Welcome to what will likely be the shortest section of my blog post series on low milk supply, about pediatricians and breastfeeding! If you’d like to follow along in order, please start at part 1: research and then continue to part 2: breastfeeding data before starting on this post.
Pediatricians and Breastfeeding: what do they know?
Pediatricians are amazing, because they have to know a lot of details about a LOT of topics.
In the United States, your pediatrician is your go-to for everything health related; you see the pediatrician an average of seven times in the baby’s first year of life, and that’s all just well-baby visits. If you’ve got a kid who as frequent skin issues, or ear infections, or is accident prone, you really get to know your pediatrician.
Our society expects pediatricians to be our go-to for everything related to babies’ health and well being, so most people go to their pediatrician first when they have a question about breastfeeding.
Unfortunately, pediatricians get very little breastfeeding education in medical school.
It’s hard to definitively find out how much breastfeeding education pediatricians get; I’ve heard of some doctors who say they only had a couple of hours of instruction on breastfeeding basics while in med school. Others have told me they had one class about how breast milk is produced and on the anatomy of the breast.
A 2004 survey of 875 United States pediatricians found that 33% of respondents had NO breastfeeding education during medical school or their residency. 12% of responding pediatricians had never read an article about breastfeeding management, and 21% of respondents had no interest in gaining any further knowledge about breastfeeding (Feldman-Winter LB, Schanler RJ, O’Connor KG, Lawrence RA. Pediatricians and the Promotion and Support of Breastfeeding. Arch Pediatr Adolesc Med. 2008;162(12):1142-1149.).
We have four medical schools in Massachusetts (Boston University, Harvard, Tufts University, and UMASS Worcester). I searched the course catalogs for medical coursework degree requirements and found that only ONE school (Boston University) has courses that mention breastfeeding as part of the curriculum- in their Family Medicine and Pediatrics departments.
A Massachusetts study done in 2005-2006 showed that just ONE 12-hour intensive breastfeeding course for health care practitioners raised the breastfeeding initiation rates at four local hospitals with low breastfeeding rates (Hospital Education in Lactation Practices (Project HELP): Does Clinician Education Affect Breastfeeding Initiation and Exclusivity in the Hospital?. Birth, 36: 54–59.).
When a parent goes to the pediatrician with milk supply concerns, what happens?
Well, I can tell you what I wish WOULD happen:
- the pediatrician listens to the parents’ concerns and asks more questions to find out what’s making the parent feel like baby isn’t getting enough.
- the pediatrician weighs the baby, and schedules another weight check within 48 hours.
- the pediatrician either
- has sufficient knowledge of breastfeeding to troubleshoot, make a care plan, and help the family or
- has a trusted lactation professional in their office or close by that can help the family within 24 hours.
What does happen instead?
Here’s an example I heard from a mom this week, who brought her month old baby to his check-up. Baby’s weight gain was slow- he just got back up to birth weight (we’d like babies to be back to birth weight within 2 weeks of birth). Mom mentioned her concerns to the pediatrician.
Doctor: “Your baby’s weight gain isn’t ideal. Have you considered supplementing with formula?”
Mom: “I’m not opposed to formula, but when I started supplementing my first kid with formula it was the end of breastfeeding for me. I really want breastfeeding to work this time.”
Doctor: “OK, we’ll check his weight again in three weeks and see how it’s going. Maybe you’ll have to give him pumped milk. See you then.”
When the mom told me this story, my jaw dropped. Three weeks? So much can go so terribly wrong in three weeks.
Thankfully, I don’t have this happen often… but it’s not the first time that I’ve seen a baby who could have benefited from much earlier feeding interventions.
With so little required breastfeeding education, how do pediatricians support nursing families in their practices?
Well, 87% of the pediatricians in the 2004 survey I cited above were confident that they could answer parents’ breastfeeding questions… yet only 37% of respondents had taught breastfeeding techniques to at least 5 families in the previous year.
53% of the respondents had NO personal experience observing breastfeeding. Ever. Not even once.
24% of respondents felt a mother should stop breastfeeding- or never start breastfeeding to begin with- if she was “too young or immature”.
I’ll say it again. Pediatricians have to know A LOT OF STUFF about A LOT OF DIFFERENT THINGS. Breastfeeding? Maybe not as high on their priority list as we think it should be.
Imagine how different the breastfeeding landscape in the USA would look if all pediatricians had to meet a competency requirement in breastfeeding and also one in formula feeding.
The American Academy of Pediatrics has developed a breastfeeding residency curriculum; it includes giving a presentation on low milk supply and other common breastfeeding problems. Their curriculum is designed to be implemented over “one rotation, one year, or during the entire length of residency.”
I can’t help but wonder how many parents dealing with low milk supply (and so many other infant feeding problems) could be helped if their pediatricians had more training in breastfeeding.
upcoming posts in the low milk supply series
part 4 onward, we’ll delve into what parents know about milk production, what they hear about milk supply, and what symptoms make them suspect low milk supply.
Stick with me, folks. It’s gonna be a long, bumpy, milky ride. I think we’re past the half way point. I could be wrong.
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