(I should probably say that I was in two minds about even posting last week's piece. I have enormous respect for doctors, the standard of their training and the work they do in tough times for the NHS. On the other hand, I think that when we're considering an issue as thorny as how to raise breastfeeding rates in our society, we have to look critically at everything that might be having an impact and wonder about how changes can be made. Sometimes we'll be barking up the wrong tree. Sometimes new insights will come.)
One point that I don't think I made well enough last week was actually about breastfeeding supporters (I include myself) and how we respond to articles in the media or comments by individuals. While I think it's right that misinformation be challenged, I can't help feeling that there's an irony in the fact that we can Tweet and blog up a storm - in what is sometimes quite an aggressive way, if only due to the sheer volume of complaints - in response to a media doctor's quote in a magazine, but have no meaningful way of addressing the same misinformation when it's dished out to women one-to-one by a GP or other health professional.
Some of the comments by doctors in response to my post took me to task - rightly - for calling for more training for GPs when their time and budgets are so sorely stretched, and when every other 'single-issue' group thinks the same about their area of interest. It was pointed out to me that if a GP must do 50 hours of CPD each year, and the breastfeeding training takes half an hour, then that means that breastfeeding must be in the top 100 things the GP considers that year (and that's assuming they all take half an hour; some will obviously take longer. Some topics GPs are contractually obliged to cover). When you start to consider the list of things that GPs need to be abreast of (!) you can see why breastfeeding doesn't automatically push itself to the top of the list, particularly in areas with low breastfeeding rates where GPs see very few breastfeeding women, or in areas where there are reasonable breastfeeding support services away from the GP.
Something that came out of this discussion for me was the idea that there is work to be done in increasing awareness among GPs, possibly via representation to the Royal College of General Practitioners, of the public health aspect of increasing breastfeeding rates and the potential beneficial impact on GPs - the cost implications of fewer appointments for ear infection, gastroenteritis and lower respiratory tract infection are outlined in this UNICEF report. I would love to see a case study showing this in practice.
Another point that was raised, and which I found fascinating, was the degree to which GP services vary across the country. I mentioned some of our local frustration with tongue-tie referrals via GP - and discovered that in North London tongue-tie referrals can be made by a midwife or IBCLC at a drop-in group, rather than by the GP, and that in Bristol, although four people across the city can snip tongue-ties, one is off sick and thus waiting times are around four weeks (a long time in the context of a troubled breastfeeding relationship). In some GP practices in the south-east parents can self-refer to an in-house GP for tongue-tie cutting, although the long-term availability of that service can't be guaranteed. Is there anything that can be done about this variability? It was suggested to me that breastfeeding supporters engage with CCG pharmacists and educationalists to discuss issues of prescribing for lactating mothers and best practice in treating breastfeeding women and infants, and I wonder if there's an opportunity - somehow, for someone - to do that work.
Finally, some really interesting ideas surfaced from the discussion. These included finding ways to have more IBCLCs working in or alongside the NHS, perhaps in larger GP practices or rotating between several practices, and the idea of increasing the numbers of peer supporters by offering them a £200 voucher incentive (as opposed to the mothers themselves). I also loved this link about innovative ways in which breastfeeding training is being delivered to busy doctors and nurses in the US.
In the end, it's a problem with no easy solution. But another common theme of the discussion was frustration with the way things are - on both sides. Perhaps we (and by we I mean anyone with an interest in breastfeeding) can start by broaching the subject with our own GP practices - we might at least open a dialogue that could be beneficial. Some great resources for doctors are Wendy Jones's book Breastfeeding and Medication and Dr Thomas Hale's Medications and Mother's Milk. The Breastfeeding Network's factsheets are another excellent source of information for GPs.
Thanks to all those who contributed to the discussions of the original post.