Booby Traps Series: Moms with breastfeeding pain suffer when providers don’t know how to help

by Tanya Lieberman, IBCLC | August 27, 2012 9:15 am

This post is the 55th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

Pain with breastfeeding is a leading cause of early weaning.  So when moms are in pain and turn to a health care provider, what kind of help do they get?

According to a recent study, it’s often not great.

Research from several studies has shown that obstetricians and pediatricians get poor training in breastfeeding management, and lack confidence in their ability to help nursing moms.

One study found that 67% of pediatricians and 39% of obstetricians don’t feel very confident in their skills at resolving problems with breast pain or cracked or painful nipples.  Significant numbers said they weren’t very confident in their skills at teaching mothers about basic breastfeeding techniques such as positioning.  And 51% of pediatricians and 26% of obstetricians report not feeling very confident of their knowledge of what referral services exist for breastfeeding support.

Some new and especially interesting evidence of the problem comes from a study published last year.  It provides a glimpse into how some providers support moms suffering from pain, and it’s not pretty.

The study, conducted at a large Southern obstetrical practice, reviewed the charts of 117 breastfeeding moms who sought help for breastfeeding pain of different kinds.  Mothers asked for help for mastitis (68%), candida (32%), engorgement (18%), nipple tenderness (8%), and clogged milk ducts (5%).

The results of the chart review?

• Inadequate breastfeeding support and management were evident.
• Non-evidence-based recommendations were routinely practiced.
• There was little documentation of breastfeeding support beyond prescribing medications, and non-pharmacological measures (such as education and help with latch and positioning) were rarely recommended.
• There were few referrals were documented to specialized providers such as lactation consultants or community support groups.
• Routine discussions about infant feeding choices and breastfeeding counseling were rarely documented.

The area in which the advice appeared poorest was in support for women experiencing engorgement.

I asked the study’s author about evidence that providers were helping mothers with the basics of breastfeeding - latch and positioning - which can eliminate pain in many women.  She said that there was no indication that anyone was helping with latch and positioning except in the case of mastitis, and that the amount of hands-on assistance was “non-existent.”  Of course, it’s possible that help was being provided but not documented, but having worked in hospital and pediatric settings it would be a bit surprising to me if the providers took the time to give this kind of assistance and didn’t record it.

As with my similar discussion of providers’ support for milk supply problems, this is a fixable problem.  As research on the American Academy of Pediatrics’ residency curriculum demonstrates, when providers have good skills moms have better breastfeeding outcomes.

If you’re experiencing breastfeeding pain, we strongly encourage you to seek the help of a trained breastfeeding support person, such as an International Board Certified Lactation Consultant or a WIC breastfeeding peer counselor.  You may also want to check out our breastfeeding resources page for recommended websites and other resources.

Source URL: http://www.bestforbabes.org/booby-traps-series-moms-with-breastfeeding-pain-suffer-when-providers-dont-know-how-to-help

---