Choosing a breastfeeding-friendly pediatrician

How can you choose a breastfeeding-friendly pediatrician? I am in the beginning of my last trimester of pregnancy. I have started my search for a pediatrician but I want to be sure I choose someone who is very supportive of breastfeeding. Can you give me some guidelines?

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Kathy Kuhn

Kathy Kuhn is a registered nurse who has been working with breastfeeding families since 1981. She has been an International Board Certified... Read more

It's really wonderful that you are taking such an active role in trying to ensure the very best health care for your baby and recognize the importance of supportive health care providers to maximize your breastfeeding experience.

The first step is to get recommendations from several sources, such as your current health care providers, a lactation consultant, your local La Leche League, other mothers and/or your family. Ask specifically why they are recommending this pediatric practice.

Think about your needs and the needs of your family. Do you prefer a large practice with many doctors that may be able to ensure the availability of a physician 365 days a year, or would you prefer a single practice physician for a more personal touch? (Be sure to ask who covers on the doctor's days off.)

As you narrow your search, don't be afraid to call the doctors' offices and ask questions. I also think it is a good idea to interview several pediatric practices and include both physicians who make the decisions and policies and the nurses who are often asked to support the breastfeeding mothers. Bring written questions to the interview and take notes.

Be very specific when trying to discern just how well they a physician supports nursing moms. Most doctors will answer in the affirmative when asked if they support breastfeeding, so ask the percentage of mothers in their practice who initiate breastfeeding and how many are still nursing at six weeks, six months and one year. Higher rates of breastfeeding may be an indication of a practice that is effectively providing support.

Ask how the practice handles breastfeeding concerns when they arise. Do they have in-office help, or do they refer to a board certified lactation consultant outside the office? How many referrals are generated each year to a lactation consultant? If they have someone on staff to help with breastfeeding, ask if she is IBCLC certified and ask to interview her as well. Ask if the pediatrician's LC has other office duties or if her only duty is to work with breastfeeding concerns. Often pediatric practices will designate a person to help the breastfeeding mothers but this person may or may not be board certified and may spend the bulk of her day working on non-breastfeeding issues.

In 1990 the World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) developed the "Ten Steps to Successful Breastfeeding" to assist maternity services in developing breastfeeding strategies designed to promote, protect and support breastfeeding. (Riordan & Auerbach 1999) Those same steps can be used in pediatric practices and you may want to ask if they are familiar with the "Ten Steps" and if they have implemented them in their office. I would imagine few have used the "Ten Steps," but you can use it as the "gold standard" and base your questions and discussion around it's recommendations.

The following questions for pediatricians are based on the Ten Steps:

  1. Does the pediatric practice have a written protocol for breastfeeding that is available and understood by the entire staff and anyone who covers for them in their absence?
  2. How much in service training has been provided for their staff on breastfeeding and what are the credentials of the person who provided the in service training?
  3. What opportunities or suggestions do they provide for the mothers to learn about breastfeeding?
  4. Do they encourage breastfeeding shortly after birth, rooming-in and on-cue feedings? If so, how to they make sure this is implemented in the hospital?
  5. How do they support breastfeeding if the mother and baby need to be separated due to a health emergency?
  6. In what sort of circumstances would they recommend supplemental feedings, interruptions of breastfeeding and weaning from the breast?
  7. What sort of support and information do they provide if supplementation or interruption of breastfeeding is medically indicated to ensure the quickest, most effective return to exclusive breastfeeding?

Be sure to ask how they feel about the current recommendation of the American Academy of Pediatrics, that states that infants should receive exclusive breastfeeding or breastmilk until about the middle of the first year. They also recommend breastfeeding as the primary source of an infant's nutrition up to a year and beyond as mutually desired by the mother and infant. (AAP 1997)

You also may want to ask about the pediatrician's relationship to the formula companies, such as, do they use formula company breastfeeding information pamphlets or videos? These formula company publications tend to have inaccurate and misleading breastfeeding information and most savvy health care providers who want to promote breastfeeding do not use them as educational tools. Do they receive gifts from formula company representatives? If they do, that may imply a more accommodating attitude toward promoting formula. You may not even need to ask this question. Look around the office for note pads, pens, mugs, etc. with the formula company logos.

In asking these questions, and others like them, I think you will get a good impression about how a pediatrician suits your personality, needs and beliefs about breastfeeding.

Good luck in your search and congratulations on your new baby.

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