This post is the 53rd in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.
Milk supply concerns are a top reason why women stop breastfeeding before they want to. So you’d think that our health care providers would be equipped to help solve milk supply concerns, right?
Unfortunately, wrong. In a 2004 study of obstetricians’ and pediatricians’ opinions and practices regarding breastfeeding, the authors found a significant number* of pediatricians recommending formula supplementation for healthy infants with slow weight gain. This is consistent with an older study which found that more than 30% of physicians chose incorrect advice for mothers with low milk supply.
Of course, sometimes formula supplementation is necessary. But “recommending supplementary feedings with formula to a breastfeeding mother,” the authors of the 2004 study note, and “may impede successful breastfeeding and might be unnecessary.”
The result? “Mothers whose pediatricians recommended formula supplementation for a healthy infant not gaining enough weight were more likely to discontinue exclusive breastfeeding.”
The alternative to recommending formula is to assess what’s happening with breastfeeding and develop a plan to fix any problems. In fact, this is how the American Academy of Pediatrics describes as the pediatrician’s role: “Become knowledgeable in the principles and management of lactation and breastfeeding; Develop skills necessary for assessing the
adequacy of breastfeeding,” and “Coordinate with community-based health care professionals and certified breastfeeding counselors to ensure uniform and comprehensive breastfeeding support.”
So, why would pediatricians recommend formula instead of helping to fix breastfeeding?
1) Because they might not understand the implications of their recommendation. The authors note: “Several studies…have found that pediatricians, obstetricians, and family practitioners may not know that supplementing during the first few weeks of life can cause breastfeeding failure.”
2) Because even if they understand this, they might lack the skills to help. The study found that 56% of pediatricians said that they were not confident in their skills in “resolving problems with mothers not producing enough breast milk.” As I’ve written before, pediatricians generally get inadequate training on breastfeeding management, and report not knowing enough to support their patients.
3) Because even if they do have the knowledge and skills, they don’t have enough time to help solve breastfeeding problems. 48% of pediatricians identified “limited time during preventive visits to address breastfeeding problems” as a very important barrier to providing effective breastfeeding support.
4) And because if they want to refer mothers for more help, they might not know how to do it. 51% of pediatricians said they weren’t confident of their knowledge of what referral services exist for breastfeeding support.
Interestingly, the study found that mothers who relied on books and other print materials had higher rates of exclusive breastfeeding. Whether that was that was due to better advice or because they had a higher level of commitment which led them to seek out resources on their own is not clear.
The good news is that this is not an insurmountable problem. As we’ve pointed out before, simply training pediatric residents better (with a free curriculum developed by the American Academy of Pediatrics) results in better clinical skills and translates into higher rates of exclusive breastfeeding.
This may be little comfort if you’ve received bad advice about supplementation, but it’s a cause for hope for future moms and babies.
If you have concerns about milk supply and are looking for help, we recommend seeking the help of a trained breastfeeding support person, such as an International Board Certified Lactation Consultant. We also highly recommend The Breastfeeding Mother’s Guide to Making More Milk, and you may want to listen to this podcast with co-author Diana West. And you’ll find good websites listed on our breastfeeding resources page.
Were you told to supplement with formula when what you really needed was breastfeeding help? How did it affect your breastfeeding experience?
*The percentage was not included in the study, but it was significant enough to produce a measurable effect on exclusive breastfeeding for patients of those physicians. I contacted a study author to request the number, but the data has been archived and is not available.