Pediatricians: when to stay and when to go

One of the keys to a great breastfeeding relationship is a supportive care provider for your child. Many pediatricians claim to be supportive of breastfeeding however the advice they offer is far from supportive. So why do we get this bad information and how can we weed out the good information from the bad? It is hard to look at a doctor and say "no, i think you are wrong". Generally the train of thought is "they went to medical school, they must be right". But how much education on breastfeeding did they actually get?

In 1999 a study was publicized by the AAP that actually asked doctors how they supported breastfeeding in their practice. The entire study is an interesting read, but the responses show that not all doctors are comfortable with breastfeeding advice and many are not offering advice that the AAP recommends. Only 58% had actually received breastfeeding management training during their residency. This means that over 40% of pediatricians who responded had NO breastfeeding management training. 72% of pediatricians who responded had no idea about the new initiatives to make hospitals baby friendly and even more had no clue if the hospital they were affiliated with was working to become baby friendly. Only 65% of pediatricians actually recommended to moms to exclusively breastfeed and only 37% of the pediatricians who responded to the survey encouraged breastfeeding for at least a year. http://pediatrics.aappublications.org/content/103/3/e35.long

While this study was done over 10 years ago it highlights the attitude that not all pediatricians are created equal and assuming that just because your doctor has a medical degree means they understand breastfeeding is a dangerous assumption. 

So what can you do?

First off, interview your pediatrician! Pediatricians are used to this. Many actually have a meet and greet so respective parents can come visit. the AAP actually has a great handout with questions to ask at an interview.http://www2.aap.org/breastfeeding/files/pdf/AAP%20FindFriendlyPractice.pdf

If you disagree with what your pediatrician says say so! State "You know, i don't really feel comfortable with this". Explain your position. Reschedule another appointment and return to your doctor with documentation helping to support your feelings. 

Remember YOU are paying your doctor for a service. While your doctor went to medical school, that doesn't mean they are always right. If you don't like your pediatrician simply walk away and find a new one. 

Some warning signs that your pediatrician is not as breastfeeding friendly as they state:
- informing you to schedule feedings (only 15 minutes every 2 - 3 hours)
- Encouraging early night weaning (ie: your baby should be sleeping through the night by 6 months)
- Encouraging cry it out 
- Pushing to start rice cereal early to help "baby sleep better". 
- Pushing solids in the first year. Food before 1 is just for fun!
- Encouraging you to quite breastfeeding for nipple pain/latch issues. 
- Not being encouraging of working with a lactation consultant
- saying things like "after 6 months there is no value in breastfeeding" 
- encouraging formula supplementation without talking with a lactation consultant. 

If you have a breastfeeding concern ask your pediatrician about talking to a lactation consultant before doing any supplementing with formula. A lactation consultant, specifically an IBCLC, is trained in breastfeeding support. They can help identify a milk transfer issue, a tongue tie, or a true supply issue. Most pediatricians are not trained to correctly identify these issues. Working together with a lactation consultant and pediatrician when issues arise is key. 

Remember that there are many parenting styles and there are many pediatrician styles. Find a doctor that you mesh with, not one that your best friend uses. Think about what is important to you to get from the doctor. Do you want someone who is more hands off and relaxed? Someone who has a checklist of questions? Someone who is female? Someone who has weekend and night hours? Also remember that your childs primary care doctor does not have to be a pediatrician. Many women use a family doctor instead if there is no pediatrician near them they like. 

The key take away from this is that as parents we need to question and research everything on our own. There are lots of wonderful supportive doctors who are great at helping moms breastfeed. There however are also lots of doctors who haven't read the newest information released by the AAP and WHO or whom haven't kept up to date with breastfeeding information. If your doctor tells you something that sets off a warning bell, ask around.