Prenatal Care Providers that Best for Babes considers acceptable meet these basic requirements, and have educated their entire staff accordingly. We call it CARE-WHO to remember the basic criteria.
C – Cheer On, Coach & Celebrate Moms: All information and messages about breastfeeding should be presented in a positive, encouraging, inspiring and empowering way that accurately educates and prepares women on what to expect and how to succeed, and on suitable alternatives to breastfeeding or pumped breastmilk including the preferred use of donated and screened human milk. Breastfeeding is neither portrayed as “easy and natural,” which minimizes real challenges and invalidates moms; nor is it portrayed as “nearly impossible” (horror stories), which discourages women from trying. Instead, it should be portrayed as instinctive, mostly wonderful and sometimes challenging, just like riding a bike, running a race or learning many other aspects of parenting; it gets easier and it is worth it! Cheering on, coaching and celebrating moms is at the heart of everything Best for Babes does.
A: Accepting & Non-judgmental. Whether you choose to breastfeed or not, have a medicated birth or not, your provider should be supportive of you and your decisions. You hire them; their job is to serve you and help you make informed decisions and achieve your realistic personal goals.
R: Refer as Necessary. We don’t expect (yet) all providers to be trained in lactation management (though it would be nice), nor do we expect them to have an International Board Certified Lactation Counselor (IBCLC) on staff (though it would be great!). But we DO expect them to refer mothers to appropriate resources in their area, such as La Leche League, Breastfeeding USA, a good birth class, a good breastfeeding class, and to an excellent IBCLC or other lactation expert with a great track record in the area. Bonus points if they know of their local breastfeeding coalition or state breastfeeding coalition. Extra bonus points if they join the Academy of Breastfeeding Medicine.
E: Evidence-Based. A good provider knows what they don’t know, and doesn’t pass on myths and misinformation. All birth and breastfeeding information given to you should be grounded in scientific research and evidence. Staff should be trained to refer and not be advising you to “give a bottle to help baby (or you) sleep through the night” and old wives tales and misinformation.
WHO: WHO-Code Compliant. The first rule for all medical professionals is to “do no harm”. Handing out formula samples or marketing materials increases a mother’s and a baby’s risk of disease, infection, and life-long health problems and has no place in a physician’s office as it is a conflict of interest. Mothers who can’t or don’t want to breastfeed should first be educated about donor milk, and the proper preparation of formula if needed. Marketing formula doesn’t benefit the physician or the mother, it benefits the formula company.
In choosing a breastfeeding-supportive Prenatal Care Provider, we highly recommend that you read: Booby Traps™ series: A Checklist for Beating the Institutional Pre-Natal Booby Traps™. Here are additional tips:
- Listen: Notice if your care provider discusses breastfeeding with you during early visits, listens to your concerns, and offers resources. A breastfeeding-friendly doctor/midwife will not only ask you if you are planning to breastfeed, but will sense if you have any hesitations and talk to you about it in a supportive and non-judgmental way. [S]he will help you get to the bottom of any reservations towards breastfeeding you may have without judgment and point you in the direction of resources, such as reading material and a great breastfeeding class. Also notice if your doctor discusses your birth options (see below for questions to ask).
- Observe: Does the office display formula advertising, and coupons, posters, etc.? These can be in the form of tear-off “information” sheets at the check-in desk, “Breastfeeding Support Kits” on bookshelves, “gift” bags in the waiting room, cards to fill out for subscriptions to clubs, etc. All of these types of marketing tactics have been shown to undermine breastfeeding. Formula reps typically bring in donuts and coffee and lunch, as well as freebies for the staff to woo their way in. If you see a lot of material it is a sure sign that there are conflicting interests at work and that the office staff may have been “trained” by formula reps to encourage unnecessary supplementation which can lead to breastfeeding failure. The more heavy the propaganda, the more you should be worried. Note: Some doctors try to keep formula reps out but they often sneak in and just leave their material in the waiting room, and busy staff doesn’t realize that marketing items have been left behind. Finally, notice if new mothers in the office waiting for their postnatal check-up are breastfeeding or bottle-feeding.
- Ask about birth: Remember, how you birth will impact your early breastfeeding experience. Find out your MD/midwife’s caesarean and induction rate. The United States has some of the highest rates in the world, with a national rate hovering around 33% and many hospitals coming in around 40% or higher. The World Health Organization (WHO) says that any time a country’s cesarean-section rate rises above 15 percent, the dangers of C-section surgery outweigh the lifesaving benefits it is supposed to provide. (And only 7% of c-sections are medically necessary.) World Health Organization, “Appropriate Technology for Birth,” The Lancet ii (1985): 436-437. We are not talking about medically necessary c-sections. If the doctor you are interviewing specializes in high-risk pregnancies, you can expect that the caesarean rate will necessarily be higher. Our concern is with medically unnecessary planned births and labors : scheduled c-sections or inductions for doctor or patient convenience (“baby by appointment”) and the excessive and often unnecessary medical interventions that become necessary during them, which in turn often result in traumatic births and/or c-sections. Ask your MD/midwife about his/her attitude towards inductions, unmedicated births, birth alternatives (hypno-births and water births, for example) and using a birth doula, whether or not you are leaning in that direction. Ask your doctor if (s)he plans to delay routine tests and the bath until after you and your baby have had at least a Magical Hour of skin-to-skin immediately after birth– crucial falling-in-love time in which ALL healthy full-term newborns are driven by instinct and guided by the warmth, security, familiar sounds and smells of its mother, to begin to trust, bond and attach to her. A good doctor is open-minded and will discuss whether these options would be suitable for you if you are interested in pursuing them.
- Ask about breastfeeding: Ask your provider when you should start breastfeeding. If he/she does not say, “barring any serious complications, immediately after birth”, a red flag should go up. The theme of 2008 World Breastfeeding Week was “Latch Within the First Hour” because of the positive effect that breastfeeding right after birth has been shown to have on its ultimate success. Ask if your provider will sign off on a birth plan and breastfeeding plan for you to give your maternity center, and ask if they will ensure that after delivery, that you are allowed to have your magical hour.
Here are some good resources for choosing a prenatal care provider:
My Best Birth: A modern, hip guide by talk-show host Ricki Lake to making informed birth decisions and having a positive birth experience.
Ina May’s Guide to Childbirth: Ina May Gaskin is the leading expert on childbirth
Pushed: This book by Jennifer Block is a wake-up call about maternity care in America. If you have accurate information, you can make a better decision!