Why do some healthcare professionals express only lukewarm support for breastfeeding? This is puzzling, since the scientific evidence in support of breastfeeding is overwhelming. Part of the explanation is that, simply put, they are human. One study showed that most healthcare providers depended on their personal experience – or their partner’s – when assisting patients (Freed). Alicia Dermer, MD, a family physician in the USA who also teaches medical students, says “Any guilt or sense of failure they may feel about their or their spouses’ infant feeding choices could affect their feelings about breastfeeding promotion.” To enthusiastically embrace global recommendations about breastfeeding healthcare professionals may have to reconcile their own feelings about their children not being breastfed, or being breastfed for only a short time.
Even today, few doctors receive extensive and practical education about breastfeeding management while in medical school or residency. It can be difficult for them to keep current with research on breastfeeding and myriad other topics. Some of the information healthcare providers get about breastfeeding comes from publications distributed by formula company sales representatives. Even the most dedicated-to-breastfeeding physician must keep up-to-date on many serious diseases and conditions, which can be distracting or overwhelming. No matter what the cause is, a doctor’s lack of knowledge about managing breastfeeding can have an adverse effect on mothers and babies.
A doctor who has little opportunity to learn about breastfeeding may be readily inclined to take the baby off the breast when treating either you or baby. Such a move is rarely necessary. Sometimes healthcare professionals recommend stopping breastfeeding when the mother has breast or nipple problems or must take a medication; or when the baby is jaundiced, has a feeding problem, or has low weight gain. These problems can be treated without stopping breastfeeding.
CHOOSING A HEALTHCARE PROFESSIONAL
So how do you find a healthcare professional who will be helpful to you as you breastfeed your baby? The health system in your country may allow you to choose who cares for your baby. If so it’s best to begin the search during pregnancy and talk with several care providers before selecting one. The Womanly Art of Breastfeeding suggests making an appointment for a consultation with a prospective doctor. Make a list of questions about breastfeeding and health care issues that are important to you.
When you go for the appointment, take note of the materials in waiting and examining rooms. Are there up-to-date printed resources that encourage breastfeeding and offer information about it ?
When you meet a doctor, try to build rapport before you begin asking questions. A positive approach works best. The idea, explains Linda Smith, La Leche League Leader and lactation consultant from Ohio, USA, “is not to confront or challenge the doctor, but to gauge the level of support for breastfeeding in that office, both in theory and in practice.”
Smith suggests, “I might ask what resource the doctor would consult – or to whom he or she would refer me for a breastfeeding-related problem or question. We can’t expect doctors to know everything about breastfeeding, but we can expect them to consult expert resources and, if there is a problem, to refer clients to an LLL Leader or International Board-Certified Lactation Consultant (IBCLC).” Ask if the doctor refers people to La Leche League Leaders and meetings or other local resources for support and information.
POSSIBLE INTERVIEW QUESTIONS FOR POTENTIAL HEALTHCARE PROVIDERS
- What resources would you recommend to help me with breastfeeding – classes, particular books or support groups?
- Who in your office will respond to phone inquiries I may have about breastfeeding?
- Has anyone in your office had specific training in supporting breastfeeding mothers?
- What can I do during labor and birth to increase the odds of breastfeeding going well?
- Approximately, what percent of the babies in your practice are exclusively breastfeeding until 6 months? How many are still breastfeeding at a year or longer?
You may like to show your healthcare provider specific websites, or articles, including from LLLI, on your phone. You could ask the provider what specific and recent education on breastfeeding he or she might have accessed.
Many parents have worked hard to find a breastfeeding-friendly doctor, realizing that this approach may minimize time, effort, and conflict in the long run. However, finding healthcare providers who understand and value breastfeeding is not always possible. Insurance companies, health maintenance organizations, or governments may limit the choice of doctors. Living in a rural area can limit choices because there may be fewer doctors to choose from. Low income or lack of insurance coverage may also limit options.
Some mothers – especially those with limited choices – worry about how to work with their children’s doctors and other healthcare providers to keep their children healthy while preserving the breastfeeding relationship. In this situation, some parents look for a doctor they can rely on to give them sound medical advice and trusts them as parents to make the best decisions for their children. Meg Hill of Germantown, Tennessee, USA, explains, “My children’s doctor was my partner in their health care and I made sure he understood that issue up front. I did not seek, nor did I accept, his advice on discipline, parenting, or nutrition. After more than 20 years of working together, we still have a good relationship and he has always respected my children, my decisions, and me.” Meg decided she would seek support for her choices on breastfeeding, nutrition, and discipline from other sources.
It can help to know for yourself what you want from your child’s healthcare providers. Do you need advice on parenting issues, or solely medical advice? As Cecilia Miller of , Florida, USA, says, “I keep in mind that healthcare providers are problem-solvers by profession, so I don’t bring up issues unless I want their advice.”
It’s not always necessary to engage in a dialogue when you disagree with your doctor on parenting or breastfeeding issues. If you get advice that doesn’t suit you, you can simply say something mild, such as, “That’s interesting. I’ll give it some thought.” Meg Hill says, “I found it helpful to deflect questions that didn’t pertain to my child’s health. When the doctor asked about night nursing, I mentioned that we were doing great and getting plenty of sleep, rather than giving specific details.”
Although you may opt to ignore certain parenting advice, honesty – the basis of a trusting relationship – is essential when a medical issue is at hand. Doctors base their treatment recommendations on what you tell them, so withholding information can inadvertently lead to medical advice that is inappropriate for your child. Also, many doctors view honest feedback as on-the-job training that helps them refine the advice they give over time.
Have Confidence
When you’re working with healthcare providers, it helps to be confident and trust your instincts. You know your child better than anyone and you have the right to make decisions you’re comfortable with. It helps to have a positive approach and remember that you all have the same goal – preserving your child’s health.
Rather than simply reacting to what happens at your appointments, make plans about what you will say and do. Here are some positive, proactive ideas:
- When you go for well-baby check-ups, talk about how you and your baby are benefiting from breastfeeding and your positive feelings about it. Many doctors deal with breastfeeding only when there is a problem, so they may not realize how often it goes well and how enjoyable it can be for all concerned.
- Do your homework. Confidence comes from knowing what you want and why. Feel free to turn to La Leche League Leaders. While Leaders do not give medical advice, they can provide breastfeeding information, help you think through the situation and your options, and locate information to help you make decisions about your child’s care.
- Mention to healthcare providers any community resources, such as LLL, that have helped you with breastfeeding.
- Provide information when the opportunity arises. Cecilia Miller says, “I have often taken the time to discuss issues with my children’s doctor or write to him later and provide him with additional facts. He has always accepted my gentle, informed suggestions, and I hope that I’ve helped future patients.” Another mother often brings an article or two that the doctor might find interesting when she comes for well-child visits.
- You never know what long-term effects your breastfeeding dialogues may have – more than one healthcare professional has changed their mind after observing a breastfed baby in real life!
How to Talk So Health Care Providers Will Listen
When speaking with healthcare providers, it helps to follow guidelines that apply to most interpersonal communication:
- Remain calm. It sometimes helps to lower your tone of voice and speak slowly.
- Make eye contact, which demonstrates sincerity and resolve.
- Be firm, tactful, and friendly – not hesitant, defensive, or antagonistic.
- Look for areas of agreement.
- Use “I” messages, such as “I feel strongly about ….”
In a complex or difficult medical situation, it may help to present a united front by attending appointments with your child’s other parent, or a support person. If this isn’t possible, you can still include the other parent verbally (“My co-parent/partner and I feel that…”).
Here are some more tried and tested suggestions you may want to apply when speaking to health care providers, :
- Think through your approach in advance, if possible. You may wish to practice out loud.
- Be clear about your feelings and goals. Stating them initially keeps you from being on the defensive and makes it easier for your health care provider to adapt advice to your preferences. You might say, for example, “Our family has a history of allergies and I feel strongly about exclusive breastfeeding. Are there treatment options that allow for continued breastfeeding without giving formula? “
- Ask for a complete explanation of any proposed treatment, including the reasons for the advice, the alternatives, and the possible result if you don’t follow this advice.
- Repeat what you’ve heard in your own words. This can prevent confusion and show the impact of the other person’s words on you.
- Make statements in a positive way – for example, ‘I’d like to try encouraging my baby to breastfeed more often before considering supplements,” rather than “I don’t want to give supplements.”
- Try the “broken record” technique if a disagreement arises – simply restate your basic position calmly and quietly at each opportunity. For example, “I appreciate your concern about her health, but now that she’s breastfeeding well, I’d like to monitor her weight for another week before we consider other options.”
- Keep in mind that although the doctor is a medical expert, the ultimate responsibility for a child’s health lies with you. You can reflect this by asking, “You’d like my permission to… ” or stating, “If I’m understanding correctly, your recommendation is…”
Remember that you can always call the doctor back if you don’t have the time or composure to get the facts straight during an office visit.
If you get breastfeeding information that doesn’t sound correct, you may wish to ask for references – especially when supplementation or weaning is recommended. You might say, “I hadn’t thought of that. Could you please suggest some reading or articles to me so our family can read them and better understand your position? I don’t want to make this decision until we’ve reviewed the research.” Asking for references can also help if your child develops an unusual condition or illness. Being an informed consumer helps you get better care.
If, despite your best efforts to work with your child’s doctor, you’ve still getting advice you’re not comfortable with, consider your options. You have the right to:
- Seek a second medical opinion, perhaps with a health care provider more experienced with breastfeeding.
- Refuse treatment.
- Find a new doctor.
- Speak with your insurance company or health maintenance organization, especially if you’re unsatisfied with the quality of medical care you’ve received and have limited options.
Conclusion
It’s not always easy to find healthcare providers who understand and support breastfeeding. Still, many parents have been able to preserve their breastfeeding relationships and work successfully with the health care providers they have. Some parents have even taken steps to help their doctors become more breastfeeding-friendly.
There are reasons to be optimistic about the future: The Academy of Breastfeeding Medicine, a worldwide organization of physicians, is working to promote, protect, and support breastfeeding and facilitate optimal breastfeeding practices. Many organizations, including La Leche League, offer materials and training to educate healthcare providers.
Further reading and Resources
Importance of Breastfeeding: https://llli.org/breastfeeding-info/benefits/
Medications- A Quick Guide for Parents: https://llli.org/breastfeeding-info/medications-quick-guide-parents/
GP Infant Feeding Network, in the UK: https://gpifn.org.uk/
American Academy of Pediatrics, Section on Breastfeeding https://www.aap.org/en-us/about-the-aap/Sections/Section-on-Breastfeeding/Pages/SOBr.aspx
Academy of Breastfeeding Medicine, an international organisation https://www.bfmed.org/
References
Freed, G.L., et al. National assessment of physicians’ breast-feeding knowledge, attitudes, training, and experiences. JAMA 273, 6: 472-476, 1995.
Surgeon General’s Call to Action to Support Breastfeeding https://www.surgeongeneral.gov/library/calls/breastfeeding/factsheet.html
Updated from an article originally published in New Beginnings, November-December 1999