Transcript:
Dr. Barnett-Trapp: There’s very few medications that actually a breastfeeding mom has to pump and dump for. And, but they’ll do it just as a, it’s not out of the, that they mean any harm by it. It’s just that they don’t know. And they want to err, on the side of caution. So in the caution is like you should probably just pump and dump.
And my challenge to them is why don’t you look it up first before you make that recommendation? Because I bet you nine out of 10 times are giving inaccurate advice.
Maureen: Join us for another episode.
Dr. Barnett-Trapp: My name’s Danielle Barnett-Trapp. I am an osteopathic family physician located in Arizona and I work for the local medical school. The osteopathic medical school and I teach for them. I also see patients and just a little bit of background, more on my training. So I attended medical school in Arizona, and then I joined the residency.
We all have to do residency in family medicine and graduated, that was about a three-year program. And after I came out, I practiced what I call full spectrum family medicine, or what we refer to as full spectrum. Meaning I did inpatient medicine, took care of patients in the clinic and then also delivered babies.
And part of the fun part of delivering babies is you get to take care of the newborns because we’re family medicine and we do everything. So cradle to grave medicine. So it’s not like you deliver your baby and then a pediatrician takes care of your baby. We get to take care of you and your baby, which is great.
So growing up, I was the youngest and so I’d never even like held a baby. So I really got into going in and seeing the babies and holding them and learning about everything. I didn’t know about anything babies, including breastfeeding. So that was, it became a passion of mine because when I was an intern in residency, I got pregnant with my first child and had to learn. We don’t learn anything about breastfeeding in medical school. So I had to learn right then from real life experience.
Heather: Can I just stop you really quick? So, yeah, cause I really don’t know, like when I first met you and I learned about your background I was so excited because I realized that I had absolutely no idea what physician training for breastfeeding looked like, or if it even existed.
So, I mean, if I, as a midwife don’t know that, then I’m sure patients don’t know that. And I think that a big disconnect happens. So you are honestly telling me that in med school, there is zero breastfeeding training.
Dr. Barnett-Trapp: Okay. Zero. Yes. Like structured in the curriculum. However, it is expected that when you do your pediatric rotation, that you’re going to learn something about it. However I’m sure as most listeners probably have experienced, not all pediatricians really know much about breastfeeding either.
Maureen: Okay. So basically like learn on the job, have fun in residency. Hope you come out knowing how to help people with lactation.
Dr. Barnett-Trapp: Yeah. Maybe if you’re lucky.
Heather: Is that just for family med or is that, would you say like all med students and residents that are like OBS even, and pediatricians?
Dr. Barnett-Trapp: I can’t speak with much authority on what their residencies put them through as far as lactation education. I’m assuming they get more than other specialties, assuming. And I imagine the pediatric residencies probably get the most out of it.
Maureen: Hm, which is interesting, cause they work the least with the parents.
Heather: So can you, for our listeners that might not understand exactly what family medicine means and how that differs from obstetrics and having like an OB GYN that you go to, like, what are some of, what is it and what are some of the perks to a breastfeeding mother working with family med?
Dr. Barnett-Trapp: Family medicine specialty is kind of like I mentioned before, we, we joke cradle to grave. You get trained on all ages, genders, for example, internal medicine doctors, they don’t get pediatric training. They’re trained in adult medicine only. And then pediatricians get trained on zero to 18. And then OB GYN get pregnant mothers, but there’s so much that they need to learn within pregnancy that they don’t have a chance to really focus on the other piece of it, which is the, that part of it. Breastfeeding.
So you can have an OB-GYN as you’re delivering doctor, you can also have a family physician. I guess one of the benefits to having a family physician is that they’re going to be taking care of you and your baby and kind of putting all of that together. If you’re lucky, I say, if you’re lucky enough to have that, because family physicians that deliver are kind of a dying breed.
Heather: Why is that? Just quick digression again, but I’m curious to hear what you have to say about that.
Dr. Barnett-Trapp: I think the reason mostly is malpractice. A lot of the family docs I’ve talked to and say, why did you give up delivery? And it’s because malpractice coverage is so much higher for family physicians.
And the ones that are still delivering a lot of them are in rural settings. So you’ll see it more in a rural setting. I live in Phoenix, Arizona. I mean, there’s not many family medicine doctors that are still delivering.
Heather: Wow. So when did you see that breastfeeding was something that you could help with as a family med doc? And then how did you even start on your journey?
Dr. Barnett-Trapp: I was very fortunate to have in my pediatric rotation as a resident, an attending physician that expected me to get a full breastfeeding history on every patient. How long did you breastfeed for? She is a breastfeeding ad, like beyond advocate. She started a group called Dr. Milk, which is a Facebook group. And it’s all for the women physicians who are breastfeeding or interested in breastfeeding. It’s huge now. And I had the great fortune of working with her. So anytime I would go see a patient, she was like, so did she breastfeed her other kids? How long did she do that?
Has she had any breast surgeries? Me being the perfectionist that I am, it was like my goal to ask all the questions so that she didn’t have a question like, well, did you ask this? And I’m like, I didn’t get it at that time. So, yeah. So I learned a little bit from that rotate, a lot from that rotation.
And then it just then having gone through it, myself with my own child, I think as physicians, we become better physicians when we get to experience things. So my, I feel like I am, I am a better physician to my patients that have children because I have children. Now that’s not always true, but like, I don’t want to say that physicians that don’t have children, aren’t great physicians to kids.
It’s just that I feel like I can personally relate more because I’m living this day in. As I struggled with my first child to breastfeed, I just kept learning more and more and more and more. And that’s just kind of built to where now that I’m super passionate about it.
Maureen: So can you tell us a little bit about the class that you teach? Just kind of what that is and who attends that class.
Dr. Barnett-Trapp: So at my university, there’s different student clubs. So you have like the family practice student club, you have the pediatrics club and the OB GYN club. And they’re always trying to put on events and having faculty come speak about things. So they asked me if there was anything I’d be interested in speaking about.
And I was like, yes, I’d love to give a talk about breastfeeding. And so it’s a combined open invitation, kind of lunch and learn, hour long session where I speak to people, students that are interested in OB GYN or pediatrics or family medicine generally. And I just go over the basics of breastfeeding just from the beginning, things that I’ve learned that I wish I would have known. So that if they ever have a patient, and they will, on a rotation that is struggling they have a little bit of knowledge to say, Hey, I’ve learned about this and this is how you can get help.
Heather: That’s interesting. So when you have this room full of physicians eating lunch, and you’re cramming a lifetime worth of breastfeeding information into an hour, like, what is some of the feedback that you’re getting from these students? Student physicians, you know, is it good or is it overall just kind of like, whoa, you blew my mind or whoa, I need to refer out for this or..
Dr. Barnett-Trapp: No, I get it. I get all of them. I mostly I get, oh my goodness. I didn’t think there was that much to it. What do you mean you don’t just put the baby to the breast so they know what to do? There’s problems that can happen and there’s ways to troubleshoot those problems? And wow. I just didn’t even know that all this even was a thing.
You know, or they’ll, I love when people raise their hand, when I talk about purple crying and they raise their hand and they’ll be like, oh my God, my, my sister went through that and they tried like five kinds of formula. And then all of a sudden at three months, the baby was great. And I was like, yeah, probably wasn’t the formula. It was probably what we call purple crying. And so their minds are blown and they’re just, you see the light bulbs going off and I just love it cause I’m like, at least I left an impression whether they ever breastfeed a kid themselves, or they interact with a patient that’s having problems. At least they can say, I remember that this is a thing. And that’s all I want is for them to remember that this is really can be a problem for people and you can, you can have a positive impact.
Heather: Do you ever get any pushback from them as you’re teaching? For example, that’s all well and good, but this isn’t something that I could handle in a 15-minute clinic appointment. Or like, do you ever get any pushback from them about it?
Dr. Barnett-Trapp: I don’t get pushback from them because these are usually first- and second-year medical students, they don’t really know that they only have 15 minutes with a patient at this point. They more so are just interested in learning about it and not really push back, if anything, it’s all positive.
Maureen: Do they ever then follow up with like, okay, when are we taking a class on this? You know, is there like a, is there a want from student positions for that? Or like within your university or other ones?
Dr. Barnett-Trapp: The only thing that I’ve noticed so far I think, well, first of all, it’s not that they didn’t want more information, it’s just that they get so much information. So this is just another little piece of information that they’re receiving and their big focus right now is, is this going to be on my board exams?
And I’m like, Nope, it’s not. So then it’s like, okay. It was very interesting, but that’s not where I’m going to put my focus right now. Obviously they need to pass their boards. But I will say that every year, and I just recently got it this year, an email saying it was one of the best lectures. Everybody enjoyed it so much.
Would you mind repeating it this year? And I’ve so far done it now going on three, four years in a row. So that tells me that there is an interest and people attend that they attended in the previous years. And it’s pretty much the same lecture, but you know, you got to hear things multiple times for it to really like sink in.
Heather: Yeah, I think it’s like seven times.
Maureen: And like one hour that, yeah, you need that a couple of times, for sure. Do you ever ask about like, what kind of what’s their, like number one question about lactation?
Dr. Barnett-Trapp: I usually start by asking, you know, how many of you have breastfed? And, and there’s men in the class, so we always make a big joke about that. But we say, how many, how many of you have breastfed? You know, or do you know somebody who’s breastfed or have you ever encountered a patient that has breastfed? And that’s about the most interaction that, you know, we do. They don’t really have questions about, you know, what they, I guess their thoughts on it, because this is a lot of, a lot of the times, majority this is the first time they’re ever hearing anything about this. Cause we’re talking about, you know, 24, 23-year-olds, that haven’t started their families for the majority. So they don’t have any experience in this at all.
Heather: How about your physician colleagues that are working with family med patients, or even if you run into any pediatric physicians from time to time, do they ever, you know, knowing that you teach this breastfeeding class and that you’re a big breastfeeding advocate, do they ever bring to you any common misconceptions or what’s the most common question of practicing physicians that they have for you as the breastfeeding expert?
Dr. Barnett-Trapp: A lot of times they don’t know to ask me. So I’m kind of an eavesdropper. So if I hear like, oh, you have a pregnant woman, like do you have any questions? Can I help you with it? So a lot of times it’s medications. I get a lot of that. Like, oh, I can’t give her X, Y, and Z medication because it interferes with breastfeeding.
And I’m like, well, who said? Did you look it up? Cause I bet you it doesn’t. There’s very few medications that actually a breastfeeding mom has to pump and dump for. And, but they’ll do it just as a, it’s not out of the, that they mean any harm by it. It’s just that they don’t know. And they want to err on the side of caution.
So on the caution is like you should probably just pump and dump. And my challenge to them is why don’t you look it up first before you make that recommendation because I bet you nine out of 10 times are giving inaccurate advice. They can take you know, a medication and still be okay. Or they’ll say the patient comes in with a cold and they’re like, we really just want them to feel better.
We’re going to give them Sudafed. And I’m like, no, like there’s other things, other things you can give them that won’t affect their supply. And so just educating them on the, on that. You know, give them anything without the D.
Heather: This very much feels like you are an island. And you’re just like reaching out to people like, would you like to join my island? It’s very fun here. We do evidence-based things. And you know the cost benefit analysis of different interventions is multifaceted. It doesn’t just go one way. Would you like to come? You know, do you feel that way? Because talking to you, that’s exactly how it feels to me.
Dr. Barnett-Trapp: I feel like, I just feel like a lot of people aren’t educated and so, and they don’t know they’re not educated because they’re really just trying to do the best thing. I recently had a, a task from a nurse that said, Hey, your patient called she’s having diarrhea and she wants to know if she can still breastfeed.
And I told her she probably should wait until she hears from you. I was like, no, don’t ever tell my patient that. Don’t ever tell them. I was like, I called her. I’m like, no, please feed your baby, feed your baby. You know, please.
Heather: Oh, my goodness. Well, thank God that you’re there to intercept those weird pieces of advice that can have a huge trickle-down effect on the way breastfeeding goes for somebody.
You know, people don’t realize that one little piece of advice from a person and a person in power, really because, you know. Physicians, patients look at physicians like, wow, the all-knowing all seeing and, you know, of course everybody’s always trying to do the best they can, but when they’re erring on the side of caution and they’re like, yep, just pump and dump for the next, I don’t know, let’s give it 36 hours. And the patient’s like, okay. And they don’t question it. And then 36 hours later, they got a brand-new bag of problems and they didn’t need to buy trouble like that. So, oh gosh. It’s so frustrating.
Dr. Barnett-Trapp: Oh, I can totally, I totally agree with you because I feel like if you’re going to have that pump and dump conversation, well, now you need to talk about nipple size and flow and paced feedings. And they’re like, what is that? And you’re like, yeah.
Maureen: And fitting a pump and flange size and like everything.
Dr. Barnett-Trapp: Yeah. It’s just like, if you’re going to give that advice, now I’ll be ready to give this bag of advice. And if you can’t give that bag of advice, then maybe recognize that there’s other people out there that can help your patients.
And they do. I’m not, I definitely don’t want to imply that physicians are just acting like they know it all when they don’t. I think they really, they really know things that they’re doing the best thing, they’re giving the best advice. And it’s just, unfortunately that the education piece isn’t there for them.
Maureen: Yeah. I mean, in light of that, and you know, you said like a lot of your students are excited about this and a lot of the physicians that you know and work with really want to encourage breastfeeding and help with it. But what do you think that their biggest barrier to helping that breastfeeding dyad is?
Dr. Barnett-Trapp: Definitely time and education. So education that they didn’t get it, or maybe didn’t know that they needed it cause they’ve never encountered that problem. So once they do encounter the problem, then they have to find the education. Like the CME or to talk to somebody and then time, I mean, even my own pediatrician, who is the biggest breastfeeding advocate out there.
I mean, if you, if you have 15-minute appointment slots and you, and you encounter a mother who’s having trouble breastfeeding their infant, that’s not a 15-minute problem right there. That’s like an hour problem because really to assess that you need a full history, you need to watch them actually feed the baby and assess the latch and then educate them.
And then it just, it’s an hour easy hour and we have 15-minute slots per patient. And you have to address on top of that, everything that comes with having a baby, make sure they’re on their back to sleep. Make sure they’re in a car seat that’s rear facing, you know, talking about immunizations and pools and guns and all this stuff that we have to do.
There’s just not enough time.
Heather: This episode is sponsored by Feed Your Baby University. Hi, it’s Heather here and Feed Your Baby University is my signature breastfeeding course, and I wanted to make it available to all of you. So you, just like my personal patients, can follow my method to make sure that you are breastfeeding with confidence, pumping and bottle feeding without nipple pain, worrying about supply or complete exhaustion. We also cover partner dynamics, which inevitably change when you grow your family and all the troubleshooting when issues do come up. So if you’ve been struggling with a lack of confidence with breastfeeding and you don’t really know where to turn, Feed Your Baby University has your back and so do I.
Also with the course, you get a 69-page workbook with graphics done by the one and only Maureen Farrell, our cohost. So if you are looking for a course that’s all inclusive with support, a workbook, oh, and a private Facebook group where I go live weekly, this is for you. Check out the show notes for details on how to sign up.
So, where do we go from here? You know, like how do we fix this situation? And if you’re a patient, how can they help, help you? Like how can a patient help a physician treat them the best way they can?
Dr. Barnett-Trapp: That’s a, that’s a hard question to answer because my gut tells me to tell them, you know, to not, to basically not get frustrated if the physician doesn’t have enough time to spend with them and not take that as it’s not important. That they should seek other help. Don’t expect whatever physician you’re seeing to be the end all be all to all your answers or to all your questions. Cause they just might not have either the education or the time that is needed to give it its full due respect to the problem.
Maureen: Right. I think a lot more people would look for that IB CLC or that other lactation professional earlier and think about putting them as part of their care team, if they had any idea how little lactation training doctors have, because most of my clients assume that their OB knows about lactation.
Dr. Barnett-Trapp: See I don’t even, I don’t, I wouldn’t be surprised if you did a survey of physicians, if they even knew what an IB CLC was.
Maureen: That’s a missing part too. Like that. Like if they can’t also then refer to the appropriate care professional, where does that leave our patients, you know? Totally out of luck unless they’re willing to self-motivate, self-educate, or unless their hospital has those on staff, which. It doesn’t happen here. I don’t know about there.
Dr. Barnett-Trapp: Well, and these times, I mean, with COVID, just going through, I just delivered a baby myself like a month or two ago and it was March 28th. So it was right in the middle of all the COVID stuff. And I was having some. I mean, I’m just going, I’m just saying like, I’m not that I’m not the expert, but I’m definitely educated and I had problems.
So I went to the hospital, had a baby. They didn’t really want to touch me too much because of COVID. It was very much door medicine. How are you feeling? How you doing? So the lactation specialist came and she was like, how’s feeding? I’m like, it hurts. It’s usually hurts in the beginning.
And I was like, yeah, I know, but this doesn’t feel the same. I know the difference. I’ve had three kids like this, something is wrong with her latch. Okay. We’ll just keep trying. It sounds like you’re doing all the right things. Bye. Well, that didn’t help me, you know, and I’m not blaming that lactation specialist that came in, it’s just that I get it.
Like, everybody’s scared of COVID. She didn’t want to get close. I understand. But even the best educated, you know, the systems still can fail them. Extrapolate that down to somebody who doesn’t know anything about it, you know, they’re gonna struggle as well. And it can be just in the system. Just don’t, when you say what to say to patients, just don’t give up.
That like always breaks my heart when patients come in and they’re like, I just stopped making milk. And my first thing in my head is like, something else happened. You didn’t just stop making milk.
Maureen: I had a question; you know just thinking about. You know, it’s kind of sorry, this is going back. I’m going back to what you were saying before about like time being a barrier to physicians. Is there a difference in family practice, like with, you know, with the opportunity that you have with your patients, do you have more time to work with them?
Dr. Barnett-Trapp: No. And if anything, I feel like sometimes we have less only because as family physicians, we’re handling so many problems, it’s not just a well-child check or, you know, sometimes. I shouldn’t say we handle more than a pediatrician when we’re talking about children, but they only see the, the pediatrician sees the child.
So they only have to deal with the issues that are leading to the child. But then the mom’s having issues and the mom’s not the patient, but they kind of are the patient, but it’s not like they get their own time slot. They almost need their own time slot. So it’s kind of, I guess that’s, it’s the same for both. I would say is that we don’t get any more time.
If anything, maybe it would be better because we could book two appointment times, one for the mom and one for the child. Whereas the pediatrician can’t do that because that’s not in their scope to have the mom as a patient.
Heather: I was going to ask if, if a patient is listening to this and they’re pregnant, let’s say, and they’re interested in getting family medicine care after delivery because they want to be able to couple up those appointments together.
Would you recommend that the patient call in advance and when scheduling say I’d like to schedule us together at the same time, so you can get a bigger slot?
Dr. Barnett-Trapp: Definitely. But I would also say they should probably ask, is this doctor comfortable with managing issues of lactation, because you can’t assume that all doctors are trained to like, to have the knowledge that I have. You know, there’s going to be some out there that are better than others, and there’s going to be some that have zero.
Heather: So what’s the best way for patients to figure that out? Like, how does a patient find a physician who has all of that knowledge?
Dr. Barnett-Trapp: I’d say, just ask. The, you know, I have a lot of patients that call and ask things all the time. Like I have this problem. Is that something that the doctor there is comfortable treating? And usually the front desk will ask me, are you comfortable with this patient? So I would just always ask. And then also, I know there are quite a few physicians that are also IBCLCs. So obviously starting with those would probably be good.
I’m not one but starting with those physicians would probably be a shoe in to know that they at least have some lactation education. I know that I didn’t mention this before, but I feel like it’s very important to understand that it’s a team. It’s not just see your physician for this problem.
You need to have, like, it takes a village to raise a kid. We all say that it takes a village, it takes a village. Well, it does in taking care of this, this type of problem as well. You should probably have your physician. You should probably seek out also an IBC LC. You should talk to, you know, friends, you should be on groups like you have, you know, and, and just talk cause everybody hasn’t had the same experience and they have a lot of knowledge that is powerful and helpful.
Heather: You know, when we were talking in our pre-interview you had said something along the lines of, I think the best marriage is between a family med physician and an IB CLC. And that is the team that’s going to get the postpartum dyad where they need to be.
And I honestly could not agree with you more because I’m lucky in that I’m a CNM IBCLCs so I can prescribe, but a lot of IBCLCs can’t. So when you have a patient who clearly has mastitis or something, the IBCLC can maybe do a home visit, they can milk you. They can do hot compresses. They can like really be hands on, but it’s also really helpful to have a person that, you know, and trust who also trusts you as a team member or you can call and say, Hey, we need some antibiotics for this mastitis and they call it in and then you do the follow-up in the clinic. You know, it just makes so much sense to me. And I hope someday we can get to the point in this crazy system of ours where we can put groups together like that so a patient doesn’t have to try to build their own village with very little knowledge. It’s so piecemeal. And I think it’s really frustrating. I mean, it’s frustrating for us as providers to try to put it together for people. It’s like, you have to be your own care manager. So I totally get what you’re saying. And if I lived in Arizona, I would be like, ready to move into your clinic and be knocking on your door.
Dr. Barnett-Trapp: But I feel like even despite geography with tele-health now, there should be a way to make these connections. I don’t necessarily need to touch a patient to diagnose mastitis. Like it’s very history based. I could even see it on a video or by what the patient’s telling me. I feel like there should be some innovative way to connect the two, like, yes.
I think it’s important to have an IBCLC that you could actually see in person cause they need to watch the latch and they need to be able to see it from all angles and adjust. But you don’t necessarily need the physician there.
Heather: Dr. Barnett-Trapp, I think you’ve found your calling. You’re going to put it together.
We’ll be your IB CLC foot soldiers on the ground, and you can be our fearless leader and we will just go milk everyone in the United States and beyond.
Dr. Barnett-Trapp: Yeah, in a perfect world.
Heather: In a perfect world. Okay. So Dr. Barnett-Trapp, as a physician, who’s also a breastfeeding advocate, what do you want our podcast listeners to leave with today? What’s your word of wisdom?
Dr. Barnett-Trapp: I want them to not give up and to have hope and for them to know that whatever they’re going through, somebody has gone through before and there’s somebody out there that can help them.
Maureen: Oh, that’s such a cute note to leave on. I wish we could give you a hug too.
Heather: Well, thank you so much. And all the patients that have you in Arizona are so lucky. Thank you so much again. Thanks.
Dr. Barnett-Trapp: Thank you.
