QUESTION: Due to healthcare plan limitations I had little choice in choosing a provider. I felt lucky to get a female OB/GYN. Alas, this person has no sympathy or understanding of breastfeeding. At my last check up she refused to examine my breasts and said something about avoiding "milk squirting out". She also put off scheduling my baseline mammogram (I'm 40 years old), again for fear of "milk sqirting out".

I feel I'm long past the "squirting" phase that seems to bother her so much. Since I'm into breastfeeding for the long haul (I breastfed my daughter until she was five!) I wonder about putting off my baseline mammogram for that long. Should I pursue scheduling one?

Dear Claudia,

Just a couple weeks ago, a brand new mother told me how she had gone to her OB for her 6-week postpartum check-up. The doctor asked if she was breastfeeding, to which she proudly responded, "yes!" Thinking that he was about to ask her how things were going, she was so upset when instead he turned to the nurse and told her to make a note on the chart for the woman to only undress from her waist down at any office visits until she was no longer breastfeeding. Same reason--"all that milk--it's so messy," he told her. He never even asked her how it was going or anything else about breastfeeding. Obviously because he knew nothing at all about it! (She actually was having some problems, but she realized right away that he was not the one to ask about them!)

She told me he made it seem like something "dirty" and "disgusting." It's absolutely mind-boggling to me that an OB could feel and act this way. But it's equally mind-boggling that our neonatologists (at least in this town) don't encourage breastfeeding! Or that emergency room doctors continue to bind women's breasts that have breast infections, putting them at risk for a breast abscess. The ignorance among health professionals about breastfeeding is abundant! (It occurs to me, also, that the legal liability is quite great if an OB doctor is refusing to examine a woman's breasts! What if she DID end up with breast cancer?) I'm afraid I can't really advise you on this because I am not a physician. I can, however, help shed some light on the situation. I know it is frustrating for you not to be able to search for a breastfeeding-friendly OB.

By the way, since your own doctor won't examine your breasts, it makes it even more important for you to do this on a monthly basis. Have you thought about finding a family physician? If you could find a knowledgeable person, he/she would be a good one to ask about the mammograms. Do you have any family history of breast cancer or any other risk factors? One of the problems with having a mammogram made while breastfeeding is that the radiologist who reads them needs to be experienced in reading mammograms of breastfeeding women--and many of them aren't. So if you decide to get one made, you should inquire about this beforehand.

The milk and the density of the extra tissue during lactation make mammograms difficult to read if someone is not used to looking at this. If your baby could go with you and nurse just prior to the test, it would make it easier to read. Is your baby still nursing often? If you have an abundant milk supply, it is very different from a woman whose baby is only nursing several time a day. Hopefully this information will help you to make a more informed decision--and remember that breastfeeding is associated with a reduced risk of breast cancer!

Cher Sealy RN, BSN, IBCLC, LLLL

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