In my book I discuss strategies for finding a breastfeeding-friendly healthcare provider. This is an important step on the road to breastfeeding success. But it occurred to me - why not give you the story from the other side of the glass? Let's take a look at what it takes to become that breastfeeding-friendly doctor.
Believe in breastfeeding. I mean really believe in it. Believe in it the same way that you believe in eating healthy, exercising, and not smoking. Sure, not all your patients are going to do it, but fewer of them will do it if they don't believe in it. And why should they believe in it if you don't? If you're not convinced then it's time for you to do a literature search of studies that support breastfeeding.
Get to know a lactation consultant. A good lactation consultant is your most important ally in your efforts to support your patients in breastfeeding. International Board Certified Lactation Consultants (IBCLCs) undergo specialized training in lactation medicine and are certified to have experience helping women and their babies breastfeed. Most IBCLCs are thrilled to connect with a physician enthusiastic about breastfeeding - the topic that they have dedicated their careers to. A good way to get a foot in the door and build good will is to shadow for a day with the IBCLC at whichever hospital you are associated with. Once the relationship is established it will be mutually beneficial. One regret that I have about residency is that I didn't use my elective time to do a rotation with the hospital lactation consultant. I would have learned a lot.
Don't be afraid of medicating nursing mothers. As a medical doctor it is your responsibility to appropriately treat your patients, and sometimes this requires the use of medication. Some doctors tell nursing patients not to take any medication ever. Don't be this type of doctor. Evaluate your patient. Choose the correct medication. Use it if you know that it's safe. If you don't know then look it up. Invest in a copy of Medication and Mother's Milk (or get an online subscription). Become familiar with the LactMed Database. Both are excellent resources. Worried about liability? Documentation is everything, and quoting reliable references will help you accurately counsel and document the risks and benefits of your treatment plan.
Become familiar with common infections related to breastfeeding. Know how to recognize and treat mastitis. Understand nipple thrush. Ever heard of Raynaud's phenomenon of the nipple? If not, then take some time to look it up. There are effective treatments for these painful conditions, and your patient will likely need a prescription from you. If you get stuck on what to do then call your IBCLC.
Learn about low supply. Inadequate milk supply is a huge topic in lactation medicine. The most commonly cited reason for a women to stop breastfeeding is perceived low supply. Not all women who stop for this reason actually have low supply. You are the diagnostician, and you need to figure it out. Inadequate supply is diagnosed when there are signs of inadequate intake: poor growth or dehydration. When true low supply exists the treatment is multi-fold. You want to get the baby fed, maintain breastfeeding whenever possible, and keep the mother's confidence and sanity intact. It's a tall order, but it's what needs to be done. Again, having an IBCLC to lean on helps.
Use formula judiciously. Formula is like a knife. Used properly, it's a vital tool. Used improperly, destruction may ensue. If true low supply exists, formula supplements can help a mother feed her baby while she works on boosting her supply. Remember that formula that replaces feedings can hurt a mother's supply. Supplementing with pumped milk should take priority, and whenever you can supplement at the breast you should do so, especially early on. Advising a breastfeeding mother to switch to exclusive formula feeding is a rather extreme measure, so think through it carefully. If there is a way that she can still safely breastfeed you should pursue that option.
Don't be too afraid of jaundice. You and I both know that jaundice can be scary. We also know that jaundice can be normal. Whatever plan you come up with for managing a concerning case of jaundice should involve a way to maintain breastfeeding. If formula is not absolutely necessary then try to avoid it (see above).
Create a breastfeeding-friendly atmosphere in your office. Invite patients to nurse in the waiting room or exam room. Advise your staff to be welcoming of nursing mothers. Don't force anyone to cover up when nursing, but offer a private area if requested.
If you follow all of the above suggestions you will stand out from the crowd as a breastfeeding champion. You don't want to be "that doctor" who the breastfeeding mother or the IBCLC complains to her friends about. Instead you can be the person who helps a mother reach her breastfeeding goals.