April 30, 2011 at 10:53 am #128097
[quote=kpzr/9145]This is why I will not put a guilt trip on a mother who has decided to give formula. [/quote]
Are there really physicians out there that would do that? I agree that saying anything like that to a mom after the fact would be incredibly insensitive.
Of course it’s easier to give formula, and I know that to some providers, the benefit is trivial, but for the sake of the mom who’s making this a priority (and the baby, who also stands to benefit), why wouldn’t more physicians at least try to be more supportive of breastfeeding women? Or at the very least learn how to manage common breastfeeding problems before first suggesting formula?
I think so much of this lies in the fact that it is nearly impossible for female physicians and physicians-in-training to follow the AAP guidelines, which makes female physicians so much more sensitive to “not guilt-tripping” other moms–I think this sentiment goes a little too far and hurts women who are desperate for support in their efforts to breastfeed. Often there is not much support at home or at work, and when the lack of support continues at the doctor’s office….many women are surprised and disappointed. And then they just give up.
(Not directed at you, kpzr, I’m more thinking of the pediatricians I worked with and their stories…and the stories of their patients.)
SW and southern, you both deserve a crown and minions to do your bidding for exclusively pumping all this time. I could never have made it as far as you. Pumping–let alone breastfeeding–is a thankless, exhausting task. Good for you!May 1, 2011 at 7:52 am #128105
I am very knowledgeable about breast feeding problems and supportive of breastfeeding moms. I do not suggest formula instead of “managing common breastfeeding problems”; as I already said, I use it only when medically indicated. Until you have been in practice and seen dehydrated or sick newborns, it is hard to see beyond the “normal” breastfeeding experience to understand that there is a medically-indicated use for formula. This is in no way the same as “taking the easy way out” and recommending formula.
I know of several physicians who do guilt-trip moms who have decided to give formula.May 2, 2011 at 10:07 am #128144
kpzr, I definitely didn’t mean to insinuate that you wouldn’t support breastfeeding! From all accounts, it sounds like you’re an excellent pediatrician, and I value your opinions on things. I just wish more physicians like you practiced in my neck of the woods.
And yes, of course I understand and respect that there are medical circumstances when a breastfed baby needs formula supplementation. It happened to my own baby. I didn’t mean to imply that I didn’t know that, so sorry for the confusion! Honestly, my kids would have been transitioned to formula, too, if I hadn’t been able to take as much time away from clinical duties as I did.May 3, 2011 at 4:38 am #128174clee03mParticipant
[quote=kpzr/9145]Honestly, I have practiced Pediatrics now for 13 years and there does not seem to be a difference between breast and formula fed infants. I see ear infections and gastroenteritis in both groups at the same rate (it seems). And formula fed infants do just as well in school as breast fed infants! So, yes, I have occasionally recommended formula for an infant with jaundice severe enough to be admitted or an infant with ten percent or more weight loss from birth weight. In these situations, the benefits of formula far outweigh any imagined risks. [/quote]
How can AAP recommend breastfeeding without evidence? I remember being taught in medical school that breastfeeding benefits the baby like less allergies, less illness (during breastfeeding) due to antibodies in the milk, less constipation of other digestive problems, etc. So these are all hogwash? Really? How can they make such recommendations that profoundly affect women without support? I am giving AAP the benefit of the doubt here because to think otherwise would be too maddening.
That being said, I would not trade the emotional bond I feel with my son while I breastfeed for anything. Pumping for a whole year was worth it. And I despised pumping. I wanted to burn the pump at the one year mark but refrained myself in case I have another one. And I still need to pump when I am on call although I pretty much wait until my breasts are about to explode before I will do it. Now it is more about bonding and less about supply of milk.May 17, 2011 at 1:19 pm #128507
As a mom of an almost 3 year old I will say this…. please do not judge me as this is my OPINION only….
I HAD to go to work when my kiddo was 6 weeks old. I was able to nurse or pump until 1 year old, at which time I felt that my son was ok without the breast milk, and I was ok without the bonding time. Honestly, I think nursing beyond 1 year is about what the parents feel is necessary. Breast milk is extremely beneficial for infants/toddlers, but I feel that after 1 they are able to get the same nutrients off of formula or natural foods. Nursing is about how mom feels about the relationship with baby. After I had to go back to work, I was able to pump a few times a day and provide sufficiant ammounts of milk for my babe (as was my sister who was a 3L in law school when she had her son). DRINK TONS OF WATER EVERYDAY IF THIS IS WHAT YOU CHOOSE!!!! I am ALL FOR breast milk, but I personally do not feel that you have to nurse to get those nutrients to your baby.
Hope this helps.May 17, 2011 at 1:23 pm #128508
You know what….. Be a GOOD mom and do what YOU feel is good for your kiddo! If you are asking these questions, there is no doubt that you have your kids best interest at heart, and once (s)he comes, I know that YOU will know what to do. It’s second nature! Be comfortable with your decision and back yourself up. YOU know what’s best for YOUR kiddo. Congrats on the baby 🙂 It’s seriously the most amazing thing that you will ever experience 🙂May 17, 2011 at 1:29 pm #128510
I TOTALLY agree. Being a good mom is first, and it’s hard to be a good mom when dealing with guilt from every angle. Get as much sleep as possible, do what’s best for eating outcomes, and change your baby’s diaper when necessary. These are the important things, no matter how you choose to solve them. BOND with your baby!!! Don’t worry about doing everything the “right way”, but instead be there for him (her), because before you know it they will be applying for medical school too!!!! 🙂May 18, 2011 at 4:09 am #128526Emily2651Participant
[quote=clee03m]How can AAP recommend breastfeeding without evidence?[/quote]
You can’t be serious. *Most* clinical recommendations issued by medical societies are without significant evidence to underpin them. As an unrelated but particularly illustrative example, check out this fascinating citation:
Khan AR, Khan S, Zimmerman V, Baddour LM, Tleyjeh IM. Quality and strength of evidence of the Infectious Diseases Society of America clinical practice guidelines. Clin Infect Dis. 2010 Nov 15;51(10):1147-56.
It’s a systematic review of all IDSA guidelines from March 1994 to July 2009, published in a flagship IDSA journal. The entire article is an amazing and worthwhile read, but I’ll quote the article’s conclusion: The IDSA guideline recommendations are primarily based on low-quality evidence derived from nonrandomized studies or expert opinion.
[quote=clee03m]I remember being taught in medical school that breastfeeding benefits the baby like less allergies, less illness (during breastfeeding) due to antibodies in the milk, less constipation of other digestive problems, etc. So these are all hogwash?[/quote]
More or less, yes. I’ve cited the abosolute best and only randomized evidence above.
[quote=clee03m]I am giving AAP the benefit of the doubt here because to think otherwise would be too maddening.[/quote]
It is maddening. The more I am in medicine, the more I am fascinated by how clinical recommendations are forumlated and the more I am convinced that a) we as clinicians *must* review primary literature ourselves and b) for my career, I am very keen to participate in the formulation of these recommendations for my own subspecialty.
[quote=clee03m]That being said, I would not trade the emotional bond I feel with my son while I breastfeed for anything.[/quote]
I understand this and to some extent I feel the same way. I plan to breastfeed my second child, at least initially. However, because I’m a hopeless pot-stirer, here’s one more citation. There is exactly one (prospective, non randomized) study that looked at brestfeeding and attachment.
Here’s the citation:
Britton JR, Britton HL, Gronwaldt V. Breastfeeding, sensitivity, and attachment. Pediatrics. 2006 Nov;118(5):e1436-43.
The clinical bottom line: there is no association between breastfeeding and mother-infant attachment. Interestingly there was a weak association between the intention to breastfeed and attachment, which speaks to the central problem with the breastfeeding literature: overwhelming and unavoidable confounding.May 18, 2011 at 8:02 am #128530southernmdParticipant
Emily – because curiosity is just getting the better of me…
Is your “You can’t stop the pancakes” from this:
If so – I just saw this the other day and thought it was hilarious!
Sorry – so completely off topic!May 18, 2011 at 9:33 am #128536
OMG too funny southern!!!May 19, 2011 at 9:34 pm #128563Emily2651Participant
southern, no, I hadn’t seen that before. Pretty funny, though.
I had a co-intern last year who used to say, “You can’t stop the pancakes.” His point was, no matter how hellacious the call night, no matter the absurb catastrophes that swirled around us … the morning would come and NO MATTER WHAT we were going to walk out of the hospital the next day … and go home … and sleep or shower or drink beer or eat pancakes.
And now I always make pancakes with my son on my days off.May 20, 2011 at 10:15 am #128577
[quote=Emily2651]s NO MATTER WHAT we were going to walk out of the hospital the next day … and go home … and sleep or shower or drink beer or eat pancakes.
And now I always make pancakes with my son on my days off.[/quote]
Love it!May 20, 2011 at 12:22 pm #128579ohiomommdParticipant
Ha-ha! When I was a new intern, a senior on with me remembered HIS version, that “no one can stop the clock from ticking” and then crying as realized he was on call Saturday night of October-daylight-savings- reset.May 20, 2011 at 10:50 pm #128587southernmdParticipant
Emily – that is possibly the best thing I’ve read in a long time. Thanks for sharing the back story!May 22, 2011 at 3:12 am #128608
loved it… plus a beer on a post call morning often is the best thing ever…or pancakes…just not coffee!
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