Health-care providers unsupportive of breastfeeding

Why won’t my health-care provider help me breastfeed?

Some health-care providers are unwilling or unable to help you with breastfeeding. It may be because of a personal bias or because they lack knowledge. Studies show that doctors receive little training in breastfeeding, and that is true of other health-care providers too. For various reasons, some providers are just not interested in helping you breastfeed. They may be uncomfortable, feel it is not their role, or do not believe that they have the time. Such providers should refer mothers elsewhere for breastfeeding care and support.  

A) Health-care providers with unhelpful attitudes

All families with breastfeeding concerns, and indeed all individuals, are entitled to a respectful, open discussion with their health-care providers about all appropriate treatment options. The information they receive should be evidence-based and current.

Sadly, some health-care providers do not help mothers breastfeed or give unhelpful or conflicting advice (Dattilo 2020; McInnes 2008). Some may offer only limited information about the benefits of breastfeeding or have a negative attitude towards breastfeeding (Ganju 2018; Quinn 2020). These are many reasons for this lack of care.

Some health-care providers have personal reasons for not supporting breastfeeding and:

  • Are uncomfortable with breastfeeding for cultural, religious, or personal reasons.
  • Are uncomfortable with extended breastfeeding.
  • Are male and are afraid of being accused of inappropriate behaviour.
  • Are biased against breastfeeding because of their personal difficulties with breastfeeding (Dixit 2015; Gupta 2018).
  • Believe that not breastfeeding is the best course if you are having difficulty (Feldman-Winter 2017).
  • Don’t believe that breastfeeding is better than infant formula-feeding (Feldman-Wittner 2017).

Others may be lacking in training and:

  • Are not knowledgeable about breastfeeding and feel unqualified to help you (Becker 2020).
  • Don’t believe it is their role to help with breastfeeding.

Sometimes institutions and external forces play a role and health-care providers:

  • Are in a conflict of interest because of ties to the infant-formula industry.
  • Work in institutions that do not support breastfeeding (Bai 2013; Bonet 2015;
    Pérez-Escamilla 2016).
  • Are not paid to support you.
  • Do not have enough time to help you.

Ask your health-care providers whether they are interested in and able to help you breastfeed. If the answers are not satisfactory, ask them to recommend someone else who can help. A lack of support or discouraging attitudes may result in earlier weaning (Fabiyi 2021; Zitkute 2020).

B) Lack of knowledge

There is not much research on the best way to educate health-care providers (Gavine 2017).

1) Doctors

Doctors appear to have relatively little breastfeeding training and may have limited knowledge (Biggs 2020; Holtzman 2018; Kim 2017; Meek 2020; Pound 2014).

One survey of Canadian paediatrician trainees showed that over one quarter had not seen a baby breastfeed and only 4% were very comfortable (Esselmont 2018):

  • Evaluating a baby’s latch.
  • Teaching parents breastfeeding positioning.
  • Addressing parents' questions about breastfeeding difficulties.

A survey from 2017 showed that over the entire course of their studies, the breastfeeding education of American doctor trainees was limited to (Rodriguez Lien 2017):

  • 9 hours for paediatricians
  • 8 hours for family doctors
  • 23 hours for obstetricians

Their knowledge of the use of medication while breastfeeding also may be limited (Davanzo 2016; Hussainy 2011).

There are now some attempts to address this (Albert 2017; Meek 2019) and there are signs that the situation is improving (Rosen-Carole 2019).

2) Other health-care providers

Similarly, other health-care providers’ knowledge about breastfeeding varies widely (Mohamad 2019; Radzyminski 2015; Ramos 2018; Shattnawi 2017; Yang 2018).

C) Conflict of interest

When a health-care provider receives rewards for encouraging patients to buy certain items, a conflict of interest can arise. The relationship between doctors, researchers, and other health-care providers and the pharmaceutical industry has long struggled with this issue.

Some health-care providers receive financial and other benefits from infant formula companies. Examples of this include free office supplies such as pads for weighing babies, free meals, and trips to conferences. Some health-care providers are employees of infant formula companies or are paid by them to give favourable talks to parents and other providers.  

Conflict of interest can also involve companies that make items used by breastfeeding mothers and babies such as breast pumps and feeding bottles

Professional codes of conduct advise health-care providers to not allow their advice to be influenced by commercial considerations and to talk to their patients about their financial interest in any products they promote.

D) Signs for concern

There are often signs that a health-care provider may not be supportive of breastfeeding. They may use one or more of the following arguments:

1) The “guilt” argument

To avoid talking about breastfeeding or providing breastfeeding care, some providers use the excuse that they don’t want to make you feel guilty. This approach assumes that women are too emotional to handle information and make good choices. This opinion of women, while once common, is simply wrong.  

2) The “quitting breastfeeding would be better for you” argument

The decision to breastfeed or not should remain with the mother. It is not appropriate for a health-care provider to make decisions for another individual. This is a very dated approach to care. 

3) The "formula is just as good" argument  

Providers may say that infant formula is as good as breast milk or that breastfeeding isn’t important. Here too, women are assumed to be unable intellectually or emotionally to handle information.  

References

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