Tuesday, April 12, 2011

An Open Letter to all American Physicians

* Please note that this letter is NOT addresses to MOTHERS. This has nothing to do with how you choose to feed your child but being supported in how I choose to feed mine. 

Dear Physicians of America

I have a great respect for your profession and all that you do both for me personally and for the people of this nation. I am writing you today because many of you are committing a disservice to your future patients, and really the future of our nation, through your lack of education on one simple and important topic. What, you ask could be something, that the seemingly most educated members of our society could be undereducated on?


Know I am guessing that more that half of you scoffed, rolled your eyes or stopped reading, and that is precisely the problem.

The American Congress of Obstetrics and Gynecology (ACOG) and the American Academy of Pediatrics (AAP) can advocate for breastfeeding and are on the front lines of increasing the number of women that choose to try. It’s expected of them, breastfeeding education is part of their job since they cater to pregnant women and children, we wouldn't expect anything less. However any other speciality? Well even knowing the basics, or being willing to research it seems like a tall order.

I recently had an experience with having a medical condition, while related to being a pregnant and a women, was not exclusive to be being a a women or being pregnant. This meant that my care came under the hand both a general surgeon and an anesthesiologist as well as countless techs and nurses. What I learned is that once the baby is out of my belly the medical community no longer takes an interest in what is best for him when deciding what is best for mom. This is both stressful for mom and baby and detrimental to both their health and well being acutely and further down the road.

You, family physicians, general surgeons, anesthesiologist and emergency room doctors are on the front lines when a woman has an acute condition. An acute condition that may be causing discomfort, pain, or any variety of symptoms. What I found in my experience was that as soon as I showed any concern or hesitation to treating myself because I was a nursing a baby I was immediately meet with resistance and misinformation. Many times in my care when I asked if something was safe for nursing a baby I was told that I was the patient not the baby, that we had to take care of me first, that they didn’t know. I was left both stressed, in pain, and scared for the well being of my 6 week old child. In this fragile and upset state I was left to hunt down the answers and research on my own.

What physicians need to know is this, if you treat women, even if women are less than 1% of your patient population, there is a chance you will encounter one that is nursing. I do not expect that every physician be as educated or experienced with breastfeeding as my OB/GYN. I do expect that every physician be aware that is the recommended method of feeding all infant under the age of 6 months old by the World Health Organization (WHO), the American Medical Association (AMA), the American Academy of Family Physicians (AAFP) , the AAP and the ACOG. That means when a women tells you she is nursing, your first response should not be “you will have to stop” it should be "how old is your child and let’s see what we can do work through this".

When faced with the dilemma of whether something is safe for a nursing mother or not the answer “well in the face of having no regulations or policies we just say no nursing” is not acceptable. This is what was uttered to my by my anesthesiologist. Note that no regulations does not mean unsafe and no data. There is information from Dr. Michael Hale on safe medications to use, there is information by and for anesthesiologists on it’s safety as well as information from the AAP. There are multiple studies showing it's safety and the Infant Risk Center at Texas Tech  on call to answer questions. A mother who did not show up to surgery armed with this information could have taken that anesthesiologists statement to mean that is unsafe and unnecessarily stopped nursing for anywhere from 12-48 hours, the range I was given. With a 6week old infant 48 hours could be the difference between successful breastfeeding and early weaning.

No physician would ever make a diabetic do their own research to see if they drugs they are being given are compatible with their condition and the drug they currently take. Yet as a nursing mom it was up to me and me alone to find the answers necessary to continue to feed my baby what is recommended by every major medical organization as what is best for her. That and my determination to breastfeed. The anesthesiologists wavering about breastfeeding and his refusal to answer my questions or to look at my research left even my husband (a strong supporter who had read it all) wavering.

I am aware that there will always be emergency situations. Cases where the mothers health and well being need to be considered first and foremost above the needs of the infant. Allowing the mother to breastfeed through potentially stressful medical situations does not only benefit her infant. There are a multiple health benefits for the mother as well from reducing breast cancer risk to helping ease a mothers anxiety. If the physician is truly "only worried about the mother" it's in her health's interest to keep her nursing.

Physicians of America you need to stop looking at the mother and nursing infant as separate patients and see them as the connected entities that they are. Because fostering and helping maintain that nursing relationship is what is best for baby and mother.

(still nursing my baby girl)

Mother's who are having surgery and may stumble upon this in the future. After having several in depth conversations with my in hospital (yep same hospital where I had the surgery) lactation consultant, consulting the above link with Dr. Hale's research, talking to my OB, my Family Physician (who care for my daughter as well) as well as reading all those links provided above I went into the surgery with the thought of pumping and dumping for four hours. I was a little slow to wake up from the surgery but as soon as I was in recovery I pumped (dumped) and I pumped as soon as I got home (dumped), and resumed nursing approximately 6 .5-7 hours after my anesthesia was started. I was not feeling any of the effects of the anesthesia, and would have felt comfortable driving a car. My lactation consultant pointed out that they have on occasion had to put a pregnant mother under general anesthesia to perform a c-section and they have never made that mother dump first. Please do your research, and question your doctors, because "I don't know, so don't" is not an acceptable answer for something common such as anesthesia and pain meds. 

Disclosure: I am not a medical professional and none of this information is intended to diagnose or treat any medical condition. ALWAYS consult with your physician and lactation consultant before nursing after taking any medication.  

Linking up with Shell's Pour Your Heart out
I'm sharing my awesome with Momma Made It Look Easy and you can too.


Robin said...

Oh, it seems like such a simple subject for them to study up on and have basic understanding of, yet so frustrating if they don't! Thanks for posting this. I would be awesome if the "right" people stumbled across it. :)

Beth said...

I have had my share of uneducated doctors when it comes to breast feeding. Funny it involves a surgeon and anesthesiologist too! I have another story involoving a pediartrician that might make your toes curl.

This Heavenly Life said...

Wonderful post, Melissa! I think that even pediatricians sometimes have a disconnect between what is recommended for their patients and what they'd like to see done. My on-call Ped. in the hospital was close to recommending formula for my jaundiced baby-girl, at 4 days old. Lactation consultant to the rescue :)

I think that if society in general were more supportive, those doctors wouldn't be so ill-educated in this area. And I know they have a LOT to know about, but...if they don't know it, shouldn't they have the *desire* to know? To search for their patients' best interests?

Kim said...


Hyacynth said...

Um, what Kim said: AMEN!

Joel said...

Great post! You are so right - any doctor that deals with surgery/anesthesiology should definitely be educated in the safety of the things they prescribe for nursing women & our babies!! What a frustrating experience for you, but I loved how you used it to encourage other women who may be going through similar things!

Elizabeth Flora Ross said...

I'm sorry that you had this experience. I was fortunate. I had to be treated for a medical condition while nursing, and surgery was a distinct possibility. I did a ton of research before I went in for my first appointment with the orhthopeadic specialist.

The first time I saw him my daughter was 2 months old. She was with me. He immediately asked if I was nursing, and then began to share with me the research concerning the treatment I would be undergoing. It was everything I had found on my own, but I was impressed he knew it. He's a hand specialist.

He assured me I could continue nursing, and that we would only consider treatment options that would be safe for my daughter. I have no doubt, however, that he was the exception to the norm.

Kate Pantier @ Mommy Monologues said...

A-FREAKING-MEN!!! 'Nuff said.

Alita said...

VERY well stated Mel.

We are ONE. (well when they were little) We should ALL be viewed as ONE while nursing.

Lisa said...

I haven't come across this while nursing either of my kids, but you are absolutely right. I am my baby's food. You need to make sure I can continue to be that. Well said.

Stopping by from PYHO. :)

Di said...

Do you hear that? It's me standing up and applauding you! Jellybean is 15 weeks old tomorrow and I am still nursing. Everyone tells me that it so admirable and I always answer with no- its what is best for him and I will do it as long he wants to.

Every medical professional should know they are treating the mother and the child if you are breastfeeding!

Shell said...

I'm glad that you did your research and figured it out- but it's a shame that you even had to!

BF can be hard enough so when there are doctors not being supportive, some moms would stop.

Anonymous said...

Good for you, mama! It's a shame how little the medical community knows about breastfeeding. Thank for for good lactation consultants.

I'm glad you guys were able to work through the issue and stick with breastfeeding.

Making It Work Mom said...

Good for you for doing your homework. I had to be put under a general anesthesia for my c-section for my 1st and it was never suggested that I dump- I just fed her. Thank God! Because I don't even know what I would have done if they would have told me to pump and dump afte my horrible labor ordeal!

Yolanda (Blaggie Plaggie: Babblings of a Mommy Doctor) said...

Absolutely, I wholeheartedly agree with the need for better education out there on breastfeeding. Tunnel vision is really easy to develop in the practice of medicine, simply because everything has become so specialized and sub-specialized. The concept of taking care of the whole patient and being aware of what's going on in that patient's life is slowly being lost. In the defense of those doctors who don't know much about breastfeeding, even pediatricians like myself who are very pro-breastfeeding, there just isn't much time spent in residency exposing and training a physician to the difficulties of breastfeeding. There's just so much material squeezed into those years in residency. We don't really get the opportunity to see the "behind-the-curtain" struggles of breastfeeding, at least until we become parents too with first-hand experience of the questions that arise.

Erin said...

When Miss H was a baby, like less than 2 months, I got an ear infection. I went to my OB (because I hadn't been released back to my FP yet). When i asked if the antibiotics were ok for nursing, he said, "I know that is important to you, but you don't need to be a martyr. Just take the medicine."

Needless to say, I had to look it up myself to make sure it was safe. It is beyond frustrating to me how little support there is for nursing mothers.

Jennifer said...

This is a great post Melissa. Thanks so much for sharing this information with nursing mothers. I think a lot of times mothers are not encouraged just because it may make it harder on the doctor.

Connie said...

It infuriates me how often Mothers are discouraged from breastfeeding.

So proud of you for finding your own info and blogging about it so that others have the information!

Jeanine Byers said...

You would think they would know enough to give you the information you needed. I continue to be astounded at what they miss.

When I was breastfeeding my son, we did extended breastfeeding. But no one told me that because I am African-American, I would need to give him vitamin D supplementation or take it myself. I found that out after they told me he wasn't getting enough.


Anonymous said...

I stopped going to a doctor when she suggested that we had had a "good go of it" with breastfeeding and that I should consider stopping so I could take meds and get more sleep.

Kathleen Basi said...

This is the situation that cries out for a certified lactation consultant. Not everyone can find one but man! am I ever grateful I've been able to find one! Even after nursing a child with Down syndrome & a heart condtition, even after nursing a third child after her, my fourth had me twisted in knots. I couldn't believe it. I needed the support desperately. Doctors aren't the end-all of knowledge, and so often they're treated as such--and seem to regard themselves as such!