Is the medical community failing BFing moms?

[Brie]

Thought this was really interesting.

www.cnn.com/2013/01/03/health/medical-breastfeeding/

(TIME.com) -- The doctor blamed it on the baby. "She's not absorbing your milk," he told Colleen Kelly in the days after he daughter was born, as the baby lost too much weight and cried constantly. Lactation consultants said, "She's not latching properly."

Kelly drove through rural Maine for hours to attend breast-feeding support groups and La Leche League meetings, yet the baby went from eight to six pounds and was diagnosed as "failure to thrive." The baby's kidneys were x-rayed and blood taken, but doctors found nothing wrong.

Not once in her travels did someone suggest that perhaps the problem was Kelly herself, rather than her baby or her ability to latch on. She told doctors that her mother hadn't been able to produce enough breast milk -- could that be happening to her?

No, they said. That was an old wives' tale. But they never even looked at her breasts.

"It was clear that none of the doctors or nurses knew enough about breast-feeding to figure out what was happening," Kelly says.

That's because lactation is probably the only bodily function for which modern medicine has almost no training, protocol or knowledge. When women have trouble breast-feeding, they're either prodded to try harder by well-meaning lactation consultants or told to give up by doctors. They're almost never told, "Perhaps there's an underlying medical problem --let's do some tests."

When women have trouble breast-feeding, they are often confronted with two divergent directives: well-meaning lactation consultants urge them to try harder, while some doctors might advise them to simply give up and go the bottle-and-formula route.

"We just give women a pat on the head and tell them their kids will be fine," if they don't breastfeed, says Dr. Alison Stuebe, an OB who treats breast-feeding problems in North Carolina. "Can you imagine if we did that to men with erectile dysfunction?"

ED, she points out, is within the purview of many doctors' services, and insurance will cover Viagra, but lactation dysfunction? It doesn't even exist as a diagnosis, no accompanying health insurance code for which doctors can bill. Within the database of federally funded medical research, there are 70 studies on erectile dysfunction; there are 10 on lactation failure.

No one argues that breast is best, but the truth is that breast-feeding is very difficult for many women, and for some, medical problems make it almost impossible without intervention. With the recent bans on giveaways of formula samples in some hospitals, it's all the more important that the medical community have the tools and knowledge to help mothers breastfeed -- or to figure out why they can't.

Until doctors and nurses are properly trained to help, women like Kelly will experience all of the pressure to breastfeed, with none of the support to figure out how.

What do doctors learn about breast-feeding in medical school? "We learned that it's what's best for baby," said my own pediatrician. "But that's it." They're introduced to evidence that prolonged breast-feeding reduces the possibilities of obesity, SIDS and allergies, but the science of it, what's happening at the anatomical level? Not so much.

"It's an hour, or a half a day, and (students) don't remember anything," says Dr. Todd Wolynn, a Pittsburgh pediatrician and executive director of the Breastfeeding Center of Pittsburgh. There were years, he says, when there was literally nothing said about breast-feeding at all.

Why so little heed? "When most of the people who are currently leaders were in training, breast-feeding was really uncommon," says Stuebe.

Many teaching in medical schools today were raised in the better-living-though-chemistry age, when infant formula was thought to trump the attributes of breast milk. (Formula was certainly an improvement over the non-pasteurized cow's milk that killed many infants at the turn of the 20th century, when breast-feeding was not in vogue). "It's generational for doctors to think it would be necessary to know anything about breast-feeding."

It didn't help that formula companies famously sidled up to doctors and nurses and insinuated themselves into hospital protocol; there's a reason that, until the bans enacted in the last few weeks in some cities, new moms left the hospital with so much Similac swag.

In addition, doctors practicing today don't know where to place breast-feeding problems --breasts are attached to the women, so shouldn't they be the province of OBs, say pediatricians. And OBs note that breast-feeding is for infants; shouldn't the baby's doctor handle it?

This leaves breast-feeding problems either to the rare family physicians, or more commonly to lactation consultants who can assist with technical issues -- improving the baby's latch and such -- but can't write prescriptions, check hormone levels or offer a diagnosis.

That's what a breast-feeding doctor -- an OB, pediatrician or family physician with a subspecialty in breast-feeding medicine -- would have done in Kelly's case: a complete physical and medical history (yes, in fact, it is relevant if your mother couldn't make milk) on mom and baby to see if any physical or anatomical factors were affecting supply.

In the mother, they might check the shape of her breasts, to see if they were hypoplastic -- a tubular shape that can indicate underdevelopment of the glandular tissue needed to make breast milk -- or evaluate her hormone levels, ask if her breast size had increased during pregnancy.

Perhaps they'd prescribe a galactogogue, a drug that promotes lactation. Today there are 88 physicians in the entire world who are fellows of the Academy of Breastfeeding Medicine, and have "demonstrated evidence of advanced knowledge and skills in the fields of breast-feeding and human lactation."

But Kelly's doctors weren't trained in human lactation, and they told her what many women with lactation failure have been told before: "We've never seen this before. You're the only one."

Yet Kelly is clearly not alone. Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, California, says that as many as 5% of all women have underlying medical conditions that prevent or seriously hinder lactation: hypoplasia, thyroid problems, hormonal imbalances and insufficient glandular tissue, among others.

But even Wolynn, who is also a certified lactation consultant, seemed skeptical when I related Kelly's tale -- usually women struggle because they haven't had enough support in the first few days after giving birth, in his experience. "Very few women really can't breastfeed," he said. "That's very, very, uncommon."

It's a "normal mammalian function," he said. Almost everyone can do it.


Because the complexities of lactation failure are so little studied and so often misunderstood, women can often feel that they are at fault, rather feeling like they are suffering from a medical issue for which they need and deserve professional help.

Dr. Marianne Neifert writes in her article, Prevention of Breastfeeding Tragedies, "The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that 'every pancreas can make insulin' or insist to a devastated infertility patient that 'every woman can get pregnant.'"

Luckily, doctors are beginning to take breast-feeding on. Wolynn, Evans and Stuebe are all fellows of the physicians' organization Academy of Breastfeeding Medicine (ABM). At Wolynn's practice, all six of the pediatricians on staff are also certified lactation consultants.

ABM has developed 25 protocols to guide physicians in treating breast-feeding problems. They've successfully lobbied to include breast-feeding issues on the exams for the American Board of Obstetrics and Gynecology and the American Academy of Pediatrics.

And the Affordable Health Care Act advises that, as of August 1, health insurance companies should provide "comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breast-feeding equipment."

Of course, we're low on those trained providers, but there are more every day, as medical schools begin to adopt breast-feeding curricula. "It's probably the most promising times we've seen," says Wolynn.

"We're in the early phases of what I'm hoping in the next five to 10 years will be more appreciated and more considered a real subspecialty," says Evans. "It's a whole new area of medicine."

Still, there's work to be done. Health insurance companies need to reimburse doctors for the time they spend attending to breast-feeding issues, to cover galactogogues, and to cover donor breast milk for women with lactation failure.

And if we're going to remove formula samples for women to promote breast-feeding, we better come up with a plan to feed the babies of that 5% of women who can't sustain them -- with 4 million births a year, that's 200,000 moms who need extra help.

Doctors practicing today -- especially those treating pregnant women and new mothers --need to know that lactation failure really does happen, and to be familiar with the potential causes of it, so that they can intervene early.

Perhaps most importantly, we need to stop demonizing mothers who can't breastfeed, guilting them into starving their kids with insufficient milk supplies rather than supplementing with formula. Yes, breast-feeding can help prevent SIDS, obesity, childhood leukemia, asthma, and lowered IQ ... but none of those matter if your baby is failing to thrive because of malnutrition.

In Kelly's case, once the baby was admitted to the hospital, she began to use formula, fed through a syringe -- she was told to avoid bottles because the baby would reject the breast. She stuck with formula, her baby gained weight, and today, "she's happy, healthy and fine," Kelly says.

But her guilt and shame continued long after the baby recovered. It wasn't until weeks later, in another doctor's office, that she happened upon an article that calmed her: some women, it said, can't breastfeed, for physical reasons. If only her doctors had read that article, too.

[matildasun]

Thanks for posting that. It is really interesting.

[karinothing]

That was really interseting. I have never understood why OBs dont' know more about lacation (and this involves everything from how it works to what medicaitons can be taken while breastfeeding).

[Deleted]

Great article. So true.

[bunch]

The anti formula campaign seems to make it criminal to admit that some women can't breastfeed. It's also like it's this big secret that it can be really difficult, even if you have a good supply. I get that at the early newborn age, when your hormones are raging, your baby is losing weight and your nipples feel like they're going to fall off, that most women can really use encouragement, because it wouldn't take much for some of them to quit. At the time time, I fully admit to judging when a friend did "all the wrong things" and then told everyone that she couldn't maintain a supply. I still feel bad for that. How in the heck could I have really known what was going on with her body? Good for them for finally saying it - it doesn't work for everyone.

Eta: I realize that this wasn't the point of the article, just something I've been thinking about lately. I do wish drs were more educated.

[holly116]

Thanks for posting!

When I had a lot of issues early on with DS (after having zero issues feeding DD) my pediatrician referred me to the Center for Breastfeeding Medicine at the children's hospital here at 6 weeks postpartum. I met with the head of the program, a dr who was a pediatrician and a LC. She was amazing and I credit her entirely for helping me successfully breastfed my son. I had previously had a few phone calls to the LCs at the hospital where I delivered, paid $70 out of pocket to a lady that runs a breastfeeding store, and had self diagnosed myself (with the help of the breastfeeding board on the bump) and treated a non-existent case of thrush. I was an emotional wreck and ready to quit.

Also, the visit was covered as a regular doctors visit under my insurance.

[hilwithonelary]

My midwife (who otherwise was an amazing provider) basically brushed aside my supply problems, told me to ditch the formula, and nurse nurse nurse. I followed her advice, and DD gained zero ounces in 2 weeks.

I tried it all. I did everything right. My supply would not come up. I'm so frustrated that everyone (both medical professionals and laypeople) seem completely resistant to accept that I have some kind of problem producing sufficient milk.

[justjen]

This really hits home. As someone who had a baby who wasn't peeing at all at 3 days old, I wish a medical professional would've intervened. I still feel so much guilt over my starving/dehydrated baby

[Deleted]

Very interesting article. I've been worried about milk production ever since my NP told me that may be why my breasts didn't grow.

[MamaMaui24]

Related - my friend EPed for her tongue tied baby because her Pedi told her that "they" don't clip tongue ties anymore and she would have to find an "old school ENT" if she really wanted to have it done. She felt like she was asking for some barbaric procedure that was outdated.

Her supply suffered (because of this and other issues) and she struggled a lot. Months later, her baby went to an ENT for tubes in his ears and that ENT told her that her son would have several speech problems related to his tongue tie. They were able to clip it at the same time as his tubes and all is good.

Just makes me sad for her that this could have improved her nursing situation from the get go had the pedi she trusted gave better (IMO) support and info re: BFing/tongue tie.

[zarapipe]

Very good article. It definately is a problem that doctors aren't trained in the area of breastfeeding. Luckily I didn't have too many problems but I can see how a lot of women don't know where to turn when faced with problems.

[holly116]

Jan 3, 2013 11:11:09 GMT -5 MamaMaui24 said:

Related - my friend EPed for her tongue tied baby because her Pedi told her that "they" don't clip tongue ties anymore and she would have to find an "old school ENT" if she really wanted to have it done. She felt like she was asking for some barbaric procedure that was outdated.

Her supply suffered (because of this and other issues) and she struggled a lot. Months later, her baby went to an ENT for tubes in his ears and that ENT told her that her son would have several speech problems related to his tongue tie. They were able to clip it at the same time as his tubes and all is good.

Just makes me sad for her that this could have improved her nursing situation from the get go had the pedi she trusted gave better (IMO) support and info re: BFing/tongue tie.

That's crazy about the tongue tie, but doesn't surprise me. One of my bed friends wasn't able to nurse her first DS at all and EPed for a year. When her family moved from Denver to KC and obviously went to a new pedi, the dr was like, yeah your son has an extreme tongue tie. The Denver pedi had never even mentioned it. Her son was three and had a speech delay at that point, caused by the tie. He had to be put under to have it clipped, but now all is good.

After all of that, I was well aware of what a tongue tie was. DS had a pretty tight one that was pointed out in the OR before my c-section was even completed. My DH had one and DD has a slight one, it's hereditary.

I had it clipped the day my son was born, no big deal all, far less of a deal than if we would have waited for speech issues. However, just because it was clipped didn't solve everything. DS didn't know how to use his newly freed tongue at all. This is what cause all the extreme nipple trauma (!) I had going on.

[pinkdutchtulips]

Jan 3, 2013 10:38:44 GMT -5 @notquiteblushing said:

Very interesting article. I've been worried about milk production ever since my NP told me that may be why my breasts didn't grow.

from the been there, done that school .. she may be on to something. w/ dd my breasts BARELY grew - i just went up a band size pg. i DID have supply issues and by 4 months dd was on formula. this time, in 6 short wks i've practically gone up a cup size already. i'm hoping that since the breasts have decided to grow this time that the supply will be MUCH better !

[Deleted]

I love that article. I was told I would have no problems BFing by a very good MW. I have hypo plastic breasts ( mild case) and inverted nipples. The second the nurse saw my breasts after DS was born she got a LC in the room.

DS ended up needing formula within 30 minutes of birth due to low blood sugar. I never produced a DROP of milk or colostrum despite pumping every hour ( nor did my breasts ever enlarge or engorge. )

The best decision I ever made in my life was to look at DH wen DS was 3 days old and say, " He is a formula fed baby, I refuse to make us insane or have tons of guilt over this."

Do I feel a pang of sadness about it from time to time, Yes. My parenting experience has been dramatically different from friends who EBF'd, or BFed at all. However my son is now healthy, HUGE, and happy as a clam. He is so smart and I am so blessed by him. At the end of the day it doesn't really matter how you feed your baby, it matters that you feed your baby, and feed them with love and compassion, not guilt and remorse.

[scribellesam]

It is interesting to me how much Breast is Best is hyped up, but there is such inconsistent support and information to help moms who want to BF. Of my dozen or so friends who have had babies, I think only myself and one other mom had what I would call an "easy" time establishing EBF (no latch issues, supply issues, etc.) And yet, people talk about it like it's this simple "natural" thing that requires no work on mom's part? We definitely need to do better.

[Brie]

Jan 3, 2013 11:36:49 GMT -5 @savestheday said:

At the end of the day it doesn't really matter how you feed your baby, it matters that you feed your baby, and feed them with love and compassion, not guilt and remorse.

Preach.

:Y:

[londoncalling]

Jan 3, 2013 10:45:31 GMT -5 @peggyolson said:

Her pedi is in the article

Us too. I <3 them. The Breastfeeding Center saved my breastfeeding relationship with DD1.

Also, if you are breastfeeding the pedi offers a mom and baby check for your first office visit. Mom is evaluated too including feeling for an enlarged thyroid, and talking with the dr. about any physical issues that you are having that could impact breastfeeding. Then you spend time with a lactation consultant and the pedi checks the baby. It's time consuming, but wonderful to have the option.

[speckledfrog]

Maybe it's because I'm on here./TB, I never thought breastfeeding would be easy. All you hear are horror stories about people's nipples being darn near ripped off, mastitis, low supply, etc. Even IRL I heard the stories. I wasn't looking forward to breastfeeding at all but it was so much better than I anticipated.

I agree with swank, my hospital/LC were really supportive. I did get annoyed with the pedi when they wouldn't tell me if a medication I needed to take would be harmful.

[Brie]

Jan 3, 2013 11:51:27 GMT -5 speckledfrog said:

Maybe it's because I'm on here./TB, I never thought breastfeeding would be easy. All you hear are horror stories about people's nipples being darn near ripped off, mastitis, low supply, etc. Even IRL I heard the stories. I wasn't looking forward to breastfeeding at all but it was so much better than I anticipated.

This.

I expected BFing to totally suck but I've been lucky to have a very easy time of it.

[jenny1223]

Thanks for sharing. I still have a lot of guilt over breastfeeding. I was doing everything "right" and DS still wasn't gaining weight. Everyone (LCs, MW, pedi, books, websites, friends and family) just tells you try this, try that, just keep trying. DH and I were fighting because he thought we should just feed formula and that I was starving DS. I felt it was my fault that I couldn't provide for my baby. DS was tongue tied and we had it clipped which helped but I know there was more going on.

[satsuma]

Jan 3, 2013 10:38:44 GMT -5 @notquiteblushing said:

Very interesting article. I've been worried about milk production ever since my NP told me that may be why my breasts didn't grow.

My breasts didn't grow during pregnancy and I still wear the same size bra now. DS was EBF up until last month when we started introducing solids. We haven't had a need for formula yet. I would try not to worry, although that can be hard once the seed has been planted.

Very good article. We had a lot of trouble nursing early on (but it wasn't my breasts' fault) and my OB straight up admitted to me that there was a dearth of research in lactation medicine. It was incredibly frustrating. If OBs are going to be encouraging breastfeeding throughout an entire pregnancy and scaring women off using formula then we 1) need a better system in place for handling difficulties when they arise and 2) need to change how maternity leave is handled in the US.

[Deleted]

I wish i knew all this prior to having kids. i honestly knew nothing despite reading several books & having an in town mom of 5 kids.

Been there, done that--so glad it's getting some coverage. I tried to BF DD1 & she never latched on. In 3 days at the hospital with nurses watching my DD1 ate nothing. She'd sit there with my boob in her mouth & sucked nothing. I didn't know any better--I knew it didn't feel like sucking or pain but I truly didn't know that was totally off. I got home & she never peed & cried virtually non-stop. I finally couldn't take it anymore & used the formula sample while waiting on a call back from the Pediatrician. She stopped crying, fell asleep & soon after finally peed. I went in & the Peds/nurses were no help. I never even heard of a LC & finally when I met someone via t he Nest (a pediatric nurse who came to my house to help me) my baby was a week old--it was too late. She'd fuss/cry even with a shield. I tried to pump & got jack shit out. I'm glad I had instinct to use the formula--I am not sure the consequence of many more days of not feeding would have been. My mom is a staunch BF advocate, the guilt ate me up for years even though my Mom said it was OK (which I really needed to hear). Fast forward to DD3 & she was almost 9lbs at birth & dropping % fast. She had a weak latch (low tone overall) & I finally started supplementing despite successfully EBF DD2 so I knew what I was doing this time. I complained about supply, did all he things you are supposed to (increase water, feed frequently, herbs, brewers yeast, etc). It didn't work & no one had any answer, test, ideas of what else to do. Turned out months later I found out I had become hypothyroid after DD3. It was a general practitioner that tested or it as part of a "physical" I requested. And I finally found the cause of my low supply--months after I gave up BFing completely.

[mellymel]

Thanks for sharing. I had a tough time BFing and tried everything, but never produced any milk. I was pumping and getting nothing. I was taking Fenugreek - nothing. I saw lactation consultants - nothing. Finally when DS was 10 days old I declared him a formula fed baby and have never looked back. I will always feel a little badly about this, but I know in my heart I tried everything. DS was only 5 lbs 9oz at birth and 5lbs 5 oz upon leaving the hospital and was a little jaundiced. He couldn't afford to lose any weight by me messing around with my supply and BFing issues any longer.

I will NOT allow myself to feel guilty if it doesn't work again this time.

[fortmyersbride]

I'm fairly certain BFing was never mentioned in med school, aside from the physiologic changes that breasts go through in pregnancy and lactation and the hormone pathways.

DD had a lateral tongue tie. Her pedi at the time argued with me that she wasn't tongue tied at all. I know what the inside of a baby's mouth should look like . I took her to one of the pedi ENTs at my hospital and he clipped it that day and fixed all of our latch problems. I then saw that pedi one more time to say "I told you so" before switching.

[brit1017]

Good article. I had a very low supply and could not EBF, but BF as much as I could and then supplemented. I was lucky enough to find an awesome LC who made several home visits, and to have a pedi who was also a licensed LC and willing to prescribe me domperidone.

[Deleted]

Jan 3, 2013 10:22:41 GMT -5 bunch said:

The anti formula campaign seems to make it criminal to admit that some women can't breastfeed. It's also like it's this big secret that it can be really difficult, even if you have a good supply. I get that at the early newborn age, when your hormones are raging, your baby is losing weight and your nipples feel like they're going to fall off, that most women can really use encouragement, because it wouldn't take much for some of them to quit. At the time time, I fully admit to judging when a friend did "all the wrong things" and then told everyone that she couldn't maintain a supply. I still feel bad for that. How in the heck could I have really known what was going on with her body? Good for them for finally saying it - it doesn't work for everyone.

Preach sister. One of my BFFs had supply issues with her first son. He only gained one pound between 2 and 4 months. You should hear her go on about how shitty the medical community is in their knowledge of breastfeeding, and how much damage some lactivists due in only presenting the happy, sunny, wonderful side of breastfeeding in an effort to encourage women to do it. The latter is also a huge pet peeve of mine and I really bristle when I hear people talking about how breastfeeing is "free" and "easy" and "painless" and how every woman has enough milk for their babies. And I had just about the easiest breastfeeding experience of any woman I know.

I think women would be better served by hearing about the benefits of breastfeeding BUT ALSO about cluster feeding, and how it hurts at first, and how hard it is to be physically tied to your newborn for weeks or months, and how sometimes there are supply issues.

Breastfeeding is totally awesome after a couple of months. But I think women who only hear the good stuff are going to think they're doing it wrong, that something is wrong with them or their babies, as they climb that Mt. Everest of a learning curve to get to the point where it's totally awesome.

[bail229]

Jan 3, 2013 11:34:54 GMT -5 pinkdutchtulips said:

Jan 3, 2013 10:38:44 GMT -5 @notquiteblushing said:

Very interesting article. I've been worried about milk production ever since my NP told me that may be why my breasts didn't grow.

from the been there, done that school .. she may be on to something. w/ dd my breasts BARELY grew - i just went up a band size pg. i DID have supply issues and by 4 months dd was on formula. this time, in 6 short wks i've practically gone up a cup size already. i'm hoping that since the breasts have decided to grow this time that the supply will be MUCH better !

Interesting article!
This was me as well. My breasts did not grow at all when I was pregnant with DS. He was great at bf, had a good latch and a strong suck but there just wasn't enough there for him. He was showing signs of dehydration and was crying and very fussy. I feel terrible now looking back and knowing he was hungry. I tried everything, fenugreek, domperidone, lactation cookies and my supply never picked up. We supplemented until 4 mths then I ended up in the hospital for a few days (unrelated to bf) and decided to just stop.
I never once got engorged, never leaked. It still bothers me that it didn't work out.
I will try again when we have number two, and I hope it works next time.

[pierogigirl]

I feel really fortunate that the hospital I delivered at offers free LC support (individual and/or support group). I went several times each with DS1 and 2 for weighed feedings because I never felt engorged or leaked with either DS. I also went to the support group for 12 mos. with DS1 and about 5 mos with DS2. Even with this support I still found breastfeeding hard for the first couple of weeks with DS1. I liked to be able to weigh the baby at the meetings so I could know he was getting enough.

[pooh8402]

That is extremely interesting. I will be printing this article out and distributing at work. I'm a nursery nurse and we have 2 IBCLCs on staff. Thank you.

Sent from my SPH-L710 using proboards

[Deleted]

Jan 3, 2013 16:33:58 GMT -5 bail229 said:

Jan 3, 2013 11:34:54 GMT -5 pinkdutchtulips said:

from the been there, done that school .. she may be on to something. w/ dd my breasts BARELY grew - i just went up a band size pg. i DID have supply issues and by 4 months dd was on formula. this time, in 6 short wks i've practically gone up a cup size already. i'm hoping that since the breasts have decided to grow this time that the supply will be MUCH better !

Interesting article!
This was me as well. My breasts did not grow at all when I was pregnant with DS. He was great at bf, had a good latch and a strong suck but there just wasn't enough there for him. He was showing signs of dehydration and was crying and very fussy. I feel terrible now looking back and knowing he was hungry. I tried everything, fenugreek, domperidone, lactation cookies and my supply never picked up. We supplemented until 4 mths then I ended up in the hospital for a few days (unrelated to bf) and decided to just stop.
I never once got engorged, never leaked. It still bothers me that it didn't work out.
I will try again when we have number two, and I hope it works next time.

Thank you both (and to the other poster too) for sharing your stories. I know to look out for issues now but I'm still hoping to get lucky.