is why they don’t refer to LCs—breastfeeding is utterly insignificant.
I bet if there were professionals entitled “vaccine consultants” who could apply peer pressure to families who chose not to vaccinate, there would be lots of referrals to them. Imagine community support groups a’la LLL where women came to overcome their fears of vaccinating, from other vaccinating moms—yep, I bet there’d be a lot of referrals.
“Enthusiasm and passion are commendable and catching. Don't lose the passion. But please, let's keep it positive. Encourage the toddler to walk by teaching and praising, not by slapping him because he's not walking fast enough.”
Just to be really clear—4 years ago, I learned a lot about posterior TT from Betty Coryllos, via Cathy Genna. First, I referred all my clients to Betty, but she is 3 hours away. Through our local ILCA affiliate, I invited Cathy and Betty to come to CT to speak. Further, we invited 30 physicians to come to an in-service with Betty to be taught the posterior clipping technique. Four came. One is now clipping posterior TTs in CT. He is the only ped doing this between Long Island and Boston. I have been with him for about 100 clippings. He is wonderful and supportive and cares deeply about the families he sees. He and I drove back to Long Island last Spring to see Betty again, b/c he wanted to hone his skills. I personally drove Betty=2
0to her farm in upstate NY after the workshops. She and I have spent countless hours discussing the issues related to TT and improving techniques for better outcome. We introduced Betty to CST/chiro, which she now ardently supports. She and I have given lectures together on integrating these practices for better outcomes. So, I am far from resistant to working with and educating—and learning from--peds. But these are peds who care about moms and babies and breastfeeding and are happy to jump on an opportunity to do better, just as I am always happy to learn to do better. It is not my role to convince peds that infant feeding IS primary care. It is not my role to mandate consequences when peds do not promote breastfeeding. That is the role of the AAP.
I have been informed in the past by docs that they have been reprimanded for not doing enough vaccines. I read that peds are urged not to recommend any other ped to a mother who does not want to vaccinate and to impugn choice-friendly doctors to parents. Does anyone impugn peds who undermine breastfeeding? If this thought process follows—shouldn’t the breastfeeding/formula “choice-friendly” docs be impugned? Again, I am simply drawing an analogy—pointing out that there is no deep and abiding support for breastfeeding among the AAP and hence, very little among the majority of its members.
Suzanne, I think your point
was meant to encourage cooperation, but consider this—we are in the
position of being the lowes
t practitioners on the totem pole---which
means the lowest paid (I am sure there are many LCs who have sometimes
wondered if this is just a very expensive hobby). We are at the mercy
of OBs and peds, who are free to publicly trash us, call us stupid to
our own clients, refuse appropriate referrals (such as for TT),
contradict us freely and insist that clients NOT follow our
recommendations. It is common knowledge that peds will only learn from
other doctors and will not attend conferences where non-MD IBCLCs are
the speakers (there may be exceptions, of course—but we all know this
is generally true). We spend our own time and money to stay current on
this information (we are not “educated” for free by pharmaceutical
companies), we spend countless hours trying to find amenable
practitioners and caring for women in perhaps the most vulnerable time
in their lives. And we should expend even more energy and effort trying
to educate people who ought to be seeking their own education? And we
are going to use that as an excuse to defend the AAP response? This
response did not come from some ped in the community—this ped
represented his entire professional body!!! He set the tone for the
position every other ped is meant to represent. Do you honestly think
it was good enough? Personally, I think the peds
who care about infant feeding ought to be outraged, not defending. And,
as I have said before, I think LCs need to stop wimping out as well. We
are never going to be docile
enough to make the AAP happy (at least I hope not!), so we might
as well start to be effective.
Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network, LLC
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