Ask the Expert

Pediatricians and Breastfeeding

by Vanessa Shanks, MD

Before my daughter was born, I knew I was going to breastfeed. Sometimes it feels so cliché to say that out loud; so many women say it. But for me, it actually wasn’t that I wanted to breastfeed, it was that I felt obligated to breastfeed. When my daughter was born, I was a board-certified pediatrician and in the middle of my fellowship in Neonatal-Perinatal Medicine—I was doing an additional three years of training to become a bona fide “baby expert.” I told every single mother I spoke to that she should breastfeed or provide breast milk, so how could I possibly even consider not doing it myself?

In the hospital after she was born, my daughter latched and we breastfed. Now, I certainly had my struggles, but comparatively they were small struggles—of course, I can only say that now, four years later. Trust me that at the time my molehills were the Himalayas, and I still distinctly remember “quitting” on four occasions before we actually weaned at 13.5 months. But looking back, what I continue to find so striking is how ignorant I was. After four years of medical school and four years of residency training, after studying for and passing my pediatric boards, I was still completely clueless.

Everyone says, “You can’t understand until you go through it” and “You can’t possibly grasp just how hard it is going to be until you are doing it,” but that is not what I am talking about. I had friends who successfully breastfed, and they warned me I would be exhausted. I had physician friends who warned me that it would be worse than working 24 hour shifts every three days for months on end. While I couldn’t grasp just how hard that would be, I knew that I wouldn’t be able to fully understand until I was living it and I had accepted that.

No, what I am talking about is how incredibly clueless and ignorant I was about basic breastfeeding—the anatomy and physiology (there’s more than one hole the milk comes out of??), the specific logistics of a baby taking a nipple into its mouth and extracting milk, what to do when you return to work, what happens when you start solids, how to wean. All of this is basic information that was guaranteed to surface if I breastfed for the one year recommended by the American Academy of Pediatrics. As you are reading this, you might think, “It’s okay. I didn’t know that stuff either at first.” And you probably asked your pediatrician. Well, I was the pediatrician!

I was shocked, and continue to be, at how much I didn’t know. What if I didn’t decide to do additional training to become a neonatologist and instead was a pediatrician in a primary care office, seeing patients, every day, right now? What if I had never had a baby to figure this out on my own? Dear Lord, what if a mother asked me to help her? The thought terrified me. I would be one of those doctors giving a crap answer, because I would have no idea how to help a breastfeeding mother because I never received proper training to do so.

You may be thinking I had poor training and you would never pick a pediatrician like me to be your baby’s doctor. I was actually trained at one of the top 10 hospitals in the country. They have an amazing program and turn out really, really good pediatricians who I would trust with my own child on any given day. But until this year, their lactation education consisted of two one-hour lectures during their three years of residency. Two hours. That’s it. Unfortunately, this is not a unique situation.

There have been several studies dating from the mid-‘90s to as recently as 2011 showing the dearth of breastfeeding education provided to pediatric trainees. While there has been some improvement over the past few decades, in 2011 a study showed that this training continues to be suboptimal in most places (as reported by the program directors themselves). However, in more recent years, there has been increasing interest from the Academy of Breastfeeding Medicine and the American Academy of Pediatrics to improve the breastfeeding education we provide to our trainees. There has also been increasing efforts to support physician mothers who are breastfeeding; as it turns out, if a physician mother has a successful breastfeeding experience then she is more likely to support and encourage her patients!

While my personal breastfeeding experience has greatly contributed to my current knowledge, my real teachers have been you—the other mamas out there, especially the mamas on Katie’s Facebook groups that I still occasionally stalk under the guise of Samantha Shanks. I was one of the original Pumpin’ Mamas and through discussions in these groups, I learned how to maintain my supply after returning to work, I learned how to start solids and what to expect, I learned how to wean. But more importantly, I learned about the heart and soul that goes into providing breast milk in so many different realms than I could ever hope to imagine. I learned to treat each mother as a person who is facing mountains, even if they look like molehills. I learned the fragility involved in each new step.

Physicians who have not been self-taught or had the proper training won’t know these things. They may know the basic anatomy, they will understand the hormones involved in lactation, they will be able to spout a myriad of benefits from breast milk and breastfeeding. But they may not know that pain isn’t normal, they may not be able to appreciate the limited function of a tongue tie even if they can identify the anatomy, they may not be able to help you troubleshoot your difficult work schedule so you can maintain your supply. A physician may be able to tell you that your late preterm baby is not getting enough milk when breastfeeding and that you need to supplement because the doctor knows what level of jaundice is dangerous and that your baby is at risk for dehydration. But physicians might not know that you then need to pump to protect your supply, and they may not appreciate how exhausting it is to nurse, pump, and then bottle feed 24 hours a day for days on end. They may not realize that while they speak these words, they are breaking your heart. Because a pediatrician’s primary patient is your baby, and they may have never been taught how to help the breastfeeding mother that comes with that patient.

When you encounter these doctor visits, you have the unique opportunity to be the teacher. The person you revere, the doctor, the person you respect and trust with your child’s life, can also be your student. Society has done a poor job of teaching our physicians, simply because it wasn’t necessary before. Historically breastfeeding has been a family matter—grandmothers, mothers, aunts, and sisters were the people who helped mothers learn to breastfeed and overcome these challenges, not physicians. But as people have moved farther away from home and families have become more complex, society has shifted in such a way that the majority of breastfeeding problems have become medical issues and women have begun seeking help from medical professionals instead. Have patience with your doctor if it seems his or her education has lagged behind this paradigm shift. Teach us gently; it is very hard and scary for a physician to admit to not knowing something, downright embarrassing at times. So be kind. And teach us.

Dr. Vanessa Shanks is originally from Baltimore, Maryland where she completed medical school before moving with her husband to Ohio for her residency training. She completed a combined residency in Internal Medicine and Pediatrics before moving back to the east coast for a Neonatology fellowship. While her original interests were in palliative care, it was during her fellowship that Dr. Shanks developed a love for supporting breastfeeding mothers. She was able to breastfeed her daughter, Samantha, for over a year during her fellowship. She developed shortcuts and tricks necessary for her success: pumping on the train, pumping in the back of a transport ambulance on the way to pick up a sick newborn, and directly breastfeeding between 28-hour shifts at the hospital. As she learned about the importance of breastmilk in the care for her NICU babies and saw the struggles of the women she worked with, she realized that every mother, herself included, needed a Balanced Breastfeeding approach to be successful.

Upon completion of her fellowship she returned to Ohio to pursue her academic career interests. In 2016 she was named the Medical Director for Neonatal Lactation Services and last year she hosted her very own Big Latch On in her NICU!

Dr. Shanks spends her time outside of the hospital with her husband and daughter. In the little time Dr. Shanks has to herself, she enjoys clearing her head and refilling her cup through horseback riding, reading, and swimming.