Some years ago, a good friend of mine had just returned from a prenatal visit. She began asking me some questions about her pregnancy and anticipated birth. At the time I was working as a labor/delivery nurse, so I felt entirely qualified to provide accurate answers. However, after hearing several questions spill out of her mouth, I asked, “Did you ask your doctor any of those questions?”
Why don’t patients ask questions?
“Oh, I tried, “she responded. “But he had his hand on the doorknob. He always has his hand on the doorknob.”
Okay, I began to understand. She is inquisitive, well-educated, and well-spoken. She was able and willing to articulate questions, but he was out the door before she could ask questions at her prenatal visit.
Is this a real prenatal visit, or just a quick prenatal appointment?
It was only a few days later that her doctor came into the labor and delivery coffee room. Chatting with several of us nurses, he mentioned that he had taken care of 40 prenatal patients at his office that day. Another nurse called him out on his claim. “Those 40 women didn’t get actual care,” she said. “They just filed by.”
Ah yes, I realized. He had his hand on the doorknob.
And for the record, this was an obstetrician whom I liked, and respected! But you can see the problem here. The doctor feels like he’s in a time crunch, and the patient feels like she doesn’t have an opportunity to ask questions during her quick prenatal visits.
What about breast assessment in pregnancy?
We used to joke that obstetricians are interested only in the real estate between the waist and the thighs. Further, the doctor’s nurse performs most of the “physical assessment,” if you can call it that. As the RN, I’ve been the one who tests the urine samples, gets the blood pressure readings, and listens to the kaklack, kaklack, kaklack of the baby’s heartbeat.
Where is breast assessment in these prenatal visits?
As far as I can tell, obstetricians rarely (if ever) assess breast adequacy during the prenatal visits. And, I seriously doubt that obstetricians are aware of the topics that the World Health Organization says should be discussed with the pregnant mother.
What does the WHO say should be discussed?
The World Health Organization has a longstanding recommendation for health care providers to address several aspects of breastfeeding with women before their 32nd week of pregnancy. Further, they name seven different topics:
- The importance of exclusive breastfeeding to the baby
- The importance of exclusive breastfeeding to the mother
- The importance of skin-to-skin contact immediately after birth
- The importance of good positioning and attachment
- Getting feeding off to a good start
- Giving no other food or drink before the baby is 6 months old
- The risks of not breastfeeding
What’s the reality here?
You could say that I’m US-centric, outdated, uninformed or biased. OK, no problem. I’ll be happy to hear it if you can prove me wrong on this one. So let me ask:
- Did you see my last week’s post about the woman I accompanied to the hospital? Did you think that communication was supportive?
- Do you know of any woman who has had such a detailed discussion with her obstetrician? I don’t.
- Did your doctor talk to you about any of these topics before 32 weeks? I bet not.
Wonder why so many women are interested, but don’t initiate or continue breastfeeding? Might lack of counseling during prenatal visits be part of the problem?
Knocking on the door with knowledge
As Terry Goodkind asserts, “Knowledge is a weapon. I intend to be formidably armed.”
Unfortunately, many women approach their first breastfeeding experience armed with little more than a book and a computer (or, these days, a smartphone!). That’s not enough.
Exchange of information about breastfeeding is a crucial component of prenatal visits. Women must either initiate the conversation, or continue asking questions until they get satisfactory answers. Without knowledge, women will find themselves either lost or bullied when it comes to breastfeeding.
The aim of prenatal care is to ensure an optimal environment for the baby’s growth and his mother’s well-being. During pregnancy, that’s in his mother’s uterus. After he is born, that’s at his mother’s breast. Communicating this to the parents is a key component of prenatal visits.
“Professional” care and education that does not address that is about as helpful as the doorknob in the provider’s hand.
Have you discussed breastfeeding at prenatal visits? Has your patient initiated these conversations?