Physicians vs. Breastfeeding

It has more than 1 year since I started volunteering as a breastfeeding peer counselor. A common complaint I have received from moms who were having breastfeeding problems is the lack of support from their pediatricians. Just recently, I received a complaint from a mother who gave birth at a hospital along Edsa sometime in June 2010. She shared that as soon as she gave birth, her husband was ordered to buy Enfalac A+ (the doctors specified the brand!), without any consultation or concern on their preferred feeding. The mom was also not instructed or advised on latching her baby. What's worse, it took 2 nights before her baby was roomed in. She had been constantly requesting that her baby be roomed in but was rebuffed by the nurses. One nurse even told her that she might regret her request to room in because she can't send her baby back to the nursery! Further, her ob-gyne and pediatricians did not offer any advice on direct breastfeeding and instead told her to use a breast pump. The pediatrician also issued an order directing them to feed the baby 1 oz. of Enfalac A+, every three hours!

I am really appalled by the ignorance and the audacity of her doctors to recommend formula AND specify a brand of milk! Mead Johnson must be paying their marketing people really well!

The experience of these parents are not uncommon in the Philippine setting. In fact, based on the numerous complaints and stories I've heard, this experience is a "norm" in our local birth setting. The parents are hell-bent on filing complaints against the physicians and hospitals. I've given her options of what steps she could take and sharing these steps here for other interested parents.

First, even before you go to the hospital, print a copy of this Department of Health Press Statement released on 21 May 2010, entitled "DOH Releases Guidelines on Physicians on Breastfeeding" Salient points of the guidelines would be:

Responsibilities of Physicians:

• Counsel pregnant women on the merits of breastfeeding starting at the first encounter, and reinforced with every subsequent visit;
• Prescribe non-human milk only when there are valid medical reasons and with information on the inherent hazards and risks of non-human milk;
• Strongly advocate for the adoption of essential newborn care, rooming-in and breastfeeding standards as mandated by law.

Prohibitions on Physicians:

• Accepting gifts or any sort of material or financial inducements from manufacturers of breastmilk substitutes and other products covered by the Milk Code;
• Accepting samples of non-human milk or similar products unless approved by the DOH, nor giving out samples or gifts of any sort coming from milk companies to pregnant women, mothers, and members of their families;
• Displaying, promoting or distributing non-human milk and other breastmilk substitutes in their offices or clinics.

Second, read up and be aware of the Essential Newborn Care Protocol which lists down 4 steps that need to be immediately undertaken to prevent newborn deaths which INCLUDES non-separation of newborn from the mother for early breastfeeding initiation. Check out this slideshow being used in the trainings and promotion for the ENC, prepared by Naima's pediatrician, Dr. Mianne Silvestre. Meanwhile, you can download Administrative Order No. 2009-0025, Adopting New Policies and Protocol on Essential Newborn Care HERE.

If you have been placed in a situation where your doctors refuse to listen and insist on giving formula and want to complain, then make sure you get a copy of their WRITTEN order, prescribing the artificial milk. Often, parents are berated by doctors when they insist on breastfeeding - and usually, parents don't argue (because as a culture, we, Filipinos are raised to believe that doctors are intelligent, always right, etc - and in fact, it is a common refrain/hope for parents to wish that their kids become doctors!!!). Once you have a copy of that written order, keep that for further action.

First step would be for the parents to write a complaint letter to the head of the hospital where you gave birth - include the particulars - name of the doctor, date, incident report AND a copy of the prescription. Don't forget to state your rights as provided in the ENC and DOH Protocol and Press Statement above.

Then, you can proceed to file a complaint against the doctors with the Philippine Medical Association. Call 929-6366 to check if the doctors are members of the PMA. If they are, write a notarized letter of complaint with supporting documents addressed to Dr. Nimfa Baria, Chairman, PMA Commission on Ethics and mail or personally deliver the letter to 2/F PMA Building, North Avenue, Quezon City. You can also file a complaint with the Professional Regulation Commission with the procedure outlined HERE. You can also file a complaint against the hospital with the Department of Health's Center for Health Development. You can download the flowchart of how to file a complaint HERE.  (*The links to CHD are broken.  You can access their Facebook page instead.) 

I would like to emphasize that filing a complaint means that you are serious and willing to follow through. It is not simply submitting the letter but you must be willing to testify during hearings if deemed necessary by the decision makers. I know that this will entail a lot of time and effort from the parents but steps like this will definitely make a huge impact in reforming the physician culture in the Philippines and hopefully, make it more breastfeeding friendly.