Well Being

How to Get Good Medical Advice on Breastfeeding

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Welcome to the latest breastfeeding bloggers theme day! Today we're covering the Good Advice and Bad Advice we've heard about breastfeeding.

Unfortunately, some of the worst advice I ever received on breastfeeding came straight from doctors. In my five consecutive years of breastfeeding, I have been told I needed to wean four times by three different doctors. I realize that the fact that I didn't follow their advice makes me sound like a very bad patient, but in fact I never went against medical advice–I simply sought a second opinion.

The first time I was told to wean was by my (now fired) endocrinologist who told me that I should wean while taking a particular anti-thyroid medication. With the help of a La Leche League leader, I presented that doctor with information about the low lactation risk for that medication from the reference book Medications and Mothers' Milk and he grudgingly “allowed” me to continue nursing. When I later developed elevated liver enzymes on that medication (unrelated to breastfeeding), he again recommended that I wean and take radioactive iodine to kill my thyroid (which, by the way, would mean that I could not hold or kiss my child for at least five days afterwards so as not to expose her to radioactivity!) I found a new endocrinologist willing to treat me on an alternate anti-thyroid medication at a dose that was compatible with breastfeeding and did not affect my liver enzymes.

The third time I was told to wean was when I became pregnant with my second daughter and the well-meaning but ill-informed pediatrician said I would be depriving my growing baby of the nutrients she needed. That time I talked to the doctor about what I had read in the book Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond and promised to continue taking my prenatal vitamin and getting enough nutrients and calories from healthful food.

The fourth time I was told to wean was when an otolaryngologist (ear-nose-and-throat doctor) recommended I have surgery to correct a deviated septum. When I asked him whether I could breastfeed after waking up from the general anesthesia (sorry doc, that question was a test because I already knew the answer), he clearly did not know but replied a flat-out “no.” How hard would it have been to say, “I don't know, but I could find out or you could ask the anesthesiologist or your child's pediatrician”? That doctor let his ego get in the way of good patient care. There was no way I was going to let him operate on me!

I shouldn't have been surprised that I got such bad advice from medical professionals. When I wrote to the top U.S. medical schools to ask about breastfeeding education, I learned that medical students generally receive one-and-a-half hours or less of training in breastfeeding over the course of their four-year education. One school said that its students receive two lectures–about 1.5 hours of instruction–in the clinical practice class in the second year of medical school. Another school does not offer any lectures on breastfeeding but students learn through web-based cases in pediatrics that happen to touch upon breastfeeding and through a rotation through the full-term nursery where breastfeeding is discussed. Take it from a Harvard medical student Tarayn Grizzard:

As a part of their education in professional ethics, medical and other health professional students should be required to learn about breastfeeding and the medical community's dealings with the [artificial] baby milk industry and its effect on child health in the United States and abroad.

The only good news came from my interview with Dr. Jane Morton, Director of Breastfeeding Medicine at Lucile Packard Children's Hospital and Clinical Professor of Pediatrics at the Stanford University School of Medicine, who spoke about the model breastfeeding curriculum being taught to certain medical residents at seven pilot medical centers.

So, how do you talk to your doctor about breastfeeding and medications or other breastfeeding concerns? How do you discern bad medical advice from good?

1. Be clear from the start with your doctor about the importance of breastfeeding to you. Before any problems arise (not that any necessarily will) ask for your doctor's support. Try something non-threatening that shows that you value the doctor and want to work together for success. “I've read a lot about the benefits of breastfeeding and am eager to get your support in my baby's care.”

2. If problems do arise, tell your doctor how you feel. “I would really like to continue breastfeeding. Is there a medication that is compatible with nursing?” If the doctor suggests supplementation with artificial baby milk, say, “I'm worried that might interfere with my existing milk supply. I would be more comfortable trying additional nursing sessions and pumping. What if we try that for a week and come back in for another check-up?”

3. Let the documentation speak for you. Provide the doctor with medical studies or references you've found on the subject.

4. Talk to a lactation consultant or La Leche League leader. While a LLL leader cannot offer medical advice, she can provide medical information for you to discuss with your doctor and help you practice how that conversation might go.

5. Ask if your doctor is familiar with the free on-line medical reference for drugs and lactation. Find out if your doctor owns Medications and Mothers' Milk and The Breastfeeding Answer Book.

6. Get a second opinion! Obviously I believe that if your doctor is unwilling to support you and your desire to breastfeed, it's time to get a second opinion. A good doctor will not be insulted by your desire to seek additional knowledge.

For more about Good Advice and Bad Advice on breastfeeding, enjoy these other entries in the breastfeeding bloggers theme day!

BreastfeedingMums talks about where to get breastfeeding help.

Motherwear Breastfeeding Blog identifies the good and bad advice out there and resources for help.

Mama Knows Breast sings the praises of lactation consultants.

The Lactivist compiles her best advice on exclusively pumping.

The Twinkies gathered breastfeeding advice from the trenches — the best advice contributed from several of her friends.

Mocha Milk shares some favorite sources of advice.

The Baby Gravy Train lists the best breastfeeding advice she received.

The Black Breastfeeding Blog describes the critical piece of support she got from her mother.

Cairo Mama tells how through her determination she made breastfeeding work.

Random Wanderings laments how bad advice can sabotage breastfeeding.