Booby Traps Series: What you should hear (and not hear) at your prenatal visits

This is the second in a series of posts on Booby Traps™ during pregnancy, made possible by the generous support of Motherlove Herbal Company.

Last week I wrote about one of the first Booby Traps™ many moms encounter:  providers’ lack of education about breastfeeding.

Your comments on that post beautifully illustrated the range of what we actually experience  in those prenatal visits.  That’s the topic of this post, so I thought I’d start with a few of your comments – my highlighting added – that point out the good and bad in prenatal visits:

My OB asked about breastfeeding and some birth preferences at my very first appointment!She also has a sign in her office waiting room that says something like, “Breastfeeding is welcome here. Let us know if you prefer a private area.” This is the same OB who congratulated me when I first came to her and mentioned I was still BFing my toddler. I know that she is a rare gem, though. I wish more doctors in general were as pro-breastfeeding as she is. After all, it is pro-good health for everyone involved. – Jorie

I don’t recall either of the OBs I went to asking if I was planning on breastfeeding. Both gave me a bag of marketing materials from several companies including 3 samples of formula each. I never thought twice about asking if my docs or my baby’s future pediatrician were pro breastfeeding. Since having the little guy, we switched doctors and my first question was if the docs I had in mind were pro breastfeeding. As soon as I asked, I was transferred to two lactation nurses who are available M-F during business hours to help with any feeding issues. I never even knew that this was a free service. Its so amazing that these resources are not advertised…Great article! – Veena

I am so lucky. My Ob was my OB with my last child. I also know she pumped at work for a long time with her youngest. I told her I was planning to breastfeed and she told me that we would make sure my high blood pressure meds wouldn’t mess with breastfeeding. I know she knows I will breastfed and she totally supports me. She has no posters supporting formula in her office. Glad to have a supportive OB! – Kelly

I was with an OB until 20 weeks with my first son and never heard a peep from her about breastfeeding. All she told me was to take prenatal vitamins and stop eating fish.  I had my first son under the care of midwives at a free-standing birth center and my second with a different midwifery practice at home. In both cases, we discussed breastfeeding often during prenatal appointments. I got such great care and support after my first was born with everything from a proper latch to the range of holds and positions that I had a great breastfeeding relationship with my first son that lasted 27 months and needed no help at all with number 2. – Kim

Research tells us that we make our feeding decisions early in our pregnancies, and that our providers are very influential in those decisions.  So, what should we be hearing at our prenatal appointments?

Here are some of the things I wish all mothers would hear.  Of course, all of this discussion should occur in a judgement-free zone.

  • An opened ended question about feeding, such as “Have you thought about how you’re going to feed your baby?” or “What are your plans for feeding your baby?”  The provider should be prepared to discuss the importance of breastfeeding to her baby’s health (and hers), and about current recommendations.
  • “What questions or concerns do you have about breastfeeding?”
  • “Here’s a list of breastfeeding support resources in our area.”
  • “Have you signed up for a breastfeeding class?”
  • “Here’s what you can expect to happen with your breasts during pregnancy as they prepare for breastfeeding…”
  • (If this is not your first breastfed baby) “How did breastfeeding go with your other baby(ies)?  Is there anything you’d like to discuss about that experience that might relate to your new baby?”
  • “There are two things we like to ask so we can prepare for a good breastfeeding experience:  Have you ever had any breast surgeries?  Has anyone ever checked to see if your nipples are inverted?  If not, I can do that when we do a breast exam.”

Here are some things you should not hear or see about breastfeeding in your provider’s office:

  • (Silence)
  • “Here’s your free bag of goodies, including some formula – just in case.”
  • Anything that would make a mother feel judged for her feeding decisions, no matter what she decides

I’m not the only one who thinks that these are topics that should be covered in your visits.  The American College of Obstetricians and Gynecologists (ACOG), has a statement on breastfeeding which encourages OBs to begin supporting breastfeeding during prenatal visits – starting with the very first one.  They promote discussing the advantages of breastfeeding (specifically exclusive breastfeeding), exploring any barriers to breastfeeding, discussing normal breast changes in pregnancy and breastfeeding and checking for inverted nipples, reassuring mothers about their ability to breastfeed, and promoting prenatal education on breastfeeding. 

Remember, if you don’t like what you’re hearing or seeing, you can advocate for change or in most cases select a more supportive provider.  As you can see from the stories in this post, there are some great providers out there!

What kind of things did you hear at your prenatal visit?  Please leave a comment telling us about your experience!



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14 Comments | Last revised on 02/23/2011


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14 Responses to Booby Traps Series: What you should hear (and not hear) at your prenatal visits

  1. Evin Cooper says:

    I was not terribly impressed with my OB until I mentioned that my toddler was ill and how grumpy I was at how many times she’d been sick since I stopped nursing her, and how I’d still be nursing if I hadn’t gotten pregnant. She said “Your milk should be coming in soon, just start nursing her again. It’ll be good for both of you.” in a totally matter of fact way. All of a sudden I was in love with my OB :)

    When I got my “goodie bag” from her, there were a few formula things but most of it was cool stuff, including a full size copy of What to Expect, and I took out all the formula crap and set it aside. She came in to talk to me, saw all the formula stuff sitting there and just scooped it up into the trash. She’s a little bit awesome :)

  2. Daralynn says:

    When my milk was drying up and I wanted help from my Doc ( prescription) she told me formula fed babies are just as healthy as Breastfed babies, GGRR

  3. Janine says:

    I grew up around breastfeeding – I watched my mom breastfeed my brother when I was seven, and there are pictures in my baby albums of me at the breast – and never thought to bring it up. The doctor who saw me at prenatal appts and delivered my son is also our pedi and she seems pro-breastfeeding but not super passionate, or maybe she could just tell I was passionate and never felt the need to press it further than that. She examined my breasts on my first visit and asked about breastfeeding.

    I didn’t realize until this week just HOW pro-breastfeeding my hospital was. I delivered at Adventist hospital in Portland and they were amazing. Although they did keep swaddling my newborn before handing him to me (I wanted skin to skin!), the nurses were breastfeeding supportive. I got a little card on his bassinet that said “I’m a breastfed boy!” (I still have it on my fridge!) and a lactation specialist met with me within hours of his birth.

    I also had a follow-up lactation appointment. I almost blew it off because I was just so tired but they were very pushy, which I appreciate in hindsight. Also, going through old paperwork this week I realized that I had two huge packets of breastfeeding information! I don’t remember whether or not I read them (newborn haze), but there was a lot of good stuff, including a chapter called “Getting through the first 6 weeks”.

    We’re pretty BF-friendly in Oregon, although one of my best friends didn’t have support and ended up using formula, so there are still issues. (She is also very low income, which makes it suck so much more because breastfeeding would have saved her money too!)

    Lastly, my son is in the 91st percentile for weight (after being born at 7 lbs) and at our last visit our doctor looked a bit concerned until we said he was only getting breast milk at which point she relaxed and said it was perfectly fine as long as he was chunked up on milkies!

    That was really long but that’s my story!

  4. beth says:

    In my experience, the question “are you pro-breastfeeding” is a waste of breath. They will always say “yes” whether they are in their heart or not–it’s what the AAP recommends. Actions speak louder then words. Are their formula freebies and posters all over the office?

    As far as pre-natally, a pro-bf dr should be encouraging breastfeeding classes, providing contact information for an LC, and making the way clear to make the birth as baby and breastfeeding friendly as possible.

  5. Jackie says:

    My first OB I started with in WA never said anything about breastfeeding, gave me my first child bag full of the goodies and I kept it, not knowing much about breastfeeding. When I moved to Colorado when I was 5 months pregnant with my DD, I found a new OB my mom recommended who was also a family practitioner so she would also be my regular doctor and my kids ped. I had started to read a lot about breastfeeding by then and when she also gave me the neat little bag with formula, I took the formula out and she INSISTED I keep it just in case it didn’t go as planned! I was mad and said NO and threw it away, later her nurse dug it out of the trash, cleaned the outside off and put it in another bag! I hated my first delivery (c-section) they gave my DD sugar water when I had specifically asked them not to and they said “she needed it and we usually don’t go by what the parents ask if the baby ‘needs’ it” They also gave her a paci when I asked them not to and when I couldn’t get her latched on properly and I asked for a LC, they said, why don’t you just try the formula? I was furious!! It went sooooo much smoother when my son was born, different hospital and different OB, who was still pushy but not as much. He never pushed anything on me except a c-section delivery. I received excellent help with BF at the hospital and they never did anything without first asking my preference. The bag I received at the hospital was geared towards breastfeeding with a free hand pump, a whole box of nursing pads, free non-lanolin nipple gel, a coupon for a free nursing cover and I even got a moby and a boppy out of the deal and several books on nursing. I LOVED it! my LC was super helpful in showing me other mothers in the hospital that were nursing and how they achieved great latch on and even sat there with me quietly through an entire 2 hour feeding just to make sure I was comfortable and got me water and more pillows and everything. And her service was FREE! So night and day difference between my two. My third with be a HBAC with a midwife, doula, postpartum doula and LC on hand when its time!

  6. Brandi says:

    My midwives only discussed feeding when I brought in a birth plan to discuss, but they said my decision to breastfeed was the best choice for me and my baby. They still gave out a formula-sponsored bag after completing my glucose screening, though.

    I also ended up delivering in a “baby-friendly” hospital – they have to go through certain certifications to qualify, including not taking stuff or handing stuff out for formula companies – very breastfeeding friendly (they even have a policy that if, for some extreme situations, if formula must be given to a baby, they will not use an artificial nipple) – they don’t even give out pacifiers, although they do love to swaddle (I also wanted the skin-to-skin as much as possible). Unfortunately, their lactation consultant wasn’t that great – the nurses helped me more – all the LC talked about was how many pumps she had sold that day (I didn’t even see her until my husband had left to bring the car around for us to leave), and they did have a follow-up call two weeks after being released to ask how the breastfeeding relationship was going.

    For this pregnancy (starting into the 2nd trimester), I’m with the same midwife group, set up for the same hospital, and still nursing my 22 month old. First appointment, the midwife walked in and I was nursing my son, so no chance for them to question if I was or not! I did have to have one appointment with the doctors in the group, and I stated how I was currently breastfeeding (I plan on nursing through pregnancy and tandem nursing until my son is ready to wean – really hoping to keep it going throughout pregnancy!) – his response was “it’s perfectly safe in early pregnancy” – so wishing I had challenged him on that statement!

    I’m still with this group because of wanting a natural birth, like with my first. I’m very involved with my local La Leche League group, so that’s where I’m getting my support and info for breastfeeding.

    As for a pedi – we decided to go with a family doc instead – and she has been very supportive of breastfeeding. She has never given us formula samples, and seemed as happy as we were when I was able to stop supplementing my son (I had low milk supply issues, ended up supplementing with formula until he turned 1 – a big reason why I’m so determined to nurse through this pregnancy). During our doc visits now, all she asks is if I am still nursing, and when I respond with yes, she says good and moves on.

  7. Miranda says:

    I never had the same OB twice with any of my pregnancies but I had great support from our ped office. When I brought my son in for his 2 week well child visit, the doctor never asked how my son was fed. He asked if any food that I was eating seemed to be affecting my son. I said no, but asked how he knew that I was breastfeeding. Our Ped smiled and said that he knew I was a mom that does what is best for her child and that meant not giving my child food from a can.

    Fastforward to my son’s 6 month well child visit, we needed to see a different doctor because ours was deployed. When this ped asked what my child was eating, I said that he was exclusively breastfed and we hadn’t started solids yet. The ped gave me a high five and said how wonderful it was.

    At my son’s one year well child visit we saw yet another doctor. When I mentioned that my son was still nursing, she gave me a big hug and said how wonderful it was. She asked if I planned on weaning him soon. I told him that we are going to go as long as my son wants. She smiled and simply said “how wonderful.”

    If i have any questions about medicine that I can take, I call our ped office and they are so wonderful. I was ill for a few days and the doc on call told me to put on some good movies, curl up on the couch and have a nurse in with my son. It didn’t make me less sick, but it made me feel better that our ped cared.

  8. S.A. says:

    I was just reading a research article on this very topic – about moms not getting their breastfeeding questions answered at prenatal appointments. Journal of Midwifery & Women’s Health:
    http://onlinelibrary.wiley.com/doi/10.1111/j.1542-2011.2010.00006.x/full

  9. Tonia says:

    From the moment I found out I was pregnant, I just knew that I wanted to breastfeed my children. I dont’ remember whether my OB’s were supportive or not. I did my own research and read about breastfeeding and made sure that everyone in the hospital knew not to give my baby a bottle. No one encouraged or discouraged in the hospital. The 2nd baby, there was not much conversation around the topic, I knew that I was breastfeeding, no one could change my mind, and I never even looked at or discussed formula. But this time in the hospital the nurses were very supportive. They sent a lactation consultant into my room, even though I said I didn’t need one, they even assisted me in nursing while I was in recovery from the C-section. When I left the hospital, they gave me all types of material about breastfeeding and support.

    I think that my experience in nursing my children was positive because I had the mind set that I was breastfeeding and nothing and no one was going to stop me.

    I think there needs to be more conversation with those who are unsure or never even considered it.

  10. Erin says:

    My OB’s office is a practice of five or six doctors, so I am sure there may be varying views on breastfeeding and whether or not to discuss it with patients. I am one of our local La Leche League leaders, and we have given them fliers about our group meetings. I was pleasantly surprised when I went in for an appointment for my third pregnancy that our flier was included in their new mom packet that they hand out on the first OB visit. They have been making copies when they run low so they can continue including them in the bags. The bags are also better than they were when I used this OB practice six and four years ago, when they had some Similac prenatal/breastfeeding mom vitamins and a few other formula-promoting items. In the pack this most recent time, everything was fine – the worst thing was that a sample of a parenting magazine was included, and of course, those always have a couple formula ads in them.

    Now if only we could figure out why every pregnant mom gets a copy of our flier, and the hospital gives out our info to moms who give birth there, why we hardly have anyone call us with questions or come to meetings! We live in an area that has about 80% breastfeeding initiation in the local hospital, but it’s like they all stop after they go home, and we can’t figure out why that is. The hospital LCs even offer a free follow-up consultation after leaving the hospital to any mom who gave birth there, and they hardly get anyone coming, even though it is free! I don’t get it…

    • Lera says:

      How are the local pediatricians? Do the local pediatricians communicate with the hospital LC’s? Do the local pediatricians make sure that any mom needing help gets her free follow up appointment with the hospital LC? Sometimes one person who is a pediatrician or a pediatric nurse practitioner can make all the difference. Maybe someone could reach out to some breastfeeding friendly people at the pediatric offices to help make sure the pediatricians are referring people to the free hospital LC’s appointments. Someone could also communicate with local childcare centers. More and more childcare centers are offering parents a list of local breastfeeding resources, and childcare centers could list both the free follow up consultation with the hospital LC and you La Leche League meetings on a list that is given to breastfeeding families.

  11. Sara says:

    My OB is awesome. At my first appointment she asked what my feeding preference was. When I told her that I Breast fed my first son for 18 months, and was planning to do the same with this one, her response was “Wonderful! That’s what’s best for the baby!” She’s never offered me any sort of new mom “goodies” including formula samples or advertising (which is great with me), and i have never seen any formula ads in her office, even including note pads, pens, etc. But I have seen ads for breast feeding classes.

    The hospital where I will be delivering offers the baby to mom for skin to skin contact right after birth (unless asked by the mom to do otherwise), all healthy babies room in with moms (unless asked by the mom to go to the nursery), there are doulas and lactation consultants on staff, and they have a stated goal of having all babies initiate breastfeeding within an hour or two after birth. babies are only separated from their mothers if there is a medical reason to do so, or if the mother asks. Formula is not offered unless the mother asks for it, same for pacifiers and sugar water. So I’m hopeful that initiation of breast feeding this time around will be just as smooth as it was for me last time :-)

  12. Lisa says:

    I don’t remember if my OB brought breastfeeding up at all during my first pregnancy (though I’m sure she must have since she knew I was bfing at the hospital). At the beginning of this pregnancy though I had to see a nurse practitioner for my first visit and when she heard I was still breastfeeding my toddler (about 14 months old at the time) she pretty much told me I had to quit bfing right away for the sake of the new baby (I knew this was a bunch of baloney though I was already slowly cutting down my daughters feedings for my own personal reasons) and I just ignored her comment about it. Then when I went in to see my actual OB and told her I was still BFing she said to keep doing it as long as I wanted. I love her for that! She did mention taking some extra calcium so I’d have enough for all three of us, but that was perfectly fine by me. I refuse to see the NP now if my OB is out for whatever reason I either wait for her to get in if she just late/at a birth or reschedule.

  13. Lynnie Lee says:

    I don’t remember talking much with my midwife about breastfeeding, I’m sure we did.. I knew that was the plan for me from the beginning. I was honestly surprised at how supportive the hospital I delivered in was! I had already prepared myself to block out any negative vibes and pressures, but there wasn’t any. Right after delivery I had my Mister skin-to-skin on my chest, and they didn’t bother me or take him away to even weigh him until an hour later after he’d had his first nurse. We had some bumpy spots the first few days, but the nursing staff and LCs were a great help. They gave us an all breast feeding goodie bag.. no formula at all! I’m so thankful that we had all that early support!

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