Choosing a Knowledgeable Health Care-Provider

by Barbara L. Behrmann, Ph.D.

© 1997 Barbara Behrmann

Physicians agree that breastfeeding provides your baby with significant nutritional, immunological and developmental “benefits.”  Yet, studies reveal that many pediatricians, obstetricians and family physicians are ill-equipped to properly counsel breast-feeding mothers.  Medical mismanagement of easily preventable or treatable breastfeeding problems is common.    So how can you find a doctor with nursing know-how?

Ask the right questions ahead of time.  “It is not enough to ask, ‘Do you support breastfeeding?’ explains Dr. Ruth Lawrence, one of the nation’s leading breastfeeding experts, ”because every doctor would say yes.  Ask him or her what percentage of patients breastfeed.  Pediatricians who support breastfeeding attract breastfeeding mothers,” she adds.  “If they have children, ask them how their own children were fed.”  This is actually what inspires many doctors to learn about breastfeeding.   

Find out what kind of lactation assistance and support your health-care provider offers patients.  How do they handle breastfeeding problems?   Do they have a lactation consultant on staff?   If so, make sure she is Internationally board-certified (with the letters IBCLC following her name).  If there is no consultant, do they have someone to whom they can refer you? 

Know the difference between a lactation consultant and a lactation counselor or educator.  Lactation consultants offer “top of the line” clinical expertise; lactation counselors provide clinical help and support for women with easily overcome difficulties; and lactation educators educate the public on breastfeeding-related issues. They all play valuable roles. But hospitals and other healthcare facilities don’t always make careful distinctions in the services they provide, and you may not realize that the titles connote different levels of expertise.

 The only official title for breastfeeding professionals is that of International Board Certified Lactation Consultant – IBCLC. To become an IBCLC, an applicant must have spent thousands of hours working with nursing mothers, have certain educational qualifications, and pass an internationally certified exam. A lactation counselor, who participates in a one-week 40- hour course and passes their exam, may offer wonderful help to women encountering common and easily corrected problems, but may be unable to recognize when women need greater intervention. The risk, of course, is that you may think you’ve gotten as much help as possible and give up if your problems continue, without realizing there are people with more knowledge and experience who could have assisted you.

To locate a lactation consultant, visit the International Lactation Consultant Association web site at www.ilca.org (919-861-5577).  

Look for indirect evidence of breastfeeding support in the office itself.  Is there a comfortable place for mothers to nurse their babies while waiting to see the doctor?  Do posters or artwork depict positive breastfeeding images?   Conversely, are there a lot of formula promotional materials lying around the office?  Does the office freely hand out formula samples?  All of this sends important messages to families.

Ask around town.  Physicians’ track records are pretty well-known within a community.  Talk to other mothers, along with childbirth educators, doulas, and others with insights into your local medical community.

Don’t rely only on your doctor for information.  Midwives, childbirth educators, lactation consultants, nurses and La Leche League leaders can all provide breastfeeding assistance, advice and support.

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Barbara L. Behrmann, Ph.D. is a writer, researcher, and author of The Breastfeeding Café: Mothers Share the Joys, Secrets & Challenges of Nursing, University of Michigan Press, 2005. She is a frequent speaker around the country and is available for talks, readings, and conducting birthing and breastfeeding writing circles. The mother of two formerly breastfed children, Barbara lives in upstate New York.