Choosing a Pro-Nursing Doctor for Your Baby

by Nancy Mohrbacher, IBCLC

During pregnancy, expectant parents tend to focus most of their attention on choosing the mother’s doctor and preparing for the birth. But choosing the baby’s doctor is just as important, especially when breastfeeding is the plan. While it may seem easiest to pick a doctor recommended by the obstetrician, the hospital, or friends and family, carefully selecting a doctor can make the difference between a good breastfeeding beginning and an untimely weaning.

Nearly all doctors today claim to be “for breastfeeding.” So families need to know more about a doctor than this in order to make an informed choice. While being supportive of breastfeeding is a plus, a truly “breastfeeding friendly” doctor encourages breastfeeding by putting in place breastfeeding friendly policies and practices. To find a doctor like this, a good place to begin is to talk to local La Leche League Leaders and lactation consultants for their suggestions. They quickly learn through personal experience and word of mouth which doctors are good with breastfeeding. After you’ve assembled a list of candidates, interview each, asking the following questions:

“Do you recommend bottles of water or formula routinely be given to newborns?” Water and formula are unnecessary for the full-term healthy newborn and can cause breastfeeding problems during the early weeks. Studies show that babies who are given water tend to lose more weight and have more severe jaundice.

Supplements can fill up a baby and make her less interested in nursing. A decrease in the time a baby spends at the breast can diminish a mother’s milk supply and cause her to become painfully engorged. Engorgement in turn will make it difficult for a baby to latch on to the breast.

Also, bottles given during the first few weeks can cause a baby to become “nipple confused,” causing either breast refusal or incorrect sucking.

If a doctor says that he or she recommends supplements “only when needed,” beware. If a baby is not nursing well, a bottle is not a solution. Instead, mother and baby need immediate help with nursing, and if the doctor is does not provide it, a mother should be referred to a lactation consultant or a La Leche League Leader.

If a doctor’s standing orders at the hospital include bottles but he or she agrees to make an exception, be sure to get this in writing and bring copies to the hospital when the baby is born. The nursing staff will follow a doctor’s usual orders unless the doctor instructs otherwise. If a baby is born in the middle of the night, it may be many hours (and bottles) until the doctor is contacted.

The most ideal breastfeeding start is one in which mother and baby are able to nurse early and often without restrictions, so another question to ask is how soon after birth the doctor believes nursing should begin and how he or she feels about rooming-in and feeding schedules in the hospital. A doctor who recommends nursing as soon as possible after birth and shows strong support for rooming-in and unrestricted nursing is probably a doctor who understands their importance to breastfeeding and to mother’s and baby’s health.

If you pick a doctor who is not on staff at the hospital where you plan to deliver, you can either request a doctor at the hospital before birth or the hospital will assign a doctor to the baby. You won’t need to interview the staff docts in depth, but ask about their policies in the hospital, such as if they give supplements and how they treat jaundice. Because a doctor’s practices have such a great impact on breastfeeding during the early days, it is worth making the effort to choose a doctor ahead of time, rather than leaving it to chance.

“How do you treat jaundice?” During the first week, more than half of all newborns develop jaundice, a buildup in the blood of excess bilirubin, which is the end product of oxygen-carrying cells. This buildup causes a baby to become yellowish in color. Bilirubin is processed by the liver, but newborns often produce more bilirubin than their immature livers can handle. In most cases, bilirubin levels decrease in a week or so, as the liver matures.

Many doctors still advise that nursing babies with jaundice be given formula, but recent research confirms that babies can safely continue breastfeeding without supplements. Depending upon the severity of the jaundice, treatment also may include the use of special lights (called phototherapy), but this needn’t affect breastfeeding.

When a baby develops a health problem, such as newborn jaundice, the doctor’s approach may have a profound effect on breastfeeding. Since about half of all newborns become jaundiced during their first week of life, it makes sense to ask before birth about a doctor’s standard treatment of jaundice.

“How do you determine whether a baby has low blood sugar?” When a baby is above or below a certain weight range, this could indicate low blood sugar, known as hypoglycemia. As a precaution, some doctors routinely recommend that all breastfeeding babies outside this weight range receive formula or sugar water supplements. But this may not be necessary. A blood sugar test can determine whether a baby has hypoglycemia.

If the doctor gives supplements according to a baby’s weight, ask if a blood sugar test can be done. If your baby does have low blood sugar, supplements can be given by eyedropper or cup to avoid nipple confusion.

“How do you handle slow weight gain?” Normal weight gain in a breastfeeding baby is an average of 4 to 8 ounces a week, or at least a pound a month for the first three months. (During the first month, weight gain should be counted from the lowest point, not birth weight.) If a baby’s weight gain falls below this, a doctor who understands breastfeeding will first look at how breastfeeding is being managed and see if changes can be made to increase a mother’s milk supply. For example, a baby who is nursing fewer than about ten times per day may need to nurse more often.

“Do you recommend a feeding schedule?” A doctor well-versed in breastfeeding usually realizes that there is a wide variation in nursing patterns among healthy babies. Sometimes a doctor who claims to be for nursing on cue will say, “But babies shouldn’t nurse more often than every X hours,” or “Don’t let the baby use the breast as a pacifier.” Most newborns, tend to cluster their feedings or bunch feedings together at certain times of the day, rather than nursing at regular intervals. Stretching out feeding times to meet arbitrary guidelines can interfere with a baby’s attempts to increase her mother’s milk supply by nursing more often during growth spurts.

In an ideal world, every baby’s doctor would understand good breastfeeding management, have standard practices that promote breastfeeding, and know how to treat health problems without compromising breastfeeding. But this ideal is not yet a reality. Until it is, parents need to take responsibility for selecting a doctor who will help them meet their breastfeeding goals.