Advice from mama to physician

It’s obvious that pediatricians have the potential to influence the health and well-being of our children in a huge way. In order to effectively monitor the health of our little ones, it is essential for parents and physicians to establish trusting, respectful relationships with one another.

And because we know that breastfeeding offers unprecedented nutritional value, protection, and bonding and sensory opportunities, it is perhaps most important that pediatricians and parents develop dialogue about infant feeding methods.

Without the creation of open conversation and mutual respect, we risk developing antagonistic relationships between two important caregivers which may put our children in undesirable and unfair positions.

Let me illustrate.

When my daughter Willow was about two months old, I started to notice small amounts of blood and mucus in her stool. I was horrified. Conveniently, I was in the midst of my Certified Lactation Counselor training where I learned about proctocolitis otherwise known as a milk protein allergy. When Willow and I returned home from the CLC training, I took her into urgent care and offered my diagnosis to the pediatrician on call.

“What exactly do you do?” she asked, presumably impressed with my new vocabulary.

“I’m a stay-at-home mom,” I replied. She didn’t respond.

After a fairly thorough physical examination of Willow, the ped handed me several sheets about rotavirus and intussusception along with instructions on how to collect stool samples for further testing.

Aside from the trace amounts of blood in her stool, Willow did not present any other intussusception symptoms. She exhibited not one symptom of rotavirus. Although annoyed and concerned by the pediatrician’s uneducated verdict, I followed her instructions.

The following week, we visited Willow’s regular pediatrician and she was just as baffled by the on call ped’s prognosis as I was. To my relief, Willow was properly diagnosed with a milk protein allergy as I had predicted. Instead of worrying about the risk of severe dehydration or putting my tiny baby through surgery, I was simply instructed to eliminate casein and whey from my diet.

Unfortunately, this is not the only frightful story I have to share about the pediatricians my daughter and I have encountered. Reflecting on these unfortunate events, I have compiled advice for parents and pediatricians alike on how to work as a team to better serve our children.

Whyte,BryonI also spoke with Dr. Byron Whyte, MD a pediatrician currently working at Pediatricare of Northern Virginia. His insight enables a more balanced discussion and has allowed me to appreciate physicians as human beings rather than the all-knowing deities that I wish they were.

The following are recommendations for making health decisions for your child:

  • Interview, interview, interview.

“You should know from the beginning who it is that you are dealing with,” Whyte says of selecting a pediatrician.

What kind of practitioner are you interested in? Does the doctor welcome questions? Does the doctor seem invested in children? Is there something about the doctor that you wish was different?

Whyte reminds us that choosing your obstetrician or midwife is just as important a factor in caring for your baby after birth as choosing a pediatrician.

“I wish we could do more on the OB end,” he says of offering breastfeeding education and support.

That’s because we know that the birth team plays an essential role in helping mothers breastfeed successfully.

“It would be great if there were a study about how much we talk about breastfeeding prenatally and how much that changes breastfeeding outcomes,” Whyte says.

What we do know is that birth experience affects breastfeeding outcome, so starting a conversation about breastfeeding prenatally is invaluable and can have lasting effects on your child’s health.

Whyte says the Baby-Friendly Hospital Initiative is very exciting because its policy to “not stick a bottle in every baby’s mouth” will help to shift breastfeeding back to the infant feeding “default”. BFHI’s model sets moms up for breastfeeding success.

Because we lack continuity of care within our healthcare system, it is often the work of the lactation professional to bridge the gap between parents and other medical professionals. It is in parents’ and children’s best interest to look for practitioners who have established good relationships with lactation professionals.

However, Whyte sheds light on the reality of relationships between pediatricians and lactation professionals within the community.

“When you’re out in the community, it’s harder to communicate,” he explains.

That’s because medical professionals working in the community don’t share the convenience of physicality like lactation specialists and physicians do within a hospital setting.

Whyte explains because they don’t always have the opportunity to talk about their patients together, he sometimes has a hard time trusting the care that patients receive from the lactation specialists.

For example, he says that if he refers ten patients to a specialist and eight of them come back using nipple shields, he doesn’t feel like they have done their job. It’s such a relief to know that there are pediatricians out there like Whyte who aren’t comfortable with overuse of instrumentation!

  • Keep yourself informed.

When Willow was seven months old, I needed my wisdom teeth extracted. I was concerned about the effect of the anesthesia on my breastmilk and milk production, so I asked our pediatrician for advice. She told me that I shouldn’t worry about it “because so many women are anesthetized during birth and they breastfeed just fine.” RED FLAG.

Dr. Thomas W. Hale, RPh, PhD runs the InfantRisk Center an evidence-based medicine and research call center. I consulted the center’s InfantRisk Helpline (806-352-2519) where I learned that two of the three drugs to be used during my procedure were hazardous while breastfeeding.

IMG_0581Luckily, my oral surgeon gladly used the alternative anesthesia recommended by the center and my breastfeeding relationship with Willow continues unharmed.

The Drugs and Lactation Database (LactMed), a peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed to, including information on maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider, offers mothers and healthcare professionals a similar resource. [Retrieved from: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT]

While the internet can be a scary place to receive medical advice, it offers parents supplemental information when they have concerns about the information provided by practitioners.

  • Trust your instincts. Trust your child.

 While I do not doubt that pediatricians are highly trained medical professionals, I firmly believe that parental instinct often outshines what practitioners sometimes pull from outdated medical textbooks.

For example, Willow recently had a urinary tract infection misdiagnosed as a yeast infection. Even after explaining how certain I was that she had a UTI judging by her symptoms, the infection went undetected for three days because our pediatrician failed to consider my intense instinct.

Looking back, I wish I would have insisted she reconsider the diagnosis.

Parents: don’t be afraid to stick up for yourself and your keen intuition! Physicians: Do not undermine the power of parental instinct.

  • Find respectful ways to convey your concerns.

I find that I have a difficult time being proactive about the issues I have encountered with physicians. I accept their advice with a quiet nod then return home to vehemently vent to my husband instead of trying to make change.

Don’t do as I do; alternatively, share the resources you find relevant with your child’s practitioner. Maybe it’s a book or a published study you’ve come across.

For instance, our pediatrician had never heard of the alternative vaccine schedule nor had she heard of Baby-Led Weaning until we reported that we would be practicing this infant weaning method. She was uninterested and unsupportive in our desire to do something “different.” Perhaps she would have been more receptive to learn about this alternative method from a professional; Gill Rapley’s books are a great resource for the uninformed.

When you find it difficult to express your feelings, it might also be helpful to bring a support person with you to appointments. Perhaps your partner is more comfortable questioning the physician and together you can better facilitate conversation.

  • Be receptive.

The other day, a girlfriend of mine told me that when she told her four-week-old son’s pediatrician that she and her son bedshare, he recited a laundry list of bedsharing safety concerns and told her that only poor, uneducated people do that. I can barely imagine how I might have reacted to a statement like that. Wrong on so many levels.

While Whyte doesn’t find that bedsharing speaks to a socioeconomic status, he does have his doubts about the safety of bedsharing when not accompanied by a manufactured co-sleeper. He cites increased SIDS risk as one concern.

My research shows that bedsharing can be done safely when mother exclusively breastfeeds. (See Dr. James J. McKenna’s Mother-Baby Behavioral Sleep Laboratory) Actually, bedsharing promotes breastfeeding and might even reduce SIDS.

When your thoughts about parenting practices differ from those of the pediatrician, it’s difficult to be receptive of their counsel. However, we must remember that physicians generally have our children’s best interest in mind and it’s always important to receive and reflect on the information they provide with open ears.

Likewise, physicians must remember that parents generally have their children’s best interest in mind.

  • Remember that physicians are humans too.

Whyte tells me that his experience as a father has influenced his work in a good way.

“It gives you the other side of it,” he says.

“For the most part, I’m speaking as a physician but the dad stuff comes in as well because I’ve been there,” Whyte says of the experiential things like being up all night with an upset baby.

He adds that as a physician and parent, he is better able to advocate for his patients.

“Listen, I know this isn’t my own child but if it were…” he role plays. Parenthood allows him to separate himself from the “sterile point of medicine.”

I am fascinated to hear about Whyte’s experience as a male breastfeeding advocate.

“There is no positive point to it,” he says.

He explains that he often watches people recoil when he talks about breasts, even in a medical context.

“These organs are completely different outside of the bedroom,” he references the intended function of breasts.

As a male breastfeeding supporter, Whyte encounters other challenges.

“[Mothers] are less inclined to nurse with me in the room,” he says. “The worst is if a mom will stop a feed.”

Whyte recalls working in the NICU. When he entered the nursery, nurses closed curtains around breastfeeding mothers to shield them from his presence.

“That really doesn’t send the right message,” he rightfully explains.

Whyte finds himself judged in additional ways too.

“I find that often times there is this sort of assumed barrier between [physicians] and [lactation professionals],” he says. “We end up in this weird tug-of-war where we are fighting for control of the baby. That’s not cool; we are all working together.”

He suggests lactation professionals not make generalized assumptions that pediatricians are automatically anti-breastfeeding.

Unless a physician “says something crazy,” Whyte encourages lactation professionals to assume that we all want the patient to breastfeed.

  • Know that you have options.

Keeping in mind that physicians are humans too, if you’ve encountered down right foolishness (like when I met a pediatrician who likened the female urethra to the vaginal canal) and can’t take it anymore, know that you have every right to change practitioners. If you do choose to leave, be honest about why. It might help the practitioner reconsider his or her practices.

Dr. Whyte starts work at George Washington University’s student health center this month where a Breastfeeding Friendly University Project has been established.

He says he’s most excited about helping people transition from childhood to adulthood.

“As a kid, mom and dad are in charge and they are kind of guiding you,” he says of adolescent health care. “The only way to get good care is to be forthright.”

Excellent advice indeed.  

kmcMom2Mom KMC shared this great resource they created to empower parents in the medical setting:

Breastfeeding empowering language in medical settings 

Goal: Productive dialogue ending in a plan that is best for baby/child

Questions:

What exactly is your recommendation/concern?  (“Maybe you should supplement with formula.”)

Why are you recommending this course of action?  (“Your baby is slipping on the growth curve.  He’s not gaining weight as fast as he should.”  Follow-up questions: “What exactly is your concern?  Is he missing milestones?  Is he losing weight?  How fast ‘should’ he gain weight, and how far behind is he slipping?”  “Are you using the WHO growth charts based on breastfed babies, or the CDC charts based on formula-fed babies?” etc)

What is the desired outcome of this course of action?  (“Formula will make the baby put on weight faster.”)  Follow up: How will that benefit the baby?

What are possible undesired outcomes of this course of action?  (Here’s where you need to be informed.  Dr. might say “none.”  This is your opportunity to state your case for why you are opposed to what is proposed, i.e. “Won’t introducing nutrition other than breastmilk increase my baby’s gassiness/fussiness?  Formula feeding causes me to miss breastfeeding sessions, which will decrease my milk supply and undermine the breastfeeding process.  What if my baby is allergic to formula ingredients?  I really need to be exclusively breastfeeding right now to help my body regulate my hormones.”  etc.)

Are there alternatives to this course of action?  (“Can I supplement with pumped milk instead?  Can I increase nutrients in my diet or take vitamin supplements to pass them on through my breastmilk?  Do I need to try feeding longer or more frequently?  Can I meet with a lactation counselor or consultant to make sure my latch is correct and the baby is getting all of my milk?”)

What if we wait on taking this course of action?  (“Let me try some of these other things first, and let’s see how the baby is doing at his next two checkups.”)

Helpful phrases:

We’re on the same team here.  We both want what’s best for my child.  I just need to understand exactly what you think is best so I can be comfortable with the decision we make together. (Lead into above questions)

I’m not sure I understand.  Can you provide clarification?

Could I please see the policy?

I’m willing to assume that risk, and I’ll sign a waiver of liability if you provide one.

Could I please speak with someone who is more familiar/comfortable with the breastfeeding process?

I’m a parent trying to do what’s best for my {sick, hurting} child.  Please have patience with me as I try to figure this out.

Please check the baby’s notes for the PCM’s orders on breastfeeding.  If there are questions, you’ll have to contact the PCM.*

*Ask your baby’s PCM to write a note ordering that the child will be breastfed through needle sticks, blood draws, IV’s, catheterizations, or any other unpleasant procedures.  No one can override a doctor’s order.

Have you seen the latest research on this?  (Direct to Academy of Breastfeeding Medicine at http://www.bfmed.org, or have research summary printed out in advance.)

I need some time to research this information.  What is the best way to contact you if I have more questions?

Read more about Mom2Mom KMC here. Visit them on Facebook.

[Please note change made 7/15: Dr. Whyte currently works at Pediatricare of Northern Virginia, not Olde Towne Pediatrics.]

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