Section 6: Integrative Case Studies
Pediatrician-Patient Interactions: 2 Views
Case Study 1
A nervous and flustered new mother walks into your office at the 3-5 day visit with her newborn.
Pediatrician: So, how are things going?
Mother: I just started breastfeeding and I don’t think I’m having much success. It’s really painful when I nurse.
Pediatrician: It hurts to breastfeed. We have some formula samples if you would want to give the baby a few bottles to give yourself time to heal.
Mother: Well, I really wanted to breastfeed until he’s a year old.
Pediatrician: Any amount of breast milk is fine. I would say that by the time your baby can ask for milk, he is too old to be nursing, but that’s just me! We have some coupons for formula if you’d like to purchase some today.
Notice how the pediatrician did not support the mother’s wish to breastfeed her child. It is our responsibility as healthcare providers to always encourage nursing as the best feeding choice for babies. Let’s look at another example, in which our pediatrician provides a more appropriate response to the same patient...
Pediatrician: So, how are things going?
Mother: I just started breastfeeding and I don’t think I’m having much success. It’s really painful when I nurse, do you know when breastfeeding will get less painful?
Pediatrician: Breastfeeding really shouldn’t hurt. It does take some getting used to at first. Pain could mean that his latch isn’t deep enough or that you might have an infection. How is the breastfeeding going otherwise?
Mother: It never seems like he’s satisfied. He’s fussy and he doesn’t sleep very long. He nurses for 45 minutes every 2 hours – I’m exhausted! I was hoping to nurse at least through the first year, but honestly I don’t know if I can handle it much longer.
Pediatrician: I understand your frustration, but don’t give up hope – let’s talk about how we might approach some of your concerns. First, you are doing something amazing for your baby by nursing. The benefits of breastfeeding for both him and you are tremendous, so you are doing a great thing! And it’s wonderful that you want to continue to nurse for so long, since breast milk is the best nutrition for your son. So, don’t be discouraged, we can find a solution. It is possible that he is not latching well, which would prevent him from nursing efficiently and lead to his fussy behavior. Perhaps the baby's mouth needs to be open wider. To help with this you might adjust the angle so that his lower jaw is farther back on your breast, or he may need to be pulled in closer to you. For some babies, it may take many tries at each feeding before breastfeeding feels comfortable. Have you seen a lactation consultant yet?
Mother: No, I haven’t, what’s that?
Pediatrician: A lactation consultant is a certified medical professional who can help you with all your breastfeeding questions. They really are the breastfeeding experts. Here is a card for some lactation consultants nearby – they are fantastic. You can also check with zipmilk.org for more information about lactation support services of all type. If you’d like, I can give you a print out of lactation support in your area? You mentioned you’re worried about supply. Is your baby gaining weight?
Mother: He is, but not as much as my sister’s baby.
Pediatrician: It’s normal to be worried about your baby getting enough milk since you can’t actually see how much volume he takes in. It is normal for breastfed babies to nurse more often since breast milk is more easily digestible than formula. It’s also tempting to compare your son to other babies, but every baby is different. Does your baby have wet and dirty diapers?
Mother: Yes, he does. We go through diapers like crazy!
Pediatrician: That’s a good sign. I would recommend seeing the lactation consultant to address your breast pain and make sure that your baby has a successful latch needed for efficient nursing.
Mother: Thank you so much! I’ll call the lactation consultant and see what she says.
In this view, the pediatrician did an excellent job making her patient feel comfortable and confident in her nursing. The counseling session is individualized to the mother and promotes breastfeeding over formula. The pediatrician addressed several common problems mothers may encounter that hinder feeding, and she referred the patient to a lactation consultant for further support.