As an obstetrician for over twenty years, I have always considered myself to be supportive of my patients and their choices when it comes to feeding their babies. It wasn’t until my wife, Jody (who’s had an extensive career as a registered nurse in the NICU) decided to obtain her IBCLC certification that I began to realize how limited my lactation knowledge and skills really were. Now she’s begun to apply her knowledge and experience to developing tools to assist me and other obstetricians in helping moms choose and succeed in breastfeeding.
In the past, I would ask expectant mothers whether they planned to breastfeed or formula feed, and would tout the benefits of nursing in the most general of terms. When moms with newborns would see me back for their postpartum exams, I would ask if they were breastfeeding, and if they were having any issues related to nursing. If a nursing mother needed medication, I would try to choose a drug which would be compatible with breastfeeding; if she called with a question or a problem, I would refer her to La Leche League, or my hospital’s LC.
While I can only speak for myself, I do believe that my experience is common when it comes to training and exposure to lactation science. I can remember only one or two lectures on lactation physiology during my medical school education, which I completed in 1984. I don’t remember any lectures on breastfeeding during the four years of my residency. Of course, I finished residency in 1988, so shouldn’t things have improved since then?
Well, I recently spoke with a third year obstetrics resident to find out how much things have changed; he told me of a single lecture, in his second year. In the hospital setting, it always seemed to fall to the nursing staff to identify and address lactation issues with new moms. Whether or not a mother was breastfeeding, for how long, and how successfully, are all very influential over how I would make other medical decisions: which antibiotic or pain reliever to prescribe, which birth control method to recommend, etc-.
I recognize now that I will need to learn a new approach that truly supports moms and lets them have the tools they need to make the best choices for themselves and their babies. It’s not easy to admit to my patients that I still have so much to learn about breastfeeding and lactation science, but luckily I have immediate access to an International Board Certified Lactation Consultant (IBCLCs have the highest level of education for lactation knowledge). OBs without immediate access to an IBCLC should make referrals as necessary. The best situation is one in which all care providers are familiar with one another and are willing to work together on the patient’s behalf.
I think most pregnant and lactating moms will find their obstetricians are just as willing to help them find ways to avoid the Booby Traps which they may encounter while preparing for breastfeeding, learning how to feed their newborns, and addressing any obstacles which may occur. At the core of our decisions surrounding breastfeeding is the Academy of Breastfeeding Medicine’s Clinical Protocol Number #19: Breastfeeding Promotion in the Prenatal Setting. We rely heavily on all of the ABM’s protocols to guide our practice and ensure that we’re doing the best we can for our patients. Asking your Ob if they use these Protocols in their office is a great way to learn how supportive of breastfeeding they are and how open they are to learning more about it.
You don’t have to wait for your obstetrician to ask you about breastfeeding. You don’t have to wait until late in your pregnancy, or even after delivery, either. Lactation can and should be part of your dialog with your doctor from the first prenatal visit, and might even start before pregnancy for women with specific concerns, such as prior breast surgery, or other medical issues.
Whether asking about breastfeeding or any other subject, you should expect someone who is respectful of your questions and is willing to take the time to discuss them with you. This may mean scheduling an extra appointment to be sure there is enough time to talk. While it would be great if all obstetricians had more knowledge regarding lactation questions and issues, a willingness to learn and an openness to discuss breastfeeding questions is a great place to start with your Ob. If your doctor is willing to work with you in breastfeeding education, then it’s likely that he or she will be open to collaborating with you regarding other important aspects of your care.
However, if you continually find that your questions are not being answered, or that your obstetrician is resistant to working with you about breastfeeding or any other concerns, then it may be time to look for another provider. Of course, this may not always be possible, and might be impractical or unwise if you are very late in pregnancy, or if other circumstances won’t allow you to consider another doctor. If you do decide to change, try to schedule a preliminary consultation with the new candidate so you can discuss your reasons for changing. If change is not possible, it might help to identify and contact other community resources, such as La Leche League or an IBCLC. Finally, don’t be afraid to speak up in a matter-of-fact way to let your doctor know how you feel.
Stephen L. Segrave-Daly, MD received his BA from the University of Pennsylvania in 1980, and his Medical Degree at the Medical College of Pennsylvania in 1984. He completed his residency at the Medical College of Pennsylvania, also, in 1988. Dr. Segrave-Daly practiced in East Stroudsburg from January 1990 to January 2007, and then joined Woodward & Associates in February 2007. He specializes in Obstetrics and Gynecology and enjoys practicing all aspects of general obstetrics and gynecology.