Choosing a Knowledgeable Health Care Provider

 by Barbara L. Behrmann, Ph.D.

(c) 2005

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.   Here are a few tips to help you find a doctor or other health care provider 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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Emma's Story:  A Prenatal Consultation

Despite having gone through medical school myself and having practiced for many years, I didn’t know a thing about lactation.  I barely remember it being mentioned in medical school and I certainly didn’t understand it from a medical or physiologic perspective when I graduated - let alone years later when I was expecting my first child.

One of my friends, a pediatrician, is an extremely strong advocate of nursing, both in her personal life and in her practice.  She paid her nurse practitioner to become trained as a certified lactation consultant and If parents come for a prenatal interview, she also has them see the lactation consultant. 

Although I wasn’t using her practice, my friend encouraged me to seek out a lactation consultant for a prenatal consultation.  At that point, I was ambivalent about nursing, though she and my husband were encouraging me to give it a try.  I had some health concerns and I didn’t know if certain medications I took would make breastfeeding problematic.  When I was starting my third trimester, I phoned up the lactation consultant at the hospital where I planned to deliver.  I’m so glad I saw her, then, when I was well-rested and physically felt great.  I could focus on our conversation and had lots of time to think through what I had learned, without any pressure.  It was a good time to be learning and thinking, better than right after the baby is born.  If that first meeting had been after a long labor, a c-section, or a sleepless night, I can imagine having had a very different outcome.  Also, because I saw her before I gave birth, we had time to check out everything ahead of time, to find out that my medications were not a problem.   

More importantly, my consultation with her got me much more enthused about breastfeeding.  I became amazed by it, awed.  I had never given it a thought as a biological function of my body.  As a pregnant woman, I was reveling in the process of nurturing the new life inside of me.  I ate and drank and my baby grew and developed.  I thought that would end when I gave birth.  Now I saw that this could continue, through nursing.  I would eat and drink and my child would grow.  Once I came to appreciate how nursing was a continuing part of the miracle of conception and pregnancy, how could I not want to experience it?  How many miracles do we get to experience in our lives? I am forever grateful to my friend for suggesting this consultation.  This meeting and my husband’s encouragement were the key factors in my decision to nurse my first child.

Susan’s story: 

Breastfeeding has reinforced my belief that you’ve got to fight for what you want.  I don’t think we were given great advice at the hospital.  No one ever mentioned cup feeding, or eye-droppers - it was either give him your breast or we give him a bottle.  There was nothing else.  And when I saw my ob-gyn at six weeks and told her what was going on with breastfeeding, she kind of shrugged her shoulders and said, “Oh yeah, I had trouble breastfeeding.  It’s really not worth it at this point.  Give him a bottle!”  And this is a woman who has a reputation for being more natural and into all this stuff that’s good for the mother and the baby!  I was shocked, really shocked.   

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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.