In this follow up piece to our March 21st article, Improving Doctors’ Breastfeeding Literacy, Holly Ellis Spiegel continues her conversation with Susan Rothenberg, MD, IBCLC about breastfeeding and how to talk to our care providers about our desire and commitment to breastfeeding our babies.

“If a multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers’ needs, the very announcement of their find would send their shares rocketing to the top of the stock market. The scientists who developed the product would win prizes and the wealth and influence of everyone involved would increase dramatically. Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence…” —Gabrielle Palmer, in The Politics of Breastfeeding, London: Pandora Press, 1988, page 1.

Two weeks ago, we published an interview with OB/GYN Dr. Susan Rothenberg, who is also an internationally board certified lactation consultant (IBCLC). In it, Dr. Rothenberg acknowledged that most doctors have – at best – a superficial breastfeeding education, and listed many of the ways in which the medical community (including OB/GYNs and pediatricians) can improve their breastfeeding knowledge base.

For pregnant women or new moms who are planning to breastfeed and are not lucky enough to have a doctor who is also a lactation consultant, speaking to doctors can be both frustrating and confusing. This often leads to more women giving up before they meet their own breastfeeding goals, let alone the recommendations from the American Academy of Pediatrics or the World Health Organization. In order to prepare themselves for these challenges, Dr. Rothenberg advises:

Take that Breastfeeding Class: A thorough class with a certified IBCLC instructor gives you the tools and fortitude you’ll need for those stressful early weeks. Taking the class before you have a baby means you’ll have a (relatively) uncluttered mind that is ready to receive information about any of the challenges you might face: reading your baby’s cues, cluster feeds, etc. “When you’ve just had a baby, you’re exhausted and overwhelmed and terrified and thinking ‘oh my god, how am I going to get this baby to eat?’” says Dr. Rothenberg. “You tend to make bad choices if you haven’t been taught that you should expect to be in that place.”

The Best Defense…: Having this information will also help you to respond with confidence to those who offer less than helpful advice. “Women often find themselves battling family members or friends who don’t understand why they’re so determined to breastfeed,” says Dr. Rothenberg, “people poisoning the well and making it that much more challenging. It’s important to realize that new moms are emotionally and physically very vulnerable. We need to do everything we can to support them and stop interfering with the process.”

Build Your Dream Team: Find out early in the process how your doctors (both your OB and your child’s pediatrician) feel about breastfeeding. Ask any of the specific questions you have. “If your doctor is giving you vague answers like, ‘oh the nurses are going to deal with that,’ or not really showing that they have an interest or a knowledge base, that might mean that you need to look elsewhere for care or rally your own troops and generate your own resources,” says Dr. Rothenberg.

One of those resources you should reach out to as soon as you suspect you need another hand in the breastfeeding department is a lactation consultant. Dr. Rothenberg has some great tips for finding the right one:

Get Those Digits Early: Ask friends and or doctors for a couple of consultant recommendations before you give birth. You probably won’t be able to meet with them in advance, but at least find out whether the consultant will be able to travel to your home, and on what notice.

Letters After the Name Matter: Make sure they have a certification from the International Board of Lactation Consultant Examiners (look for “IBCLC” after their name, or search USLCA’s directory). “There are lots of different so-called certifications for lactation consultants that don’t require nearly as many hours of training or as much knowledge,” says Dr. Rothenberg.

Get a Sense of Their Availability: “Ask, ‘if I run into a problem and I call you, will I be able to see you in a day or two? A week or two? How busy is your schedule?’” Dr. Rothenberg recommends. A lactation consultant’s visit usually takes anywhere from one to 3 hours, depending on your baby’s feeding schedule. The LC will sit with you, talk through your breastfeeding goals and challenges, and also watch at least one feeding. You should also make sure you find a consultant who is either able to make a home visit or who works very nearby to you so that you can easily reach her office. She should also have a highly precise scale (to the 10th of an ounce) so that she can measure your baby’s weight before and after a feeding to determine how much he is eating.

When asked whether there was anything else Dr. Rothenberg most wanted women to know about the early days of breastfeeding, she emphasized a myth that needed debunking. “Breastfeeding should not hurt. Pain is a sign that something is wrong. Trust your instincts: if you’re in pain and someone tells you it’s fine, you need to talk to someone else. If someone is telling you in the early days that your nipples need to toughen up, that’s not true. Nipples don’t toughen up; your baby just learns to latch better over time.”

Another possible cause of nipple pain could be a tongue-tie. “I see lots of patients in pain for a long time because no one has realized that their baby is tongue-tied,” Dr. Rothenberg says. “About 3-4% of babies are tongue-tied and about 40% of babies with a breastfeeding issue have some degree of tongue tie that’s impacting their ability to latch. They have a procedure and the tie is released and all of a sudden, breastfeeding becomes much easier, the baby starts gaining weight and it doesn’t hurt any more.”

If you think your baby has a tongue-tie, seek out advice sooner than later, getting a second opinion, if needed. Dr. Rothenberg warns, “a lot of pediatricians are told it’s [tongue-tie] not a real thing, so it’s often ignored and under diagnosed. When in doubt, if there’s clearly a breastfeeding issue and the mom is in pain and there’s any detectable tongue-tie, I would err on the side of correcting it because it’s such an easy, low-risk thing to do and it almost always helps to some degree.”

In conclusion, Dr. Rothenberg encourages all breastfeeding mothers and pregnant women planning to breastfeed to have heart. “I spend a lot of time telling my patients: Trust your baby, trust your body,” she says. “I think it’s something you can’t hear often enough. Just having that knowledge that your baby really can do this is incredibly empowering and can have a huge impact on what happens in the coming days and weeks and months.”

Holly Ellis Spiegel is a writer and freelance film and video producer based in Brooklyn. She’s produced four feature films including the Sundance-selected Prairie Love and countless videos for parents and families on CafeMom and other outlets. She is also a new mom. See her work at

Susan D. Rothenberg, MD, IBCLC, FACOG is the Associate Director of Obstetrics for the Department of Obstetrics and Gynecology at Mount Sinai Downtown in New York City, where she has been a faculty member since 2000. A breastfeeding advocate for many years, she lectures on breastfeeding support at the local, regional, and national level. Dr. Rothenberg is a member of the American College of Obstetricians and Gynecologists Breastfeeding Expert Work Group, and serves on the board of directors of the Academy of Breastfeeding Medicine.