A Breastfeeding Paediatrician Dr Vicky Thomas, ST8 paediatric trainee, Northern Deanery
Ascribing all infant problems to breastfeeding
t is a truth universally acknowledged that middle class professional women in their twenties and thirties are the demographic most likely to try to breastfeed. Which, of course, includes medical women. We are also a demographic with huge social clout when it comes to breastfeeding promotion. What we say, as obstetricians, general practitioners, paediatricians, surgeons and physicians to our patients, has a huge impact on parents in wider society. Nearly twenty years ago, Freed et al identified that US paediatric trainees’ knowledge of breastfeeding was patchy, coloured by their own personal experience of parenting and not evidence based. Little seems to have changed in the intervening decades. As UK breastfeeding rates drop still further, the need for healthcare providers to be able to give accurate and supportive breastfeeding advice becomes imperative. Prior to having my son, my own breastfeeding knowledge was fairly basic. I was positive about breastfeeding, encouraged the mothers I met to initiate or continue, but had little understanding of the more complex physiology or practicalities. At least, I thought, I knew what I didn’t 30
know and tried to direct women on to more appropriate support. Unfortunately, the NHS resources to support breastfeeding mothers are varied and often inadequate. Most women running into trouble end up cradling a screaming baby with one arm while sobbing on the sofa, desperately googling ‘why do my nipples look like they have been grated’ with their other hand. Over the last year and a half I have become involved in mother-to-mother support. The first lesson this taught me is how much I still have to learn. I am only an expert on breastfeeding my baby – I may have suggestions that other mothers find useful, but I am a novice in many ways, and I am constantly grateful for the input of other nursing mothers. I have something of a head start when it comes to the science of feeding, and with a subspecialty interest in paediatric endocrinology I am overjoyed at having my own hormonal feedback loops to play with, but I am learning all the time. As an active participant in breastfeeding peer support, I find myself regularly cringing at the arrogant and ignorant misinformation from my colleagues reported by the women in my network. Here are some of the most common.
I hear this so much. When a breastfed baby is seen by medical staff, any issue with that baby is at risk of being attributed to the breastfeeding. This leaves us wide open to missing important diagnoses. Sadly, I have seen all of the following conditions initially misdiagnosed as breastfeeding problems: acute lymphoblastic leukaemia, congenital adrenal hyperplasia, urinary tract infection, cardiac failure, pyloric stenosis... The list goes on. When breastfed infants present with faltering growth or other issues, the physician’s brain must be engaged rather than reflexively telling the mother to reach for the formula. A similar issue is the knee jerk reaction experienced by breastfeeding mothers with other health issues who are started on medication. It is common to hear of mothers told to stop breastfeeding, when the medication they are being prescribed is actually safe in lactation, or where a safe alternative is readily available. There is a lack of awareness amongst clinicians of sources of information other than the BNF, such as the pharmacy support provided by the Breastfeeding Support Network, or Hales ‘Medication and Mother’s Milk’ (http://www.medsmilk. com). Such resources provide much more detailed information on medication safety in breastfeeding which can be used to help women make informed choices.
Not understanding the urgent need to resolve feeding issues It would seem obvious that there is a degree of urgency in sorting out feeding problems where women are in pain or unwell, yet they are often left to struggle on with tattered nipples and mastitis. A week’s delay in resolving the problem may seem minimal to a health professional but when a woman is feeding every 90 minutes or so, and almost continuously overnight due Medical Woman | Autumn 2014
Published on Sep 17, 2014
The magazine for the Medical Women’s Federation (MWF), the largest and most influential body of women doctors in the UK which aims to promot...