Bridging the Divide Between Breastfeeding Mothers and Their Doctors

I am on the phone with the pediatrician again.  Not my regular one – she is on maternity leave – but another doctor from her group.  It has been a long last couple of weeks for me and my 13-month-old son.  He’s had a persistent, reoccurring ear infection and has been prescribed a very powerful antibiotic, since the more mild antibiotics he was prescribed a few weeks ago weren’t helping and he continued screaming in pain every time he would lay down on his left side.  I am sleep deprived and frustrated.

These new antibiotics seem to have done their job.  The infection has cleared up – no more screaming – but we are left managing a side effect from the antibiotics: severe diarrhea.  I’ve called the doctor this time because my son has broken out in a screeching, fire-engine red diaper rash.  I was initially concerned about an allergic reaction to this new antibiotic, but I soon realize what is really going on when I begin to feel a persistent, needle-like, almost itchy sensation deep in my breast tissue.   Yeast.

But, the doctor disagrees with me.  “They’re completely unrelated, “she says flatly.  “If you have a yeast overgrowth in your breasts, you did not get it because your son is taking antibiotics.  He is just sore from all the diarrhea.  Continue giving him the medication until it is all gone, put some Desitin on the rash, and things will be fine in a few days.”  She says nothing about why I might be experiencing pain in my breasts. I roll my eyes, but thank the doctor for her time and hang up.  

The new mom I was five years ago probably would have believed what she was being told and followed the doctor’s advice.    After all, I’m not the one who went to medical school.  But the mom I have become after having breastfed two children over the last 5 years has learned the hard way to be a very skeptical creature when it comes to medical ‘advice’ as it pertains to breastfeeding, and I suspect this doctor of being either misinformed or ignorant.

My skepticism is confirmed when I flip to pages 480-484 of my copy of “The Breastfeeding Answer Book” – a nearly 700 page treatise of breastfeeding information that cites nearly 400 peer-reviewed medical publications.  Sure enough, right there in black and white I read what this doctor apparently never learned in medical school, or during her years of practice – that yeast overgrowth (a.k.a. thrush) is, in fact, associated with antibiotic use in either mother or baby , and that a mother and her nursling(s) can pass a yeast overgrowth back and forth to each other.  According to the book, successful treatment means that “…both mother and baby will need to be treated simultaneously…” because yeast can be difficult to get rid of.  A quick call to my local LLL Leader helps me narrow in on some treatment options to try (the book lists quite a number of them) and in a few days with the help of some probiotics and over the counter antifungal creams, both my son and I are feeling better. 

I wish I didn’t have to be so skeptical.  I wish I could just trust that the information pertaining to breastfeeding or my status as a nursing woman I hear from my and my children’s doctors is accurate and evidence-based.  I mean, we’re talking about the normal way to feed a baby here, right?  We’re talking about a way to feed a baby that has been demonstrated, among other things, to result in lower rates of childhood obesity, type 1 and 2 diabetes, leukemia, SIDS[i], higher IQ[ii] and even better emotional well-being[iii].  And, we’ve all seen the study that suggests it can reduce a mom’s risk of premenopausal breast cancer by 60%[iv].  60%! Why wouldn’t our doctors be all over that?

Unfortunately, however, between my two children who have been seen by various pediatricians from several practices and doctor’s groups and my experiences with my own personal physicians is that it is just not the case.  Instead, my experience has been that among the medical community in general – and, even among those that we would most expect to be knowledgeable such as pediatricians, nurses, midwives (yes, even midwives), and obstetricians –ignorance and misinformation regarding the fundamentals of lactation and the basic dynamics of a mother/baby breastfeeding relationship abound.  And, despite my best efforts, I have yet to find a local pediatrics practice that actually follows American Academy of Breastfeeding Medicine protocols for a breastfeeding-friendly office (although I do know there are a few in the greater Chicago area).  

What I have gotten, at best, is a lot of lip service about pediatrics practices being ‘breastfeeding friendly.’   Offices have claimed to be ‘breastfeeding friendly’ even though their patient handouts use the terms “breast milk” and “bottles” interchangeably, they have free formula samples and coupons littering the waiting room and stacked behind the front desk, they use infant growth charts with formula company names stamped on the bottom, they offer new parents no information about safe co-sleeping, and they often reinforce the idea that at a certain age, babies “should be sleeping through the night” while giving no consideration as to whether or not this is a good thing for a mom’s milk supply.  And, I have never found a local practice that has an IBCLC on staff holding regular hours for appointments (although I have observed that a few have given referrals to local lactation consultants in independent practice).

So, what’s a nursing mom to do in this environment of indifference, ignorance, and misinformation?  I’m no expert, but this is the way I’ve learned to handle it for myself and my children, sometimes learning the hard way:

Be a critical thinker and know where to go for trusted, evidence-based information regarding breastfeeding

Always, always, always, double-check with a trusted, up-to-date, and evidence-based source to make sure that you are getting accurate information from your health care provider.  This might be a person who can help you locate the information you need such as a breastfeeding counselor, group leader, a CLC or IBCLC, or it may be an online or print resource that you go to directly yourself.  Examples that I have found especially helpful are: LLLI handouts or books such as The Womanly Art of Breastfeeding or The Breastfeeding Answer Book, Breastfeeding Answers Made Simple, Breastfeeding USA information, The American Academy of Breastfeeding Medicine’s protocols, the InfantRisk Center, etc…

Be an advocate for your baby, yourself, and your nursing relationship

It has been my experience that health care providers seem to forget that even though the cord is cut after birth, moms and their nursing babies are still biologically and emotionally connected through the act of breastfeeding.  From time to time, you will need to remind care providers that you are involved in a nursing relationship with your baby (or babies) and that when a physician is treating one of you, they are really treating both (or all) of you.

This also means that in addition to locating breastfeeding-friendly care for your children, you need to keep in mind that you need to find breastfeeding-friendly care yourself, whether it be a gynecologist, primary care physician, or a mental health care provider.

Trust yourself and what you know to be true

According to the Surgeon General’s Call to Action to Support Breastfeeding (2011), “Inadequate education and training of clinicians has been identified as a major barrier to breastfeeding, and education on breastfeeding is not a core element of most medical school or residency programs or of programs in nursing education. Unfortunately, there are few opportunities for future physicians and nurses to obtain education and training on breastfeeding, and the information on breastfeeding in medical texts is often incomplete, inconsistent, and inaccurate. ” (p.46)

What this means is that it is entirely possible that even your average nursing mom does know more about breastfeeding than your average doctor.  Trust that if you are informing yourself from up-to-date, evidence-based sources you are doing the best for you and your baby.

Be respectful and choose your battles wisely

Let’s face it.  Until doctors undergo the education they lack, this situation presents a huge grey area with the potential to threaten the doctor/patient relationship, which is predicated on the notion that doctors are the trusted experts.   Plus, health care providers are people too, and no one likes to be told they are wrong.  Confrontation, accusations, and show-downs are likely to be met with hostility.  When you have concerns, bring them up, but do so in a firm, but respectful way.   I like to bring evidence-based print resources with me to appointments (like my copy of The Breastfeeding Answer Book), and just hand them over while simply asking, “But, what about this?”  This forces the doctor to argue with the data, and not with you.

Compromise

While I haven’t been able to locate a local pediatrics group that I would consider truly breastfeeding friendly, I have been able to find a physician within a group who treats me with respect, listens to my concerns and takes them seriously, respects my breastfeeding relationship, and is open to new information.   Needless to say, I do my best to make my appointments with only her.  It has been my experience (and economic privilege) that access to a doctor like this is a truly valuable resource worth its weight in gold.  I’m grateful to have found her for the care of my children.

But moms, change won’t come if we just grin and bear it.  We moms need to speak up and demand that it is not good enough for our medical care to just be breastfeeding-marginally-neutral.  In order to help moms meet their personal breastfeeding goals; we need health care providers who are truly supportive.  It is my plan to write the management of my children’s doctor’s group a letter telling them about my experiences.  I hope to demonstrate that there is demand among moms for doctors who practice in truly breastfeeding friendly environments, and we can and will vote with our feet.

Now, because I’d like to end this post on a positive note, and send the love out to local physicians who are helping to support breastfeeding moms, tell us Chicago moms, what experiences have you had with a truly breastfeeding-friendly healthcare provider?

Author Bio:

Elise is a proud breastfeeding mom of two who lives in the Western suburbs of Chicago with her wonderfully supportive husband.  When she is not wasting time on Facebook, cleaning up after her children, or trying to keep up with her garden, she works part-time as a freelance museum consultant and is also the owner of Sling Savvy, a resource for parents and educators interested in learning about the benefits of simple, fabric baby carriers such as slings and wraps.  She underwent breastfeeding peer-counselor training in 2010 through LLL, and is passionate about mom-to-mom support.  She facilitates breastfeeding and babywearing classes for expectant mothers at Elmhurst Yoga Shala. She would like to thank her mom for breastfeeding her. 


[iv] http://archinte.ama-assn.org/cgi/content/abstract/169/15/1364

[Editor’s correction: Recent research shows no correlation between antibiotic use by baby and yeast overgrowth in the mother. Breastfeeding Answers Made Simple contains up-to-date evidence on this issue.]

3 thoughts on “Bridging the Divide Between Breastfeeding Mothers and Their Doctors

  1. Glad you followed your instincts! It took us 3 physicians before being referred to a breastfeeding-friendly office. She treats the whole family, so when something affects one of us, she includes all of us in the treatment. And her first response is always to imply that a mother is breastfeeding, instead of bottle feeding or formula feeding. She is amazing! Keep searching… You may find one yet.

  2. Hi Elise, As the coauthor of The Breastfeeding Answer Book (BAB), I’m sorry to say that the information you quoted in your article is out of date. That book was written nearly 10 years ago and more current evidence indicates there is no connection between baby taking antibiotics and yeast overgrowth in the mother. (This doesn’t mean you couldn’t have developed an overgrowth of yeast in another way, but I would encourage you to consider other possible causes for your symptoms.) You also mention my book Breastfeeding Answers Made Simple (BAMS). That is the most up-to-date reference. I encourage anyone who still has BAB to replace it with BAMS. –Nancy Mohrbacher, IBCLC, FILCA

  3. I’ve changed doctors and pediatricians numerous times since I first became a mother in 2005, and none have been truly knowledgeable or supportive about breastfeeding until recently, when I came to Homefirst. Every single doctor at this practice knows their stuff, and is fully committed to supporting women in their breastfeeding goals. Dr. Rosi especially, is my favorite breastfeeding-friendly doctor. Whenever I’ve seen him for some type of treatment & I remind him that I’m still nursing, he gives me the biggest smile ever, showers me with compliments, gives me all kinds of interesting breastfeeding facts, and tells me fascinating stories of his work with mothers over the years. He’s a lactivist too, and has been incredibly supportive of my desire to become a midwife and IBCLC. I’m done nursing now, but was very happy with their practice as a nursing mom.

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