Is Your Doc Breastfeeding-Friendly or Breastfeeding Phony?

At MaiTai’s first well baby check-up, his pediatrician was supportive of his being breastfed. She assured me, “Your milk is good, don’t worry!” (Okay, I hadn’t been worrying… until now?). When MaiTai turned six months old, she was also supportive of continued breastfeeding coupled with the Baby-Led Weaning method of solid food introduction when I mentioned that the traditional puree-spooning route that she typically suggests (like most pediatricians) just wasn’t for us. At his one year appointment, naturally I expected her to be supportive of continued breastfeeding. To my surprise and disappointment, she was not. In fact, when she found out we were still giving the boob, she said, “You should really switch to cow’s milk now. It’s more nutritious.” Is it? Is it??

Here’s what I think. If your breastfeeding-friendliness has an expiration date then you aren’t truly breastfeeding-friendly. If you give out the expert pediatric advice that an infant should switch to another species’ breast milk due to an untrue claim, then not only are you not breastfeeding-friendly, but also not breastfeeding-educated. A frightening pair of descriptors for an individual with pull and power within the professional medical community and influence among new parents.

Was our pediatrician the only one? Let’s take a look at the bigger picture.

What You Need to Know

In a questionnaire by the American Academy of Pediatrics given to a sample that “represents a large proportion” of its organization’s Fellows who work with infants aged from birth to 2 years, it was found that despite the AAP’s support of breastfeeding as the normal and ideal source of infant nutrition, many pediatricians did not demonstrate the guidelines in their practice.

“The Survey reflects the opinions of respondents who were sufficiently interested in breastfeeding to complete the questionnaire. Thus, even in this population of ‘interested’ respondents, their knowledge gaps are profound, and their less than positive attitude is noteworthy.”- AAP

What They Should Tell You:

Six months of exclusive breastfeeding, and continued breastfeeding for a minimum of one year is medically ideal for most infants.

…But the Survey Found:

“[B]reastfeeding, as the exclusive feeding practice for the first month after birth, was recommended by only 65% of responding pediatricians; only 37% recommended breastfeeding for 1 year.”

What They Should Tell You:

Breastfeeding is the only unequaled form of infant nutrition; infant formula is an inferior product marketed as a substitute nutritive option when it should be treated as a medicine in remarkable circumstances.

…But the Survey Found:

“A majority of pediatricians agreed with or had a neutral opinion about the statement that breastfeeding and formula-feeding are equally acceptable methods for feeding infants.”

“When discussing infant feeding options for the first month with parents of healthy, full-term infants in their practice, 65% of pediatricians recommended breastfeeding exclusively, 20% made no recommendations, 13% recommended breastfeeding with formula supplementation, and 2% recommended exclusive formula feeding.”

What They Should Tell You:

Most medicines and medical treatments do not preclude breastfeeding; the list of true contraindications is actually very short.

…But the Survey Found:

“Reasons given for not recommending breastfeeding included medical conditions with known treatments that did not preclude breastfeeding.”

“28% of respondents indicated that they would discontinue breastfeeding for breast and/or nipple problems.”

23% instructed to not breastfeed with mastitis.

Other reasons for recommending against breastfeeding include: inconvenience/time demands of breastfeeding, father’s desire to participate in feedings, baby is teething, mother’s milk supply seems inadequate, mother appears too young/immature, mother has cracked nipples, baby is jaundiced, etc (all of which have treatments and preventions that do not necessitate the termination of breastfeeding).

What They Should Tell You:

Baby-Friendly certification for delivery hospitals is important because, well, if baby hospitals aren’t especially friendly to babies then what the hell are they doing?

…But the Survey Found:

“The majority of pediatricians (72%) were unfamiliar with the contents of the Baby-Friendly Hospital Initiative.”

“The majority of pediatricians (82%) did not know if the main hospital with which they were affiliated had applied to be a Baby-Friendly Hospital.”

Compared with Baby-Friendly hospitals, only 11% of respondents in other clinic settings “inform pregnant women about breastfeeding so they can make an informed decision.”

“Only 44% recommended that the infant be put to the breast within a half-hour after delivery.”

Nearly half the respondents didn’t even know if their hospital had a written breastfeeding policy! (It should look something like this).

“(59%) indicated that the infant should be fed on demand, whereas only 31% recommended the more appropriate nursing frequency of 8 to 12 times per day.”

Only 23% said “no pacifiers in the hospital.”

Rooming-in was recommended by only 51%.

Only 36% instructed about unrestricted breastfeeding.

“22% routinely recommended some form of supplementation.” At least this appears to have improved from mid-nineties era, when a different study found only about two-thirds of practitioners and half of residents knew that supplementing during the first few weeks of life could be disastrous to breastfeeding establishment.

What They Should Tell You:

Breastfeeding requires education and a learning curve–on the part of the baby, the mother, and no less importantly, their postpartum care-giving and support team.

…But the Survey Found:

“The majority of pediatricians had not attended a presentation on breastfeeding management in the previous 3 years…many primary care physicians believe their training in breastfeeding management has been inadequate, and they lack confidence in their breastfeeding management abilities.”

Only “58% of pediatricians had some education on breastfeeding management while in medical school or residency.” (Really??) Males older than 45 were less likely.

Traditionally, pediatricians do not receive any more education in infant feeding during their medical studies than their peers in other unrelated specialties (several hours’ worth of a class primarily focused on formula feeding). Thankfully, the AAP recently implemented a Breastfeeding Residency Curriculum, of which all materials are available online.

“Those respondents indicating confidence in their abilities were more likely to have a large proportion of patients breastfeeding in their practices, [but] the same respondents were not necessarily the most knowledgeable with respect to breastfeeding.”

“Respondents practicing in clinic settings had the fewest prenatal visits, the lowest rate and duration of breastfeeding, were the least likely to recommend breastfeeding, and reported the longest period of time before the first postnatal visit.”

“Office personnel responsible for answering telephone questions regarding breastfeeding had varied training in breastfeeding management: informal training by physicians (64% respondents), reading articles and other literature (54%), attendance at lectures or workshops (39%), and attendance at presentations and discussions with lactation consultants (31%). Of the respondents, 27% noted that their staff either had no specific training or did not know what training their staff had in the area of breastfeeding management.”

“A large proportion of pediatrician respondents routinely recommended the introduction of semisolid foods (30%), iron (22%), and/or vitamins (41%) before 5 months of age to exclusively breastfeeding infants.”

What Does This Mean?

“Pediatricians often find themselves providing advice and treating the breastfeeding mother as a patient even though the medical care of an adult woman is generally perceived to be outside the scope of a pediatrician’s practice.” – AAP

Though the survey was 15 years ago, keep in mind that most of these professionals are still busy working and advising in clinical settings today, alas the findings are still poignant and useful to assist in the search for the best caregiver.

“The Survey indicates that breastfeeding attitudes and management issues have not changed substantially from earlier studies. Of concern is that pediatricians now are likely to recommend semi-solid foods, iron, and vitamins before 5 months of age, and to recommend supplementary feedings and pacifiers in the first few days after delivery.” – AAP

What to Look For

1). Choose an office/hospital that is breastfeeding friendly. This means you’ll feel comfortable breastfeeding in the waiting room, you won’t fee pressured to hasten a feeding to coincide with the nurse’s or doctor’s timing, and you won’t be confronted with formula samples, advertisements, and marketing materials either directly or in waiting areas.

2.) If your OB/Gyn, primary care doctor or pediatrician isn’t referring you to a lactation consultant or breastfeeding specialist for a breastfeeding problem, be wary. If his or her “solution” for a breastfeeding problem comes with a prescription or a direction to avoid, temporarily halt, or supplement breastfeeding, you’d better get a second opinion from a professional who specializes in normal infant feeding.

3). Seek a practitioner who has firsthand experience with breastfeeding for a duration that’s significant to you. Personal experience does affect professional attitudes and practices.

4). Also, it’s best to choose a pediatrician who is well-versed in the mother’s nursing concerns and not only those of the infant (after all, breastfeeding is a dyadic relationship and mother/baby should be assessed simultaneously to avoid conflicting advice from different practitioners).

5). For more help, check out the following links:

“How to Know a Healthcare Provider is Not Supportive of Breastfeeding” – Dr. Jack Newman

“Your A-Team: Finding a Breastfeeding-Friendly Pre-Natal Care Provider, Hospital, and Pediatrician” – Best for Babes

“Were Your Doctor’s Children Breastfed?” – Lactation Narration

“Your Prenatal Care Provider: The Best for Babes Selection Guide” – Best for Babes