I expected that having a baby as a pediatric subspecialty fellow was going to be a challenge. But I could never have anticipated how scary it would feel to step into the world on the other side of the clinic door. My friends invited me to join a breastfeeding support group on social media “so that I knew I wasn’t the only one up with my baby at 3 a.m.” I learned a lot more than that.
I learned that some mothers trust anecdotes from strangers more than advice from their pediatricians. They recount unsatisfying visits with their pediatricians and then ask other mothers to comment on the advice. As I sifted through a lot of nonscientific and sometimes medically dangerous advice, I also was offered a new perspective. Many mothers will lie to their pediatricians about sleeping and feeding habits because they don’t want to be judged or don’t want another canned answer. Instead of engaging in discussion, they nod, smile, and return to their online support groups.
Dr. Marielle J. Fricchione
Very little literature exists on how to partner with mothers to guide them through the breastfeeding journey. These are intimate and individual journeys for each mother and often for each new child. For most mothers who choose to breastfeed, their infant is asking them to learn a new endurance sport, and the body and mind have to start running a marathon on day 1. Breastfeeding consumes nearly every waking moment of at least the first 6 weeks of the infant’s life. It is the most important, stressful, and wonderful part of their young child’s life to date. Pediatricians need to understand and offer advice that reflects this struggle.
So how do we expect pediatricians to help new mothers when our pediatrics residencies lack a basic breastfeeding curriculum? We need to fix it soon because breastfeeding mothers expect evidence-based breastfeeding advice, and as I learned online, they may even fire you if they don’t like what they hear. Although many pediatricians may feel uncomfortable with counseling an adult woman about her body or even treating her, the American Academy of Pediatrics recommends that we do so (Pediatrics 2012 Mar;129[3]:e827-41). There are even resources available to guide billing of extended breastfeeding visits.
The basic science of breastfeeding and how to counsel on common concerns need to be represented in our residency curriculums, as a lack of training early on can perpetuate itself in practice, leading to pediatricians who give outdated advice, reassure when they should counsel further, or give the mother the impression her concerns are irrelevant. Mothers expect more of us when it comes to breastfeeding, and we should expect it of ourselves.
In the meantime, some resources I found helpful were:
• “The Nursing Mother’s Companion,” by Kathleen Huggins (Boston: Harvard Common Press, 2010). This is a great book to help those in training really understand the stresses and common concerns of breastfeeding moms.
• newborns.stanford.edu/Breastfeeding. This is a good online source for those who want a quick tutorial about the early days of breastfeeding.
• AAP Breastfeeding Residency Curriculum (www2.aap.org/breastfeeding/curriculum/medical_knowledge.html). These are learning modules to build knowledge of lactation pathophysiology and how to address mothers’ common concerns.
• www.drmilk.org. This is a support group for breastfeeding moms who are doctors.
Dr. Fricchione is a pediatric infectious diseases fellow at McGaw Medical Center of Northwestern University and the Ann and Robert H. Lurie Children’s Hospital of Chicago.