These days there has been debate in the blogosphere maternal and pediatric following an entry by Pilar Martinez, lactation consultant, who said in her blog Maternity Continuum that pediatricians should be lactation consultants and that generated the response of Dr. Amalia Arce, better known as the pediatrician mom, who wondered if pediatricians really should be, considering that they not only study just two hours of breastfeeding in the race, but also study very little other important things, because most knowledge is acquired later when they reside .
I am a nurse and father of three breastfed children and therefore I know the situation from outside and from inside, so I understand pediatricians when they say they studied little breastfeeding because in the race you study little of everything and then it is everyone who decides what knowledge to reinforce and update, but positioning myself as a father who did not know anything about all this, who came to these blogs with a newborn baby and in search of certain information that I would say perplexed: Oh, but is it that pediatricians are not lactation consultants?
Pediatricians should be lactation consultants.
And I would ask myself because every father who takes his son to the pediatrician for routine checkups and checks assumes that the person in front of him is an expert on the issues discussed there. If I take my son to the pediatrician and my wife asks if he or she does not breastfeed, how many do you take, how is it going, if it hurts or not, if it has cracks or not and if you have any doubts, I understand that you are interested because , in case of finding any problem, will be able to give a solution.
So you don't know about breastfeeding?
I have not said that. Many know a lot about breastfeeding and many know what they have learned on a day-to-day basis, with their myths and confusions included, because in recent years many things have changed and the one that has not been recycled is at risk of becoming evident.
The same thing happens with nurses. I don't remember how many hours of breastfeeding I did in the race, but it sure was more than two. Even so, it is a subject that is part of a much broader subject (maternal and child nursing, it was called) that is also part of a curriculum whose mission is to train the nurse to have a base and be able to go to work where you prefer . Then each one, in his job, specializes more or less as he wishes. As I wanted to do pediatrics and as soon as I became aware that breastfeeding was the natural feeding of babies and that I should, as a healthcare provider, have knowledge to be able to help mothers who wanted to breastfeed, I became a lactation consultant, I studied about it.
I did it because human milk seems to me to be one of the basic pillars of children's health and an issue that nurses and primary care pediatricians should master because, as preventive health agents that we are, we must try to offer the best to children and children. more information to mothers and fathers to prevent the disease and to achieve the best possible state of health.
So, if they don't know, why do they talk?
This is the crux of the matter. I believe that pediatricians and nurses have to be experts in breastfeeding, but as Dr. Amalia Arce says, there are many issues related to children who must study and know and cannot cover everything, so it would not be a tragedy that a pediatrician did not know too much about breastfeeding.
As a father I have visited more than one pediatrician with my three children and some have heard them talk about breastfeeding noticing that they know a lot about the subject, others have heard them give outdated and counterproductive information and others have not heard them say anything, staying in the question of whether or not they know.
What I mean by this is that if a pediatrician doesn't know enough, nothing happens. I myself have had complicated cases in the consultation and I have ended up asking IBCLC breastfeeding consultants for support, with more experience and knowledge than me. I even know of pediatricians who also use them when they are not able to give an answer. The problem comes when a pediatrician does not know and also advises. He does not know and gives recommendations from decades ago. He doesn't know and his speech is full of prejudices and mistakes. He does not know and a breastfeeding is loaded for not being able to say he does not know.
You don't know the trouble that happened
As a nurse in a primary care center that shares consultation with several pediatricians I see everything. Successful comments and perfect advice and misguided comments and erroneous advice. Many times I find myself in a complicated situation, because I hear the pediatrician say things that are not and I feel the need to correct his words. It's complicated, it's a predicament because parents can lose confidence in both the pediatrician and me ("let's see if you clear up"), but many times I take a chance because in the end I think about the baby and I think he deserves to have the opportunity to Things are going well for him.
The last thing that happened to me about it was a week ago, when a mother came with her 11-day-old daughter having gained 10 grams in 6 days. The pediatrician, when in doubt, He recommended that he start supplementing with artificial milk and, as the mother was reluctant to throw and the towel, she urged him to breastfeed the girl to double the weight (weigh it before breastfeeding and weigh it after breastfeeding). In about 20 minutes the girl took 60 grams of milk she had taken and while we put it on the scale she poured milk through her mouth (come on, it was full). I went to discuss it with the pediatrician, convinced that he would say that the bottles were not necessary, and he replied that "already, but if in 6 days he does not gain weight that milk is not feeding him".
Then he came to talk to the mother and explained that there are better and worse milks, that there are moms who have milk with less protein and less fat and that could have a very watery milk and that is why the girl did not gain weight. In addition, to give strength to his argument, he added that he would surely still be with colostrum and that sometimes the rise in milk may take up to weeks. The mother asked: “Colostrum? With eleven days you have? ”, To which she replied convinced that yes, no doubt.
He confirmed that he had to take a bottle of artificial milk and said goodbye after a few last indications. Then I saw myself in the dilemma of saying "until another day" or of saying "ok, now let's talk seriously." I thought about the girl, I thought about the mother who didn't want to give the bottle and I thought about myself and how badly she had just left (the pediatrician has no idea and the nurse didn't say anything either) and I told her that I didn't agree with anything the pediatrician had just said.
The mother told me that I did not agree because I wanted to breastfeed and had read a lot during pregnancy and that the rise to the weeks, the colostrum at eleven days and the poor quality milk had not read anywhere . We started a new strategy omitting the bottles and with the slogan of going to the hospital to do urine and / or blood tests if I still did not gain weight within two days, in case I was suffering from a urine infection or problem that was causing me to consume calories the rest.
After a few days they returned and the girl had gained a lot of weight only with breast milk. The reason I only gained 10 grams in six days? It's a mystery ... the important thing is that the girl was fine. The problem is that the pediatrician will continue saying such nonsense to many mothers because when I have tried a posture approach I have received a “you don't have to explain anything to me, that I already know”. Luckily it is not the pediatrician I have to work with every day.
Lactation consultants exist because pediatricians did not help mothers
Therefore, to the question of Dr. Amalia Arce, whom I deeply respect, I answer yes, that pediatricians and nurses should be lactation consultants, precisely because The figure of the lactation consultant was born from the knowledge gap that originated from not being recycled by health professionals.
The mothers saw that they could not find solutions for their problems related to breastfeeding and decided to try to solve them themselves. They started gathering to give themselves moral support and tell themselves about tricks and experiences and ended up training and learning to the point that today many know more than many pediatricians and nurses.
So it is not that pediatricians have to be lactation consultants, it is that lactation consultants exist because of the pediatricians. Consequently pediatricians have to be what they were supposed to be, specialists in the topics they deal with daily in their consultation, one of them being breastfeeding.
I understand that a pediatrician can one day tell me that my child has a slightly strange disease and that he does not know enough, but that he tells me that he does not know about breastfeeding I understand less because every day they see babies and every day they ask them things related to breastfeeding. Failure to breastfeed, at the primary care level, is to fail at the first step of a baby's life because The first thing a baby needs at birth is to keep getting defenses (The placenta can no longer be given, so give the position to the mammary gland) and continue receiving human warmth.
Photos | Christyscherrer, c r z on Flickr
In Babies and more | Can we trust pediatricians when talking about breastfeeding? What criticisms can pediatricians make towards prolonged breastfeeding? (I) and (II), Role of pediatricians in promoting breastfeeding: baby's first days
