A Lactation Consultant’s Wisdom On Choosing the Right Doctor for Your Baby (regardless of where or how you plan on birthing)

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BUT FIRST:
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This article is based on my professional experience working with new parents in the communities which I lovingly serve (San Antonio, Texas USA and its surrounding rural areas). ​ It's possible that other parts of the US or other countries have different models of healthcare than the relationships represented in this article (pediatricians, midwives, general practice doctors and lactation consultants).

​The thoughts shared below are based on my experiences with the referral of mothers and babies to their healthcare professionals when clinical scenarios present to me during lactation consultations. In order to prevent bias toward any genre of providers, no physician, midwife or other lactation consultant was directly involved in the writing or review of this article,.
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​My hope is that the following thoughts are insightful to parents seeking to build life-long relationships with providers who support them and their babies.

​-Laura

​Choose a Doctor Who Supports Your Family's Health Goals
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One of the most important things that expectant parents can do is choose their baby's doctor well before their sweet baby arrives, even when planning on birthing with a midwife (more on this below). Many parents don't realize that they don't have to wait until their insurance company, hospital or midwife provides them with a list of pediatricians (a list not usually given to parents until after baby is born). In fact, by doing their homework about doctors prenatally, parents will have time to think about what matters most to them and be able to make an educated choice about the providers who will support them.

Discovering Your Family's Health Values

Your pregnancy (or your baby's gestation, if you are adopting) has given you a few months to think about your growing family's future health. If you haven't already talked to your partner or other support people about health topics that are important to your family, as soon as possible is the right time. Educating yourself about health topics and defining your health values will prove very important to choosing your baby's doctor.

What are health values?
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Your health values are those things that are important to you and your family when it comes to health and wellness, and these values are different for every family. For example, when it comes to babies some families will discuss vaccinations, circumcision, the family's diet, a mother's breastfeeding goals, and even the what-ifs of childhood (discipline/behavior or adolescent issues). Once you and your partner or support person have talked about what is most important, it will be easier to ask your friends and community for referrals to providers who will support you (much more about about how to do this in just a bit).

Valid points to ponder...

Choose your baby's providers based on their ability to support all of your family's health goals, not just one or two of your health goals.
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1. AVOID DISAPPOINTMENT: All too often parents are disappointed upon discovering suddenly that their pediatrician isn't as like-minded as they believed (and this disappointment can go both ways since providers also want patients who are like-minded and compliant), and usually that is because the pediatrician was chosen based on only one or a few shared health values, or was chosen last-minute. For example, the pediatrician who is unconditionally supportive of one health value may not support or be knowledgable about another one. Getting to know your baby's doctor prenatally gives both you and your baby's doctor the opportunity to see if you are a good fit for each other. LAURA'S NOTE: Doctors care just as much as parents do about whether or not a family is a fit with their practice values. It's important to know that doctors are able to ask that parents with differing views on health values seek care from other providers if a family's health values request that a doctor practice outside of their practice protocols. This doesn’t mean they’re bad doctors, it just means they aren’t a fit with your family, and that’s ok because and others will be.
2. TALK ABOUT IT: Know also that just because a doctor may not share your exact health values doesn't mean that they may not be a good overall fit with your family. While it's important to choose a doctor who is easy to talk to and can make you feel like a partner in your baby's care, it’s also important that you as a brand new parent are able to trust your doctors advice during moments of overwhelment with a new baby.
3. THINK AHEAD: It's important to choose a provider who you feel your growing baby/child can eventually trust and will feel comfortable being examined by (this includes being touched by and talked to) over the course of their childhood and adolescence. Choosing a provider who may have strong future-compatibility and connection with your children and your family may outweigh slight incompatibilites with health-values during their newborn stage. Laura’s Note: Learning consent and body-autonomy starts at birth, and choosing providers who ask you and your child for consent to touch, and are able to speak directly to your child once they’re old enough to talk is a very important point to ponder.

Choosing a Doctor Who Supports Your Breastfeeding Goals

Ideally, because breastfeeding is still relatively new to our chapter in humanity, in addition to the health topics discussed above, it is wise that breastfeeding families choose a physician (or midwife for care during baby's first weeks) who has taken the time to update their practice with contemporary and evidence-based breastfeeding management skills. If your doctor or midwife is not also an International Board Certified Lactation Consultant (most are not, and that's ok) it is important that he or she have access to or knowledge about resources that offer prompt care from International Board Certified Lactation Consultants (IBCLCs) as a supplement to their medical care and guidance. IBCLCs are breastfeeding experts who help troubleshoot and improve breastfeeding and will provide information about your baby's feeds which is helpful to doctors.

Remember, you doctor or midwife doesn't have to be a breastfeeding expert, but knowing who to refer you to when a breastfeeding expert is needed is an important aspect to consider when choosing a provider for your baby.
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Midwifery Care
Does this advice apply to me since I plan on using a midwife as my newborn's healthcare provider?

​Yes! It absolutely applies!

In the same way that parents who deliver with a midwife prepare a Plan B for birth (in case of a hospital transfer) there is a lot of wisdom in asking your midwife for referrals in selecting a doctor just in case your baby needs one during the early days. Midwives can be an excellent referral source for families seeking like-minded physicians. In fact, there are two points when families who see midwives will need to have their baby's care transferred to a doctor.

These two points during midwifery care are:

• When a baby reaches their age limit to be cared for by a midwife (in Texas, this is 6 weeks of age)
• When a baby's health goes outside of normal and healthy

Remember that selecting a doctor for your baby "just in case" won't mean that your baby won't continue seeing your midwife for their healthy and normal newborn care. It simply means that you will be prepared when your midwife is ready to transfer your baby's healthcare to a doctor. Also, rest assured that just because your baby has to see a doctor during your early weeks for medical reasons, doesn’t mean you can’t resume care with your midwife until baby is old enough to graduate out of their care.

Some important things to think about:

• Emergency Rooms: Not being registered with a doctor's practice can cause parents to be routed to a hospital emergency room for their baby's routine and non-emergency medical care--although in cases of emergencies babies should always be taken to emergency rooms for evaluation and treatment. Being registered with a doctor (yes, this could involve taking baby in at least once to the doctor's office so that there is an established patient-provider relationship) would allow parents to be able to call their doctor in cases or non-emergencies, instead of being seen at an emergency room for non-emergencies.​ Most doctors who have not yet seen baby at least once will not offer medical advice over the phone, and will refer families to emergency rooms. ​
• Other Providers: Other healthcare providers often require families to be on-record with a physician in case clinical situations arise during their care for which a report or a referral is necessary. For example, speech pathologists and lactation consultants are examples of healthcare professionals who work with babies who may require that a baby have a doctor.

Finally, here are some TIPS that can help you pick the right doctor for your baby:

• ASK AROUND: One of the best ways to choose a provider who is supportive of your wellness and breastfeeding goals is to ask friends, family members and peers who they have been supported by.
• MAKE A "SHORT LIST": Now that you have asked around and made a list of a handful of providers that may be a good fit for your family, narrow the list down to the ones you are most curious about. Calling the office to schedule a prenatal consult can give you an idea of how welcoming or helpful their office staff is, which is an important point to ponder.
• ​VISIT THEM: Many providers are very willing to meet with expectant parents (this is often free or covered by health insurance or public health coverage). These meetings serve as a "Question & Answer" session for both parents and providers.
• ASK THE RIGHT QUESTIONS: In addition to making a list of all important health topics and values that you want to discuss with your baby's doctor, make a list of what matters most to you and your partner with regard to breastfeeding. ​

Questions to Ask Your Baby's Doctor

Below are are some questions (mostly about breastfeeding, but can be insightful for all parents) to ask your baby's doctor. Having attended a breastfeeding class during your pregnancy can help your understanding of contemporary breastfeeding practices, something which will be helpful when asking your future pediatrician about their breastfeeding supportiveness. If you haven’t yet taken a breastfeeding class, now would also be a good time to register for one.

Questions about breastfeeding to ask your baby's doctor:

Remember, the only "right" answers to these questions are the answers that most closely match your family's health values.
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• Can you tell me about your breastfeeding-supportiveness?
• How long do you support breastfeeding for?
• In what circumstance would you recommend that I stop breastfeeding my baby?
• Do you have a board-certified lactation consultant who you regularly refer to when families need expert breastfeeding support?​​
• At what age do you feel babies should begin eating solids?
• LAURA'S NOTE: I have met exceptional general practioners andfamily medicine doctors, HOWEVER, in San Antonio, where I live, these providers don't usually see newborns or babies (although a few do see them regularly). Because of this, it's always a good idea to ask how many babies the general practice or family practice provider sees regularly. This is an important question to ask, especially in urban areas where general practitioners and family medicine doctors see mostly older children and adults. If a provider doesn’t see newborns and older babies regularly, I would personally find one that does.

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And, here are some additional points to ponder when choosing a provider:
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• Is the doctor's office close to your home, or your child's caregiver?
• Does your baby's doctor have flexible hours?
• What hospital does your baby's doctor visit (or admit baby's/children to when needed)?
  • Not all doctors see their own patients during hospital admissions. Many private doctors use the hospitals' doctors (called "hospitalists") to assess their patients and send them reports.
• Is it important for you to be seen by the same provider at every visit? Many practices have multiple providers which can be attractive to some parents, yet overwhelm others.
• What services does your provider offer (do they do urgent care/same-day apps., do they have a lab on-site, etc)?

To conclude...

Remember that you will be seeing your baby's doctor during your baby's first days, first months, throughout their first year--and of course, every single time you have a medical question or concern about your baby (which will be frequently, trust me). Needless to say, your baby's doctor will be a very big part of your baby's life (and of yours) so taking the time to choose them wisely will be one of the most important choices you will make for your baby's future health!

If you found this advice helpful, make sure to share it with your friends! 💜
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Helpful Links:

• La Leche League article about working with your baby's doctor
• Choosing Your A-Team by Best for Babes
• The American Academy of Pediatrics link on choosing your pediatrician

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