Doctor on lack of doctors' breastfeeding education

[RoseDuperre]

Awesome new post from the Academy of Breastfeeding Medicine blog.

Excerpt:

I went to San Francisco, because I never been there, in 1999 to attend an AAP meeting so that I could get some needed continuing medical education credits. One of the speakers, ABM member Dr. Nancy Wight, spoke on breastfeeding. Almost every word was news to me. Medical school, residency, chief residency and part of a neonatology fellowship and I did not know about any of the content she was presenting. One of the other speakers lectured on lice- that I knew something about. But breastfeeding? Nope. How did Dr. Wight know this stuff when I didn’t? Who taught her yet set me loose on an unsuspecting patient population armed only with my personal 7-week breastfeeding experience?

[proudmomof4]

Remarkable post, my impression so far was that many physicians really weren't interested in anything beyond medical school - unless their own BF experience taught them differently.
Here's another interesting point: as far as I know, both LLL Leaders and IBCLCs have to go through a process of reflecting their own BF "histories" and of reflecting their own personal biases before their accreditation. This is certainly not part of medical school either.

[rparker]

My husband is a pediatrician and his formal education on infant nutrition consists of a handful of pamphlets: half from LLL, half from a formula company.

[haydn'smommy]

I'm a PNP, and until I had my own child, I knew NOTHING about breastfeeding. And, in hindsight, I probably sabotaged many a breastfeeding mother. I just wasn't taught anything at all about it. I was taught that this is best but formula is just as good, etc, etc, etc. And, I'm sick when I think how many times I told mamas to stop nursing because of slow weight gain, jaundice, etc. Just sick. But, I didn't know.
After I had Haydn, and I struggled to nurse, I started doing a ton of research which culminated with me becoming a CLC (and hopefully, IBCLC, next year). Now, I'm the "lactation specialist" for my practice, and I am combatting the lack of knowledge and education in my doctors. It makes me so sad that we don't value breastfeeding more and that we don't prepare physicians and physician extenders in how to encourage and support breastfeeding.

[phathui5]

It's ridiculous that someone can become a pediatrician without taking at least a semester class on breastfeeding. Absolutely ridiculous.

[proudmomof4]

Originally Posted by haydn'smommy

I'm a PNP, and until I had my own child, I knew NOTHING about breastfeeding. And, in hindsight, I probably sabotaged many a breastfeeding mother. I just wasn't taught anything at all about it. I was taught that this is best but formula is just as good, etc, etc, etc. And, I'm sick when I think how many times I told mamas to stop nursing because of slow weight gain, jaundice, etc. Just sick. But, I didn't know.
After I had Haydn, and I struggled to nurse, I started doing a ton of research which culminated with me becoming a CLC (and hopefully, IBCLC, next year). Now, I'm the "lactation specialist" for my practice, and I am combatting the lack of knowledge and education in my doctors. It makes me so sad that we don't value breastfeeding more and that we don't prepare physicians and physician extenders in how to encourage and support breastfeeding.

I'm assuming PNP means Pediatric Nurse Practitioner (I'm German - familiar with only a few of the GPs, MDs, LCs etc.)?
It sounds like you learned a lot from and with your child (don't we all?) - good for you! When you're saying you knew "nothing" about BF: was it just never mentioned or never taught as part of some curriculum or were the books hopelessly outdated?

[haydn'smommy]

Originally Posted by proudmomof4

I'm assuming PNP means Pediatric Nurse Practitioner (I'm German - familiar with only a few of the GPs, MDs, LCs etc.)?
It sounds like you learned a lot from and with your child (don't we all?) - good for you! When you're saying you knew "nothing" about BF: was it just never mentioned or never taught as part of some curriculum or were the books hopelessly outdated?

yes, pediatric nurse practitioner. i just wasn't taught it. i was taught formula feeding but other than "these are the benefits of breastfeeding" and "breastfeeding is best" i wasn't taught how to support mom, how to help with latching/positioning/problems (oversupply, thrush, etc). i wasn't taught what to look for with weight gain, how to manage slow gain or jaundice without giving formula and bottles. the education just wasn't there.

pak

[minkajane]

I'm in school to be a medical assistant and I think even at this level we should be taught about BFing. There's no mention in the Obestetric and Gynecological Assisting chapter in my clinical book or the female reproductive system or nutrition chapters in anatomy beyond the basic half-paragraph rundown of a few benefits. Of course, these same books illustrate all males as circumcised and state that consent is not required for mandatory school vaccines, so I don't have much hope for them.

[Amys1st]

With dd2, we spent 3 mos in the nicu. 2 of the fellows were nursing mamas. I would run into them in the "pump room". One was having issues after she came back to work with nursing and the bottle. Also a supply issue. I coached her on a few specifics and at one point she seemed embarrsed she didnt know this. I reminded her, I had a few years of nursing under my belt and she was a new mom. She replied its true they dont teach you much in school about it. I told her she wasnt a just a physican, but a mom who is just trying to do her best for her new baby. We talked Mom to Mom at that point.

I remember another time after dd1 was born, a ped who was a new mom came to a meeting. If the leader didnt call her "Dr" no one would have known. She came to several meetings before she went back and she said having her baby made her a better Dr, because she learned so much about nursing etc and was going to tell her patients some different things now.

[dollysods]

In med school, I believe we had one lecture that included the physiology of breastfeeding. That was it.

In my family medicine residency, we had a 2 lectures on breastfeeding-- one done by a pediatrician full of just plain wrong information (the breastfeeding moms in the room argued with him) and one by a lactation consultant that was a bit more helpful, but was just focused on emotional support for the breastfeeding mother. So very little instruction in practical support was given.

We have a lactation consultant in our office who is somewhat helpful but never breastfed. She tends to schedule breastfeeding pts with the 3-4 of us who have breastfed because the other residents are at a complete loss for the most part about what advice to give...

So much of the medical professionals' advice and knowledge seems based on personal experience. So I am sure that breastfeeding my 2 year old while pregnant puts me in a different category of advice giving than the physician whose babies were "allergic" to his wife's milk, or the doctor with supply issues...

[KristyDi]

Originally Posted by minkajane

I'm in school to be a medical assistant and I think even at this level we should be taught about BFing. There's no mention in the Obestetric and Gynecological Assisting chapter in my clinical book or the female reproductive system or nutrition chapters in anatomy beyond the basic half-paragraph rundown of a few benefits. Of course, these same books illustrate all males as circumcised and state that consent is not required for mandatory school vaccines, so I don't have much hope for them.

the whole post is appalling, but particularly the bolded parts.

[proudmomof4]

Originally Posted by Amys1st

(...)
I remember another time after dd1 was born, a ped who was a new mom came to a meeting. If the leader didnt call her "Dr" no one would have known. She came to several meetings before she went back and she said having her baby made her a better Dr, because she learned so much about nursing etc and was going to tell her patients some different things now.

We certainly would need more doctors of that kind!

[zarasmom07]

Originally Posted by dollysods

We have a lactation consultant in our office who is somewhat helpful but never breastfed.

This just baffles me. I doesn't seem like you would be as effective if you had no first-hand experience to back up your knowledge. As said in pp, I know for LLL leaders you have to have had at least 9 months of personal nursing experience to even begin the leader application/training process.

Of course a great argument for this would be Dr. Jack Newman!

[PatioGardener]

Originally Posted by zarasmom07

Of course a great argument for this would be Dr. Jack Newman!

exactly! i think it can be an advantage for an LC or knowledgeable MD not to have breastfed - no personal issues to cloud the consultation as often happens when MDs give breastfeeding advice.

we don't expect surgeons to have had appendicitis, or oncologists to have had cancer... what we expect is good evidence-based non-biased care. fortunately most ibclcs give this regardless of their personal breastfeeding situation.

nak

[proudmomof4]

Originally Posted by PatioGardener

exactly! i think it can be an advantage for an LC or knowledgeable MD not to have breastfed - no personal issues to cloud the consultation as often happens when MDs give breastfeeding advice.

we don't expect surgeons to have had appendicitis, or oncologists to have had cancer... what we expect is good evidence-based non-biased care. fortunately most ibclcs give this regardless of their personal breastfeeding situation.

nak

But then, many people find it weird when Catholic priests hold sermons on marriage and family or even host marriage classes. Or when conventional farmers offer advice on organic farming. Or when childless / childfree people volunteer parenting advice. Or when male doctors tell women how and where to give birth.

In other words: I don't think "been there" needs to be a disadvantage but of course you have to be able to separate this mother's issues from your own - which is what LLL Leaders and LCs are expected to work on continuously. On the other hand, "been there" offers the chance of being more authentic than speaking from an exclusivley theoretical point of view.

[PatioGardener]

Originally Posted by proudmomof4

In other words: I don't think "been there" needs to be a disadvantage but of course you have to be able to separate this mother's issues from your own - which is what LLL Leaders and LCs are expected to work on continuously. On the other hand, "been there" offers the chance of being more authentic than speaking from an exclusivley theoretical point of view.

I agree - btdt can be advantageous for health care providers (when supporting moms and giving evidence based health care advice). i don't think it is automatically a disadvantage (see Dr Jack Newman).

for non-health care providers (lll leaders, peer councilors) i think the btdt aspect is crucial.

nak