Breastfeeding promotion - a view from a UK doctor

Welcome to the Milk Mama Diaries Carnival (July).  For this month, we join the National Nutrition Council - Department of Health in celebrating Nutrition Month with the theme "Isulong ang Breastfeeding - Tama, Sapat at EKsklusibo!" [This is Tagalog - apparently, it translates as "Push Breastfeeding Forward - Correct, Sufficient, and Exclusive." Participants will share their experiences in promoting breastfeeding or their tips on how breastfeeding should be promoted.  Please scroll down to the end of this post and check out the other carnival participants.

OK, compulsory intro over.  As you can probably deduce, this blog carnival is based in the Philippines.  Undeterred by the fact that I don't know remotely enough about the Philippines to advise on how breastfeeding promotion should best be done there, I figured, hey, no problem, I'll jump in with a post about how I think the healthcare system in the UK should promote breastfeeding.  Reading more of the ongoing discussion on how dramatically different the situation is in the Philippines has made me question the wisdom of that blithe decision.  While I think at least some of what I say is universally applicable, it's easy for me to talk about breastfeeding as just another of life's choices when I have the luxury of living in a well-off country with a clean safe water supply.  I believe there are multiple advantages to breastfeeding even when living in such a country; but they don't begin to compare to the frightening consequences of formula feeding in undeveloped countries.  I think that treating the two situations as comparable would be a terrible idea.

However.  By the time I'd reached that conclusion the post was practically written, and I do think that the basic principles behind the approach I advocate are universally applicable.  So I'm going to go ahead and post it and let other carnival members make the choice as to whether or not they wish to include it on their lists.  If any think it more appropriate not to, then I will fully understand that.  I also ask anyone from the Carnival who does read this post to bear in mind that it was not written with the Philippines or any other developing country in mind, and that some of what it says will therefore not be applicable.  One specific and important example is my belief that it's quite reasonable and low-risk for a woman to give the occasional bottle of formula - the research on which I base this opinion is based entirely in developed countries, and should not be taken as applicable to the situation in countries where safe water supplies are not universally available.  In those countries, a single bottle of formula or drink of water can indeed be extremely dangerous for a baby.

So.  With all that in mind, this is my vision of how I, as a doctor in the UK, would like to see the healthcare system in the UK go about discussing and promoting breastfeeding.  (It is, sadly, very far from the way that it does so at present...)

At the first prenatal appointment, I think it would just be mentioned as something to be discussed at further appointments.  This is simply because there's so much else to discuss at that point that it just doesn't seem like the best time to get into such a complicated subject.  So I'm picturing it more as something that gets introduced and not gone into - "OK, your next appointment will be in a month's time.  At that point we'll check you're OK, have a further chat about what sort of things to expect from the coming months, and start talking about how you want to feed the baby and the pros and cons of the different ways.  Meanwhile, here's some information for you to look through."   The antenatal pack would contain some leaflets on the subject, introducing the kind of information I'll discuss below.

At the next consultation, the midwife (the prenatal care system in the UK is midwife-led for normal pregnancies) would bring up the topic and ask the woman what thoughts she was currently having on how she wanted to feed her baby.  Obviously, at this stage there would be some women who had made a definite decision (which might be for full breastfeeding, full formula feeding, or mixed feeding), some who were thinking more generally in terms of "I'll give breastfeeding a shot and see how it goes", and some who had no idea at all. 

This would be the starting point for discussion and information-giving that would be gradually developed as indicated over subsequent consultations from then throughout the woman's involvement with the midwifery services - so, throughout her pregnancy, she would be finding out more about the decision and having the chance to continue all options, and, after the birth, the midwives would be ensuring that things were going well and looking at what they could do to provide help and support if not. 

After a woman was discharged from midwifery services, the health visitor would take over the same role - keeping an eye on how things were going, providing support, discussing with women who had difficulties what their options were and what the best way forward would be, and troubleshooting by, for example, warning breastfeeding women about what to expect during growth spurts.  Doctors would do the same thing at the six-week check and opportunistically at other times that they happened to see the mother or baby.

During these chats, there would be a lot of points to cover:

• The pros and cons of different feeding choices - discussed as clearly and honestly as possible.  This would include both evidence-based information of breastfeeding benefits, and practical considerations.
• The practical information needed to implement whatever choice the woman made - whether this be information on how to get breastfeeding to work out well and where to seek help if needed, or on how to mix formula and sterilise bottles safely, or both.
• For women who wanted to try breastfeeding/mixed feeding, a troubleshooting discussion of the problems and booby traps that might arise, and ways of dealing with them.
• For women who wanted to try formula-feeding, a sensitive discussion of the reasons why, and of whether any kind of compromise was possible.  If she was put off by a previous bad experience or by seeing a friend's bad experience, did she know that every breastfeeding experience is different and that breastfeeding another child might not come with the same problems as breastfeeding the first one?  If she was put off by the thought of all the initial difficulties to be overcome, did she know that those difficulties don't affect every woman and would she consider it worth at least giving breastfeeding a brief try to see whether it worked out?  If she wanted to be able to hand her baby over to someone else for a bottle once in a while, did she know that this was still an option for most breastfeeding mothers (either the much-maligned occasional bottle of formula, or pumped milk)? (She might, of course, flat-out not wish to discuss it at all, in which case the midwife would respect her wishes, let her know that the subject was up for discussion any time she wished to introduce it herself, and let it drop thereafter.)
• For women who wanted to breastfeed exclusively, a discussion of whether to introduce bottles of pumped milk, and, if so, when and how to go about it.

All of this would be backed up by written information that would be available in the initial booking pack given to women, with lots of discussion on where to go for further help if needed.

Midwives would aim to keep all information both honest and easy to understand.  This means that:

• They would not try to gloss over potential difficulties.  Breastfeeding can be very easy and, when it goes well, is far more convenient than giving formula, but it doesn't always go well and, for some women, can be very difficult indeed.  While there's no need to approach the subject with an attitude of what my mother calls 'Doom, doom, on the doom drums', it also doesn't do women any favours not to at least warn them of the possibility that breastfeeding may be a miserable experience for them, and, if so, that this is not absolutely guaranteed to improve with time.
• They would be honest about both what the science shows and what it doesn't.  There is extremely good evidence that breastfeeding has a number of health advantages over formula feeding; unless there's some reason such as HIV or a non-negotiable medication regime incompatible with breastfeeding why a woman is not even able to give breastfeeding a try, a woman considering formula-feeding should know the information in favour of breastfeeding in order to be able to make a truly informed choice.  On the other side of things, breastfeeding promotion campaigns have had a regrettable tendency to leap on any study that shows any apparent benefit of breastfeeding with little regard to the quality of the research, or to flat-out confuse opinion with fact.  Where we have strong evidence for a particular benefit of breastfeeding, we should tell women this.  Where the evidence is equivocal or there just isn't much of it one way or the other, we should be honest about this too.
• The research would be presented with actual numbers where possible, rather than just a laundry list of diseases for which the risk is reduced by breastfeeding.  However, these numbers would not be presented as "Formula feeding increases your baby's risk of this disease by X per cent", but as the actual likelihood of a baby being affected by a particular disease simply as a result of the formula feeding (or, to flip it the other way, the likelihood of a breastfed baby avoiding a particular disease simply as a result of the breastfeeding).  The reason for this is that, especially for rare diseases, percentage increases/decreases can be a misleading way to present information.  For example, the worrying-sounding figure of a 36% increase in SIDS in formula-fed babies actually equates to, on average, slightly less than a one in seven thousand chance of dying of SIDS as a result of being formula-fed (and, of course, that's before accounting for the fact that you can reduce your baby's risk below average in other ways).

Throughout these discussions, mixed feeding would be on the table (so to speak) as a possible option, rather than the choices being seen as a very black-and-white breast vs. formula.  That way, women who felt overwhelmed at the thought of exclusively breastfeeding would be aware that giving breastmilk was still an option, and might feel more able to try to do so.  Again, women would of course be given honest and accurate information about the various pros and cons, including the fact that we really don't have a huge amount of data on how mixed feeding stacks up against either full breastfeeding or full formula-feeding, simply because most studies don't consider it as a separate option.

But the most important thing about these discussions would be that the ultimate goal they would be based on would not be that of getting as many women as possible to breastfeed, or to breastfeed for X amount of time, or to breastfeed exclusively.  All those goals and targets have fueled the attitude that, at its darkest, has led to health care professionals browbeating women and endangering babies in the name of breastfeeding promotion.  Instead, the main guiding principle would be "How can I best ensure that this woman has all the information and support she needs to make a genuinely informed choice with which she is going to feel comfortable?"  Because, at the end of the day, that - not breastfeeding - is what matters most.

 

Check out the other Carnival posts:

Three Ways I Promote Breastfeeding by Example - Dainty @ Dainty Mom

A Simple Breastfeeding Campaign - The Lazy Mama

I Am A Breastfeeding Mom - The Painter's Wife

Why I Don't Nurse in Breastfeeding Rooms - Legally Mom

The Low-Milk-Supply Mommy Did It! - The Odyssey of Dinna

Breastfeeding Promotion Tips from a Formula Feeder (Yes, you read that correctly...) - The Fearless Formula Feeder

On Promoting Breastfeeding - ImPerfectly Created

Milk Mama Diaries 3 - MimmaBenz

Breastfeeding Mama - canDIshhh

I *heart* Breastfeeding - The Mum Side

Spreading the Word on Breastfeeding - Mommy Kuwentos

Taking Breastfeeding Further - Mec

A Breastfeeding Formula-Fed Mother - Soprano Mother

Breastfeeding: Promoting It Even If I Didn't Get Lucky The First Time Around - Glamma Momma

I am your breastfeeding friend - Lyndel's Mom

Thoughts of a LactatING Counselor: Breastfeeding is More of Psychology! - Handy Mommy

More on Breastfeeding Promotion plus a Guest Post - Chronicles of a Nursing Mom

Celebrating My Magic Milk - Denise

Breastfeeding Sisters - Isis Evasco

Comments

[Jenny]

Sarah, Thank YOU for joining our carnival. I learned a lot from your post, especially since you are talking as an MD practitioner. It is interesting to read that pregnant women NORMALLY see a midwife for prenatal visit but such is not the case here - maybe for rural areas, where there are no ob-gynes etc. but in the major cities, Metro Manila, Cebu, Davao - pregnant women from all walks of life see an MD - an ob-gyne. Some doctors charge as low as P150 (USD3) for a visit while for others it is free. I have had several friends who want to do homebirth but found it really difficult to find a midwife here in Metro Manila - forget about asking doctors to help you with your homebirth plans.
Next, I am quite intrigued that feeding option is discussed by the midwife during prenatal visits. Here, the ob-gynes NEVER talk about breastfeeding (unless you are lucky to have an ob-gyne who IS a breastfeeding advocate). Some ob-gynes will just tell their patients - hey breastfeeding is the best - and that's it. no further explanations. If moms didn't attend breastfeeding classes or seminar, the first time they will hear about feeding is after they have given birth where nursery nurses will tell them to top off with formula because their milk hasn't come in or simply tell them that formula or bottles is not allowed in the hospital because they are baby-friendly. So you can just imagine where that leaves the poor mother.
As you can see, we still have a long way to go in terms of breastfeeding promotion especially in the medical field. Our government has limited funds and it is usually private groups who promote and advocate breastfeeding aggressively.
Thank you for joining the carnival and sharing with us another "view" of how breastfeeding gets promoted.

[Mec]

It is my dream that OB Gyns here would actually
1) initiate discussions about feeding options (and maybe instruct or direct the mother to resource people/literature)
2) instruct the mom to have a preliminary consult with a pedia (because there is really no point person, so to speak, here of who to really go to for expert breastfeeding advice that is readily available and usually, parents only meet their pediatricians after giving birth)

Your post is very illuminating. I think there is a growing movement of bringing back the midwives/having doulas here too, but it's going to be a very slow process realizing that... right now, midwives here are just glorified nurse assistants in the city... or a town oldie who massages bellies who may or may not really know what she's doing

Thank you again for joining our carnival

[Dr Sarah]

Thank you for commenting! I want to clarify something that may not have been clear: What I'm talking about is my ideal of how I think things should go. Midwives do indeed discuss breastfeeding at the prenatal visits, but it's very far from the approach I've outlined - women report being given insufficient information and/or browbeaten if they don't feel like breastfeeding.

My own experience was that it was pretty much tickbox - "Can you name two advantages of breastfeeding?" (and I was expected to come up with two from a list that they had that I don't even fully agree with). "Do you know about the importance of skin-to-skin contact after the birth?" "Do you know that your baby does not need anything else for six months after birth?" And if they got some sort of acknowledging grunt in reply they would tick the box to say that this had been discussed. But I suppose, in all fairness, talking to a doctor is different from talking to someone with no healthcare experience and they may have not wanted to go into things in detail in case I felt patronised by being told stuff I already knew.

Thanks again for commenting, and I am looking forward to reading the rest of the posts!

[Legally Mom / Fritzie]

Thank you for having an interest in our breastfeeding advocacy here in the Philippines. Just like you, I believe in an INFORMED CHOICE with respect to breastfeeding vis-a-vis formula-feeding (or even mixed-feeding). However, and as I mentioned in my comment on Formula Feeder's post, the scenario in the Philippines, a developing country, is "DRAMATICALLY DIFFERENT" from that in the UK or the US. (And I appreciate the fact that you highlighted this in your post.)

First, there can be no genuine INFORMED choice if the only information most Filipino women have access to is just about formula and its benefits. We are bombarded with TV commercials saying how formula improves our children's immunity, IQ, eyesight, etc. but there is hardly any readily accessible and available information on the benefits of breastmilk. There can be no genuine informed choice when most of our doctors and health professionals, the persons who are supposed to be knowledgeable about breastfeeding, fail to discuss breastfeeding with moms and would-be moms.

Second, in a country where more than a majority of its 100 Million people earn less than US$10 a day, and with most of the families supporting 3 to 6 children, you can just imagine how deplorable the living conditions are. The truth is, the appropriate and suitable infant formula (from 0-6 months, 6-12 months and so on) is NOT an AFFORDABLE CHOICE for millions of women here.

So what do we see in our country? We see babies drinking "am", the thickened water coming from boiling rice. We see babies drinking "diluted" formula with the wrong water to formula ratio. Why? Because infant formula is expensive and the mothers have to make sure that it will last longer. We see mothers feeding their babies with milk that is not meant as a breastmilk substitute (like filled or skimmed milk). We even see mothers feeding their babies with diluted powdered orange juice drink!

Again, thank you for your post. I hope that one day, our health personnel here would do what you've just outlined in your post.

[Fearless Formula Feeder]

Dr. Sarah, I have a request. Can you move here, run for office in the AAP, and smack some common sense into everybody?

This is probably my favorite post about breastfeeding promotion, ever.

FWIW, I shared your fears about participating in the Carnival. I'm ultimately happy I did because I learned a TON about the situation in the Philippines and it has really opened my eyes in many ways. But like you, I took the approach of discussing the wrongs of the current state of BF promotion in affluent Western nations. It's interesting, b/c in the case of the Philippines, I can definitely see why hardline lactivism is necessary and beneficial. But it has simply never been like that where we live, so now more than ever, I feel like it does a disservice to women everywhere to treat our situation like that of a developing nation. Imagine if the power of American or British lactivists were harnessed and used to aid the women who have blogged so wonderfully in this carnival?

[Teri Noto]

Legally Mom, if you wish for the kind of bullying that we experience in developed countries, you must have no idea the kind of damage this bullying does. I would not wish the way that I and other formula-feeding moms have been treated on my worst enemy, and to say that you need "hardline lactivism" like what we have in the U.S. and UK and that it's "necessary and beneficial" is a dangerous and highly counter-productive statement.

You are essentially saying you WANT women in the Phillipines to be bullied, harassed, given the evil eye, psychologically damaged, and their babies put at risk for giving formula. You really want to tell someone who has a good reason not to breastfeed that she's an inferior mother who will never have a good bond with her baby? That she may as well give the kid up for adoption because she doesn't want what's best for him/her? Because lines like that are so commonly spoken by "hardline lactivists" in developed countries that they're now saying women who have a hard time breastfeeding should receive extra screening for post-partum depression. There are forums full of women who have been treated so cruelly by "hardline lactivists," and it is unconscionable to advocate exporting that kind of bullying.

You are essentially saying you support babies being re-admitted to the hospital because "breast is best" and avoiding booby traps has been pushed so hard by hardline lactivists that babies have been starved into dehydration or malnutrition? There's no money or political correctness in studying that occurrence but believe me, it happens. A lot more than you'd think.

And before you say it's supposedly so rare to not be able to breastfeed or breastfeed exclusively, how do you really know? And even if it is only 1-5% of women, what do we do for those thousands of mothers? Even in developed countries, among women who would kill to breastfeed, who have all the support in the world, there are scores who are unable to. How many? There's no point in studying it when all you're going to be is bashed as a "booby trap" by the "hardline lactivists." But if we who have access to the best medical care in the world can't all do it, how can we in good conscience inflict bullying on those who don't have that kind of medical care?

Obviously, you haven't been on the receiving end of being denied proper medical care for your baby because your baby's pediatrician was a "breast is best" bully--but I have. By two different doctors. If you had, you might realize just how counterproductive bullying is. What this author is advocating is that breastfeeding be a part of the mother and baby's whole medical care. The way I see it, if we push for better health care overall, there will be a foundation for creating a better breastfeeding environment. Pushing breastfeeding without recognizing the medical care aspect is putting the cart before the horse; how can a breastfeeding mother feel supported without health care professionals countering the onslaught of formula info that Dr Sarah indicates has happened? And no matter what, in no case is there room for bullying.

Saying that hardline lactivism is necessary to get people to breastfeed only says to me that the people who push breastfeeding are so insecure that they have to resort to strong-arm tactics. If breastfeeding activists become "bad cops" then why would any woman choose to go their way over the "good cop" of celebrities supporting formula? I don't have all the answers to resolving the situation, but what I do know is that complex problems like this are rarely solved by simplistic solutions. Hardline lactivism--better known as bullying--is a simplistic solution. We owe it to the women of the Philippines to think of something better.

[Donna]

Teri, are we even reading the same comment?? Legally Mom has mentioned the imbalance of information in the Philippines, and otherwise agrees with Dr Sarah, yet you are accusing her of supporting bullying, hard-line activism...? I am confused...is there a page of comments I am missing, or did Legally Mom edit he post since you wrote yours??

In any case...as someone from a developed country with a similar maternity system to the UK, Dr Sarah's ideas sound very sensible to me.

[Dr Sarah]

Donna - I've just read the same reply from Teri in response to a comment from Legally Mom on the Fearless Formula Feeder's blog. (I think this is the link, but linkages on comments always confuses me so I may not have that exactly right - hopefully that'll get you close.) I suspect what happened was that she had a couple of pages open, typed a long comment separately, and posted it on the wrong post.

Very glad that you and FFF liked my post! Now let's brainstorm how to make it happen!

[Legally Mom / Fritzie]

Just to clarify, I am NOT advocating bullying in whatever form or for whatever purpose.

This was the paragraph that I posted in Formula Feeder's post which led to Teri's comment that I want Filipino women to be bullied.

"5) Finally, and as pointed out by fellow Filipina mom Jenny, most Filipinos are non-confrontational. It's a cultural thing. Insofar as breastfeeding advocacy in this part of the world is concerned, I have yet to come across with "breastfeeding bullies" and NGOs which "demonize" formula companies. But sometimes, I do wish we have one. :)"

The last sentence should be taken into context and in line with my ENTIRE comment. In the Philippines, babies DIE of diarrhea because of unsafe drinking water. In the Philippines, and contrary to what Teri assumed, we have very few doctors who are breastfeeding advocates. In the Philippines, breastfeeding as an OPTION is hardly discussed by doctors and health professionals. But we are given free baby books sponsored by formula companies (so you can just imagine what's stated there.)

Teri assumed that I haven't been on the receiving end of a pedia who is a breastfeeding bully. She is CORRECT. Because we don't have that here. I, however, have encounted several health personnel who, upon informing them that I want to breastfeed, asked me if I could do it and still went on to prescribe a specific FORMULA because my milk may not be enough.

I hope you would take the time to read my entire comments. I am not advocating bullying. What I have been saying is that the breastfeeding issues in the US and the UK are not the same issues we have here in the Philippines. That the suitable alternative that women in rich countries have is NOT an affordable choice for most women here.

And it is true that I may be IGNORANT (the word that Teri used) of what's happening in developed countries. But please understand that this carnival is not about the US or the UK. We are talking about breastfeeding promotion in the PHILIPPINES.

Finally, let me emphasize that I am one with Teri in her fight against bullies, whether they be breastfeeding bullies, or as in our part of the world, formula bullies.

Now, I wonder how she'll react to Formula Feeder's comment that "[i]t's interesting, b/c in the case of the Philippines, I can definitely see why hardline lactivism is necessary and beneficial."

[Fearless Formula Feeder]

Just to be clear, by "hardline lactivism" I meant coming down on the formula companies, campaigning pediatric organizations, holding nurse-ins, talking about the risks of formula (which in the case of your country sounds like a very real risk, due to improper usage - this is not the case in the US/UK so the "risks" are typically overblown). NOT bullying. To me, at least, bullying means women verbally assaulting or denigrating other women for their choices. I don't believe there is ever a justification for that kind of behavior. (Not that I think you were advocating that either, LegallyMom, but I wanted to clarify my point...)

[Anne]

Hi - I'd like to share with you some interesting research I stumbled across relating to the idea that giving an infant the odd bottle of formula won't hurt. Whilst I pretty much agree with what you've said, I also feel it's important to state WHEN it's safe to do this. For example, there is lots of talk about the virgin gut, and the effect of the introduction of any milk or food other than human milk prior to gut closure. Of course this is the ideal, and one I strongly support where possible. That's discussed in this (widely shared) article http://www.health-e-learning.com/articles/JustOneBottle.pdf and I don't wish to labour the point here! However, as the mother of a child who was taken to SCBU after birth and fed formula (without our consent) within the first 24hrs of life (donor milk was available), I have a slightly different concern. My daughter went on to develop a cows milk protein intolerance following just two bottles (approx 70mls) of formula milk. This - I believe - resulted in her suffering badly from silent reflux, which required strong medication and I also had to undertake a strict dairy free diet in order to breastfeed her (bear with me!). I searched for information about whether or not there could be a link between the formula given to her so early in life (she was ebf after we left the hospital), and her intolerance/ the resulting silent reflux. I turned up a couple of pieces of research which I would like your opinion on. http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1988.tb10727.x/abstract
http://www.journalofdairyscience.org/article/S0022-0302(05)72868-X/abstract
The first
Due to the open-ness of the newborn gut and the fact that it's 'expecting' colostrum in order to seal it, the introduction of that 'occasional bottle' of formula which you referred to in your piece, within the first few days of life may actually have a much bigger impact on a newborn than if it were given later at (for example) 2 months of age. It is interesting to me that of 39 infants who were ebf in the first study I've linked to, ALL 9 who went on to develop CMP intolerance had been given formula whilst in special care - just as my daughter was. 'Possibly early inadvertent and occasional exposure to cow's milk proteins may initiate sensitization in predisposed neonates. Subsequent exposure to minute amounts of bovine milk proteins in human milk may act as booster doses eliciting allergic reactions.'. It is clear that the small fat globules in cow's milk formula penetrate the wall of a neonatal gut much more easily than the fats in human colostrum, or in mature human milk. I personally feel that hospitals & parents should avoid giving formula wherever possible to newborns because of the risk of 'setting up' an allergic reaction in these children. I find myself wondering how many cases of CMP intolerance are basically down to this - seemingly small - intervention. Therefore I personally feel that it's not possible to make a blanket statement saying the 'occasional bottle' is ok - since the timing of those bottles may actually be very significant. I look forward to learning your thoughts.

[Anne]

Also re. The UK's safe water supply, I think it's important that we don't take that one too much for granted. Over Christmas we had no water for 5 days. I live 20 miles from Belfast and the problem affected many thousands of people in both city and country. I was advised to boil snow. It made me think about how we take our clean water supply for granted. Our shops v quickly sold out of bottled water. Many parts of the world are now living under 'water stress'. I think it's very easy, perhaps a little too easy, to dismiss these things as 'not going to happen here'. http://mythnomore.blogspot.com/2010/12/back-to-basics.html

[Pandora Sale]

Excellent post. It makes me realize the energy of words and pictures. I learn a lot, thank you! Wish you make a further progress in the future.

[Mary Ann Santos]

Hi, Dr. Sarah.

I seem to be posting a very late comment. :) This time last year, breastfeeding wasn't at all in my mind. I just got pregnant last Oct 2011. I am mix feeding my 3 month old son now. You know how I got to know about all the benefits of breastfeeding? I just happened to go to a workshop for moms when I was pregnant. I just went there to meet up my fellow pregnant friend. The workshop wasn't really a priority. I was even surprised that the talk had a lot of portion in the workshop. I don't think it was mentioned in the title/name of the workshop.

Mommy Mec is right in her post. I had two OBs before and I was never asked if I wanted to breastfeed. Their main concern was me and the baby inside me. Baby outside my womb is already under the pedia. And since I didnt have a pedia yet at that time, breastfeeding was discussed to me at all.

Which brings me to my next point which I hope you can help me. I am epileptic and under medication, Lamotrigene. When I initiated a talk with my OB if I can breastfeed, she told me to ask my pedia. And again, since I didnt have a pedia yet at that time, I wasn't able to ask a pedia. I asked around and a few friends gave me readings about lamotrigene and breastfeeding. I showed the readings to my pedia on the night before I gave birth and he seemed to be ok with. I showed it to my neuro too but for him, it wasn't very conclusive. Now that I am seizures almost once a month, my neuro is advising me to stop breastfeeding all together. It seem to be taking a toll on my health. He is not sure if it is the main reason though.

Hope you can help me or refer me to someone. I still want to breastfeed but at the same time I don't want my health to deteriorate (I want to be healthy enough to run after my son :) . We don't know if we can increase my medication without harming my milk.

Thank you.