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Monday, January 14, 2008

You mean those things are for milk???

Image courtesy of La Leche League, International

A question emailed to DrDrama:

"Why [does] it seem to be so hard to find a doctor who is really knowledgeable about breastfeeding or at least knows enough to put the parents in touch with a lactation consultant rather than just telling them to give formula instead? I'd be interested in hearing about your personal experiences learning how to breastfeed compared to what you learned in med school [and residency] about it."

I think what pediatricians are taught about infant nutrition has changed over time. Around the time of the introduction of mass market formula (btw, did you know Similac stands for "similar to lactation"? Genius marketing tactics.), many pediatricians touted the benefits of formula feeding during the infant period. Thus, you have several generations of our mothers and grandmothers who never breastfed their babies and in fact, sometimes view it as vulgar (yes, someone told me that once).

Fast forward to the 80's. It is a time of shoulder pads, big hair, bigger earrings and Miami-Vice inspired fashions. In the midst of all that, docs start practicing evidence-based medicine and we start during biochemical analysis of breast milk and we discover that lo and behold, breast milk actually has good stuff in it. Stuff like antibodies, easily digestible proteins and such. So slowly, the recommendations start to change. So officially, we all know the AAP recommendations (or at least I hope we do) to preferably exclusively BF for the first 6 months and ideally a year or more. We are taught from day one that "breast is best". We would love it if everyone did. Pediatricians "know" that breastmilk is the way to go, but to be honest, most just want the kid to gain a healthy amount of weight, breastmilk or not. I think this is a holdover from the heyday of formula, but that opinion is slowly changing.

I had the advantage of having trained with a couple of pediatricians who breastfeeding gurus and one of whom has probably coached every new mother on our staff through the early weeks of breastfeeding. I emailed her questions and paged her when I had a plugged duct 9now that's service). That is one of the perks of being on the inside of the medical field. Most people aren't that lucky. Our hospital's newborn clinic really pushes to have women breastfeed as much as possible, but they have the luxury of time to allow a new mom to breastfeed and to be coached by experts. I have seen a particular doc take up to 45 minutes helping a baby learn to latch on. I think that some pediatricians outside of an academic setting wouldn't always know when to refer someone to La Leche League or a lactation consultant.

I think the main constraint many new BFing moms run into is time:
-the lactation consultants in the hospital are overwhelmed with requests
-the initial pedi visit is relatively short in most non-academic clinics and there is an emphasis on the baby's weight gain
-no one really tells you that it can take up to 2 months to really get the hang of BFing

I will say that my BFing experience was probably just as frustrating as anyone else's. I did do a couple of things that experts say not to do, but I was like, "Screw it. My ass hurts, my boobs hurt and I am wearing feminine products that look like torture instruments. I need some sleep". I will preface what I did with the fact that I wanted to send my daughter back almost every single day for the first 6 weeks. I am not sure where I would have sent her, but I wanted her to go there! BFing can be an incredibly frustrating experience, especially for someone who is a bit of an occasional a control freak like me. Here's what I did (by no means an expert).

-I sent my hubby to the nurses' station (okay, I yelled at him; details, details) to get a stash of bottles of formula, just in case. I gave her an ounce and she spit it up. I then spent 10 minutes crying that "I didn't like the way the formula looked in her mouth" and tried to get her to latch on again. That was the last of formula for a 7 months.
-I pumped during the first weeks home to relieve the pain and to have enough bottles so that my darling husband could do some nighttime feedings.
-I gave her a bottle of pumped milk in the first week, nipple confusion be damned

I sort of viewed the whole initial BFing process as a battle that I was going to win because I gave myself no other option. But I held onto those Similac bottles like a talisman. I was extremely lucky to have a husband and a mom who both supported and helped me with the whole thing, so I made it with exclusively BFing for 6 months. Someday though, I will be taking my boobs back someday, I hope!


Amanda said...

The best thing I did when it came to starting BFing was to schedule an appointment with a lactation consultant a couple of days after leaving the hospital. Neither my mom or mother in law ever BF. A friends good experience was all that was driving me to trudge along. Without the encouragement from the LC that our latch was good, our daughter was gaining weight, and that the discomfort would end I couldn't have kept going. Thankfully my peditricians office is very BF friendly, and many of the doctors are also certified LC! I don't see why more doctors do not do the same.

DrDrama said...

I completely agree. I am thinking of becoming an LC at some point, as well. I think it is such a useful thing to know how to do as a pediatrician.

Melissa & Jon said...

I can't even imagine how many mothers would be elated to have a pediatrician who was also an LC. With Grant in isolette over the course of the first couple weeks, I had a lot of comments from nurses that basically said to make things easier for myself and just let them give Grant a bottle. I was lucky that our hospital's LC was an amazing advocate for us. She really went above and beyond and even helped me push to be given medications that would allow me to pump and not have to pitch my milk, but have it be able to be given to Grant. I made it through that without giving Grant a drop of formula, but there is no way I could have done it without help!!!

Michelle said...

this is why you need to have a practice and I can be the lactation consultant for your patients. seriously!

Anna said...

Seriously. If you were in private practice and were a lactation consultant (or hired Michelle), I would be banging down your door.

Val said...

I hope to be able to get the same breastfeeding tutorial you got from Deb! :) I should schedule her in now.

Mandy said...

I didn't even have the benefit of a LC in the hosptial where I delivered -- just a revolving door of nurses who all told me something different. My favorite was the one who (after 10 min with us) left the room commenting that I shouldn't be in so much pain because I'm a brunette and saying that she was going to get me a bottle of formula. This from the woman who reprimanded me for not "toughening up" my nipples with a towel prior to delivery :)

Luckily my pedi was far more knowledgable and supportive.

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