fbpx

Why ALL Physicians Should Learn The Basics of Lactation Care

Lindsay Moore-Ostby, MD, IBCLC explains why EVERY physician should learn the basics of lactation care

September 30, 2022

Primum Non Nocere: Why ALL Physicians Should Learn The Basics of Lactation Care

As a physician who specializes in breastfeeding and lactation medicine, I frequently give lectures to various medical professionals on the basics of lactation care for their patients.

I work in this field every day, so the need for widespread education of my medical colleagues seems obvious to me. But I often find resistance to my offer – understandably, medical education must cover a vast array of topics, and is already crammed full. And physicians who are in practice are increasingly bombarded by tasks that leave too little time for patient care or keeping up with ongoing medical education, much less adding entirely new topics to learn. Additionally, when a subject hasn’t been taught for so long, it can be hard to see why it is now necessary. In my own training, I didn’t learn much about the actual ins and outs of lactation care either, so it didn’t occur to me until much later that it was so important either. I understand these hesitations, but I am on a mission to change the culture of lactation education and care in modern medicine. Primum non nocere applies here, as it does in all aspects of medical care and our oath to this profession. So let’s talk about why EVERY physician should learn the basics of lactation care.

First and foremost, physicians in almost all specialties will encounter lactating patients. They may not always realize it if they don’t ask about it, but they are seeing them nonetheless. They may be caring for the pregnant or lactating parent as an OB, primary care physician, or even a sub-specialist. Or perhaps they are a pediatric surgical specialist who sees infants, many of whom are ingesting human milk either at the breast or with pumped milk. Each of these patients may have concerns about their milk supply, how to properly pump and store milk day to day, whether the medicines and tests you order them or their child will affect breastfeeding, and how to manage chronic illness, acute care needs, and mental health with the unique demands of producing milk to feed their child. Lactation care is NOT only relevant to primary care and OBGYN, you will soon come to realize.

Don’t think you see many patients with lactation related care needs? Trust me – start asking, and you will likely realize just HOW MANY of your patients are affected in some way by lactation related concerns. You may even come to realize just how many you let down by not knowing to ask, or knowing how to refer them to proper resources for care. Don’t feel bad – just do better now that you know better.

Of course, knowing that many of our patients struggle with lactation related issues and need our advice about how to manage them doesn’t mean we actually know anything about how to properly help them. Many of us weren’t trained in even the basics of lactation. We learned about pathology like cancer that can occur in the breasts. We know the basics, that mammary tissue makes breast milk when needed, and there are ducts that lead to holes in the nipple where the milk is ejected. But we don’t know much beyond that – how to help with latch, how to form a differential diagnosis for nipple pain due to nursing, how to pump breast milk properly or even that there are different sizes of breast pump parts to fit different nipple sizes during pumping. Unfortunately this often leads us to not bring it up at all, or to give inaccurate or even harmful advice.

One common example of bad advice and mismanagement is when patients are often advised to “pump and dump” for a medication or procedure. Physicians often do not know how to access evidence based sources for these scenarios. Spoiler alert: it is very rare for pumping and dumping to truly be medically necessary, despite the frequent advice to do so in our usual medical resources for medication management.

 

Spoiler alert: it is very rare for pumping and dumping to truly be medically necessary, despite the frequent advice to do so in our usual medical resources for medication management. Click To Tweet

 

We often don’t even realize the harm we do by defaulting to “pump and dump”, because we don’t know enough about the physiology and reality of lactation to realize the harm that this advice can cause. Truly, it is often harmful emotionally, even physically, to our patients. The gold standard of care is NOT pumping and dumping by default. Not even close. And there are actual easily accessible resources to help with this, we just have to be aware of them! It truly doesn’t take as much time as you may think to learn the basics and how NOT to mess things up for your patients in this regard.

But isn’t this what lactation consultants are for? Of course, lactation consultants are an invaluable resource for our patients in these matters. A good lactation consultant is worth their weight in gold. But there aren’t enough of them out there! And they aren’t the front line – as the physician, you will often see the patient first. They may not know how to find lactation consultant help, or it may not be quickly available to them. So if you as the physician don’t know how to recognize lactation related problems, determine when to refer out for care, how and who is best to refer to, and know how to give at least non-harmful and ideally somewhat helpful basic advice, then your patient may slip through the cracks and harm will occur.

As a physician AND lactation consultant myself, I know the differences in training and appropriate scope of care between these roles. Lactation consultants (IBCLC) are not physicians, and their scope of practice does not include making medical diagnoses or treatment plans. The IBCLE certification advisory board states:”The IBCLC certificant neither practices medicine nor diagnoses a disease or disease process unless the certificant is separately licensed or authorised to perform such procedures. An IBCLC certificant does: carefully assess, document findings, and refer appropriately as needed, to obtain a medical diagnosis and possible treatment.” This highlights the need for physicians to step up, seek out at least basic lactation care information, and be prepared to help lead the care team. This will lead to proper, more timely care. It will also improve the cohesiveness of the full care team’s management approach. Patients frequently tell me how confusing it is when they get conflicting advice from their doctors, lactation consultants, and even social media. The more we all learn about the actual evidence based care our patients deserve, the more we can reassure them and earn trust with actual cohesive, team-based care.

All physicians should have a basic foundational understanding of the anatomy, physiology, and pathophysiology of human lactation and feeding. These basics should have been covered in our basic didactic courses in medical school. Luckily, you can learn the basics in a very short time when you’re adding it to an already sound basis of general medical knowledge.

 

Luckily, you can learn the basics (of lactation and breastfeeding) in a very short time when you’re adding it to an already sound basis of general medical knowledge. Click To Tweet

 

Beyond that, the needed knowledge will vary by specialty and patient population served by each physician. All physicians should know how to access evidence based medication and procedure related resources, and should have a basic understanding of the physiologic and pharmacologic factors that affect these recommendations. OB-GYN, emergency medicine, and primary care physicians (even those just seeing adults!) should add a basic knowledge of common problems related to lactation, such as nipple pain, milk production concerns, and mastitis to start. And a smaller number, like myself, will be needed to learn the full intricacies of lactation care at a sub-specialist level.

Luckily, there are evidence-based resources available to help physicians learn the basics of lactation care. And I am finding more often that this information is being included in medical school and residency curricula. Many programs even offer electives in lactation care now! I often recommend courses by IABLE as a starting point to learn the basics for both those in training or who have completed their training, though there are other options around of course.

Stay tuned for a future post where I will give you more information on resources to learn about lactation related care.Happy learning, my colleagues. I am excited to see a future where every physician recognizes the value in learning about the basics of lactation care and realizes how this will elevate their patient care.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

Share

Leave a Reply

Your email address will not be published. Required fields are marked *

This learning experience is powered by CMEfy - a platform that brings relevant CMEs to busy clinicians, at the right place and right time. Using short learning nudges, clinicians can reflect and unlock AMA PRA Category 1 Credit.

Of Interest

Subscribe To Our Newsletter

Get updates and learn from the best

The Unhappy Physician

The Unhappy Physician

Daniel Paull MD explains why he thinks that despite what the public thinks, most physicians are unhappy.

Social Dissections

[SERIES] Social Dissections

Join us in a visual and audio show, where we host light conversations with some of today’s standout healthcare experts.

David Norris, MD, MBA

Negotiate as a Physician and Win

Catch this 8-part series, hosted by physician & business consultant David Norris, MD, MBA & produced by Dana Corriel, MD. Learn to be a stronger negotiator with these important tactics.

Brand Your Social Media Content in a Day

Doctors Exploring Social Media

Raw and real social media-related questions, discussed in a video collection, hosted by Dana Corriel, MD, over a casual – but fun! – virtual setting.

Olga Calof, MD

Olga Calof, MD

My philosophy of care is to personally connect with patients, so we can work together to understand their disease, how it should be treated, and how to modify lifestyle choices to live the best life possible.

Judith Hong, MD

Judith Hong, MD

A board-certified dermatologist who loves and teaches mindful art classes, dance, and Reiki.

Deborah Gutman, MD, MPH

Deborah Gutman, MD, MPH

I coach and mentor pre-health and medical students with a growth mindset for successful applications to medical school and residency.

Want More?

Be a part of our healthcare revolution. Don't miss a thing SoMeDocs publishes!

Disclaimer: SoMeDocs assumes no responsibility for the accuracy, claims, or content of the individual experts' profiles, contributions and courses. Details within posts cannot be verified. This site does not represent medical advice and you should always consult with your private physician before taking on anything you read online. See SoMeDocs' Terms of Use for more information.

follow us

© 2024 SoMeDocs. All Rights Reserved.

Soak up our content & grow

Earn CME

Drop your email address below and we’ll email you the link for earning CME (through CMEfy). Please check your spam folder if you do not receive our email. We’ll also add you to our Sunday newsletter, so you can earn more CME’s reading our content!

Support A Platform that Celebrates Real Doctors

For just $10 a month, you can help keep this openly accessible site available to all & help us sponsor in more doctors.

Interested in subscribing
to our unique content?

Interested in subscribing to our unique content?

I acknowledge that this site is not to be used for medical advice.

Play Video
Our Founder Answers Your BURNING Question

SoMeDocs

“Why should I become a member of SoMeDocs if I already have my own space online?”

Site SoMeDocs Logo, square

WANT TO STAY IN THE LOOP?

DON'T MISS A SINGLE CONTENT PIECE.