Talking with medical professionals

Remember that this is unedited text -- like "letters to the editor." Identifying information, such as names, has been removed; but otherwise it is posted here pretty much as it came in. So read it as personal opinion shared with warm intentions but without authority of any kind.

Some of my grandchildren have a pediatrician who nursed her own toddlers. What a fortunate family! And how far we have come since my own children were toddlers. -- NJB

Our doctor walked in for my 2 yr. old's well baby exam as we were nursing. She asked how long we planned to nurse, and I replied however long my daughter wants. The doc said okay, and made no other comment. How very different from other doctors we have been seen by. When my son was about 6-7 months old, I developed mastitis. The on-call physician's assistant who saw me wanted me to wean. Luckily I knew then that breastfeeding would be beneficial, and I had the gumption to say no, my son would not take a bottle. Sometimes, we need to be taught how to say no, in no uncertain terms and ask for alternatives. Can treatment be delayed? Is there another medication/procedure? Let the doctor know that breastfeeding is not just a way to nourish a child, but a nurturing relationship also. And, if need be, get a second opinion.

One reader says many mothers find their doctors: ". . . unsupportive, unknowledgeable and occasionally downright hostile regarding continuing to breastfeed. THE WOMANLY ART OF BREASTFEEDING touches on this some but I think even as more doctors realize the importance of breastfeeding an infant we still find that many, if not most, do not understand that continuing to breastfeed past infancy is important to some women (not to mention their toddlers). We often get calls from mothers (sometimes in tears) who are told they need to wean because of some procedure or medication that they need. When they go back to their doctor and stress that they want to continue nursing they are often viewed as difficult or too lazy to wean and are often told that their are no good reasons to continue, that their milk has no nutritional benefit, they are only doing it for their own sexual enjoyment etc."

One of the issues surrounding mammograms, at least as I heard people discuss on the Internet, is that if there is a concern, an ultrasound should be done. I think The Womanly Art of Breastfeeding addresses this, and I know it's been discussed numerous times on the Lactnet list. The specific issue with an older nursling, is that many mothers do not want to tell their doctors. I know some mothers who are older and either need a baseline or are 40 and are told to have yearly or every-other-year mammograms. They are either given grief when told they are still nursing, or are fearful esp. if they are nursing a 4, 5, or even older child.

I'd like to second the notion that more information is needed about things like Mammograms. They told me there was no point in doing it until I stopped nursing unless there were other risk factors besides my age or evidence of breast changes/lumps. Also it would be nice to have a source for definitive information on whether to worry about medication. After age 2 my son nursed once per day for just a couple of minutes at a time and I find it hard to believe I needed to worry much about him getting any medications passed through my system. More guidelines on this would be nice, or where to go for more info.

A couple of times during the course of nursing my boys, my internist has prescribed medications for me. He is clueless about breastfeeding, and quite unsure which medicines are OK for nursing moms. We found the best reference was not the Physicians' Desk Reference or LLL, but the pharmacist at the area women's hospital.

Fortunately, my internist is willing to admit his ignorance about lactation, and very happy to get expert advice from the pharmacist.

I looked for something on dealing with medications a mom might take while nursing. With a newborn sometimes it's all right to postpone medications for the mom, but as the baby grows older there isn't as much support from doctors as to what can be safely taken or what can be still delayed. Specifrically I was looking for information regarding high blood pressure after my third daughter was born. I kept getting medication postponed -- trying other methods to lower my blood pressure, but could not find any information about medicine that would have been ok to take. I realize this information is hard to keep current, but this situation led to weaning our last child before she was ready.

Although you talk about getting enough rest, you don't mention other ways in which a mother who does extended nursing can best take care of herself. Recently I went to the endocrinologist (I was feeling very lethargic and yes, my thyroid medicine needed adjustment) and he advised me that I should be taking 1500 mg calcium a day! also enough iron...now I do take a daily vitamin, but had not been worrying about calcium and he said that might be why my joints have been hurting (of course, it could be from lifting a 30-lb. little boy, rolling around on the floor, etc...).

Another challenge is that many medical problems cannot be treated satisfactorily when one is nursing (or at least that is what certain doctors will say). I recently went to the dermatologist, with a number of "small things" that I had been saving up . . . . This doctor, who had been very positive about my nursing the first year was aghast that I was still nursing, and said she could not treat any of these things until I stopped nursing. In addition, she said I have rosacea, for which I need a topical antibiotic gel, etc. . . but not until I stop nursing. As I left she said "so I'll see you in a couple of weeks!". I told her I did not plan to stop until my son was ready, and it would probably not be in two weeks! So a challenge for a mother who nurses a long time is putting some of her own health problems on hold, if this doctor is indeed telling me the truth. When I have time, I will get another opinion. [Note from NJB: Yes, do get another opinion.

I'd suggest to every nursing mother ask for SPECIFIC references to anything a doctor says that goes against the "mothering" instinct. I had to go so far as to tell a doctor I was NOT going to wean, that she still gets Immunological benefits from me not to mention emotional sustenance at the same time. I really liked the doctor but I HAD to draw the line for her sake AND mine...

I too have had to deal with Drs. who say that I don't need to be breastfeeding, wean him, its my sexual pleasure, etc. I find that I resort to bringing my Womanly Art of Breastfeeding or other LLL books and showing them where it says child-led weaning is best and then they say they can't help me get better until I wean. ARRGGHH! [What] about the new AAP guidelines stating to breastfeed until "mutually decided upon."

In my personal experience, I have found (to my surprise) that my pediatrician was not as supportive of breastfeeding as I had hoped. At my son's 9 month checkup I asked her a question about how much he should eat, and she said something about how much formula he should take a day. (I was asking about solids!) I mentioned that we were still nursing and her comment was, "Oh, you're still doing THAT!" Since that time I decided it was none of her business unless there was a medical need. Also, once when my son was sick I called the pediatrician's office and was told to cut back on his nursing (which is generally advised when formula is used). Fortunately I knew from La Leche League that breastmilk is considered a clear liquid, and so disregarded this advice.

A mother with a nursing three-year-old writes of having a lump in her breast. A breast surgeon refused to order a mammogram because he said it would make her milk radioactive. The logic this mother applied in response was this: "If I have my leg x-rayed will it make my blood radioactive, too?"

[One breastfeeding counselor writes about talking with] "women who have been told ludicrous things by their physicians about nursing older children. One physician told a mother that she would make her son into a homosexual if she didn't wean him. Another doctor blamed a mother's miscarriage on the fact that she was still nursing her one-year old once a day. He told her that by not following his weaning advice, she had caused the death of her baby. Yet another doctor told a mother that a human female does not have the nutritional stores to be able to support a pregnancy and nurse a toddler."

Note from NJBumgarner: It seems to me that physicians are part of the same culture as the rest of us and are subject to the same misconceptions and misinformation as are we, our neighbors, and relatives. Unfortunately we sometimes give disproportionate weight to what medical professionals say, even when they venture outside their fields of expertise. It would help if they would distinguish between professional opinions, for which they have evidence, and their personal opinions. They have the same right to personal opinions as anyone else, but these opinions also carry no more weight than anyone else's. Sometimes it is up to us to ask -- and there is no reason for our asking to be anything but courteous -- what research there may be behind an opinion that makes us uncomfortable.

How to Know a Health Professional is not Supportive of Breastfeeding, by Pediatrician, Dr. Jack Newman, MD, FRCPC.