The United States has the lowest breastfeeding rates of most developed countries. And this is a fault of the systemic issues at play. I invited Amanda Gorman, founder and chief clinical officer at Nest Collaborative and Pediatric NP, to discuss:

• Why our rates of breastfeeding are so low in the U.S.
• How the lack of paid family leave impacts these rates
• How we can advocate for breastfeeding families

 

Amanda Gorman
Find out more about Amanda and Nest Collaborative at nestcollaborative.com , listen to Amanda’s Podcast Breastfeeding unplugged  or connect on Instagram @nestcollaborative 

00;00;01;01 – 00;00;34;15

Amanda Gorman

We have the highest initiation rates in decades, with about 86% of families initiating breastfeeding, meaning right after delivery. Baby’s first intake is breast milk. That is huge because that’s across all populations. Uninsured. Insured. Out of pocket. Private pay. Rural. Urban. That’s huge. Unfortunately, two out of three of those families are not even able to make it to what’s minimally recommended, which is to explicitly breastfeed for six months.

 

00;00;34;17 – 00;00;40;05

Amanda Gorman

And you know, as I say it, I think today’s generation population got really six months.

 

00;00;40;08 – 00;01;01;15

Dr. Mona

Welcome to the PedsDocTalk podcast. This show’s success is largely due to you and the way you share the podcast with others and leave reviews. So thank you so much for joining us today. I am so grateful to have the most amazing guest to guide you in your parenting journey. Topics about all things parenting, newborn and child health, child development, and parental health.

 

00;01;01;22 – 00;01;20;12

Dr. Mona

Today’s guest is Amanda Gorman. She’s the founder and chief clinical officer at Nest Collaborative and a pediatric nurse practitioner. And we’re talking about why breastfeeding rates are so low in the United States. So thank you so much for joining me today, Amanda.

 

00;01;20;15 – 00;01;23;29

Amanda Gorman

Thank you so much for having me. I’m excited to be here. Yes.

 

00;01;23;29 – 00;01;42;28

Dr. Mona

Well, I’m so happy that we’re having this conversation and that you are joining me to talk about this, because compared to a lot of other developed countries and just countries in general, United States has very low breastfeeding rates and there’s a lot of systemic issues at play here. But I cannot wait to have a deeper dive with you on why this is.

 

00;01;43;02 – 00;01;46;15

Dr. Mona

But before we get into that, tell us more about yourself.

 

00;01;46;18 – 00;02;05;02

Amanda Gorman

Yeah. Thank you so much. So like you mentioned, I am the founder and chief Clinical officer at Nest Collaborative. And collaborative is an online platform where we offer not only virtual lactation, telehealth support, but we offer a preventive model of care, which hopefully will make a little more sense as to why by the time we get to the end of the conversation.

 

00;02;05;02 – 00;02;19;19

Amanda Gorman

But we do offer these services every day, seven days a week. We have a wonderful team of about 75 board certified consultants, and we do this in a bit of a different way, hopefully to address what we’re going to talk about, which are low extended rates of breastfeeding in the US.

 

00;02;19;22 – 00;02;40;02

Dr. Mona

Amazing. And at the end we will be linking resources and obviously more about the Nest Collaborative as well. So we’ll have that for you as well for all of our listeners. But where do we even begin? So first, why are rates so low, but also percentages of what we see in the United States in terms of breastfeeding rates, maybe initiation and also at six months to a year or whatever?

 

00;02;40;02 – 00;02;40;28

Dr. Mona

We have there.

 

00;02;41;01 – 00;03;03;05

Amanda Gorman

Yeah. So I will start back with kind of where and how I discovered this problem. And that was in my own primary care practice. I did not independent. I worked in a large public hospital out in San Francisco doing pediatric primary care, and I staffed a clinic where we specifically saw newborns who had been discharged early. So we would see them back on day of like 2 or 3 to monitor their weight.

 

00;03;03;05 – 00;03;25;29

Amanda Gorman

And their bilirubin, which may be familiar with babies, are at risk for John is actually breastfeeding is preventable. Jaundice. So we would see them back, check those data points. I’d hand newborn baby back to mom, and every mom would then look at me with engorged breasts and say, can you help me feed the baby? And I would say, no, I have absolutely no idea how to help you feed this baby.

 

00;03;25;29 – 00;03;46;12

Amanda Gorman

And I thought to myself, why don’t I know this vital piece of information for human development? If I am a pediatric provider and quickly realize that we in pediatrics are not trained in lactation support, OBS are not trained in lactation support, and these families had very little resources to get them through this really what is typically a really tricky time period.

 

00;03;46;12 – 00;04;03;11

Amanda Gorman

And they realized, wow, we’re doing this promotion, this healthcare promotion, promoting breastfeeding, and we don’t have the preventive resources to help them through it. I at that point hadn’t had kids, so I didn’t really know the problem until about two years later. I gave birth out there at Kaiser San Francisco. Great resource, health system I was in.

 

00;04;03;11 – 00;04;37;08

Amanda Gorman

Health care is a huge breastfeeding valley city. I had the health insurance. I paid the cash out of pocket to get the lactation consultant to come. And still it was a nightmare. It’s just more difficult than I ever anticipated. Frankly, the entire birthing process and experience for me, I was a bit traumatized more that I was actually a trained trauma nurse and had no idea what I was in for, so I was more or less a woman scorned when I started in this collaborative, because here I had been taught, you know, I went to nursing school at Columbia, at UCSF, and we we were taught how important the medical home is and that that

 

00;04;37;08 – 00;04;57;26

Amanda Gorman

the families have a root. And if they’re seeing ancillary providers, whether that’s a neurologist or a behavioral health or lactation consultant, they all need to get fed and be integrated together. And so the collaborative piece in this collaborative is really an attempt to address that, because our families, we do see the lactation consultant who would guide us and then that information never circle back to the pediatrician.

 

00;04;57;26 – 00;05;26;06

Amanda Gorman

So number one, families don’t have consistent advocacy and consistent messaging because like I said, pediatric providers mostly aren’t trained and they’re trained to get that, baby said and growing. And it’s that is combination feeding or formula feeding. And that’s what they’re going to do. They don’t want this baby readmitted for jaundice. They don’t want to lose five. So it made sense to me because we had the lactation specialist kind of floating outside of the solar system.

 

00;05;26;08 – 00;05;48;06

Amanda Gorman

I realized also in that first hand experience, that affordability was a big issue. I’ve always used, or worked in public health systems, huge Medicaid populations. So how are we expecting them to pay these two $300 out of pocket to get these lactation specialists in? And that’s not going to happen. Frankly, I myself hoped the problems went away because I wasn’t going to do this routinely every week.

 

00;05;48;07 – 00;06;06;18

Amanda Gorman

And then the biggest problem is we had a provider shortage. We only have about 18,000 more or less board certified lactation consultant in the US, many of whom are working in the hospital system and they’re not available in the community. And what we’re doing is offering these families the third Thursday night meeting at the local hospital once a month.

 

00;06;06;19 – 00;06;24;18

Amanda Gorman

What we do know is babies don’t work on banking hours. All right. So we need a feeding problem. And moms in pain, babies hungry. We can’t wait weeks and we can’t even wait days. And that’s really what we’re looking at. If we find someone in the community who’s even available, we need help, typically within 24 hours or less.

 

00;06;24;21 – 00;06;51;18

Amanda Gorman

So we had an access issue, we had an affordability issue. We had, barriers related to poor integration into the medical homes and that’s kind of where I started, was how do we create something that adequately addresses those barriers, but is also following what the evidence says actually work. So how do we implement interventions that are proven to extend the duration of breastfeeding along with addressing these barriers.

 

00;06;51;18 – 00;07;11;09

Amanda Gorman

So big hill to climb. But that’s where we started. And I’m thrilled that that’s where we got telehealth just happened to be a vehicle that we experimented with to address the provider shortage. And we didn’t know if this was really going to work. We didn’t know if you could adequately and effectively help families virtually. It was a very new concept.

 

00;07;11;09 – 00;07;34;26

Amanda Gorman

In 2017, no one was looking for a virtual telehealth, right? So or rather virtual breastfeeding support. So how we’re families going to find us? Frankly, the medical homes thought we were a little bonkers because, you know, naturally, pediatric providers and OB said this needs to be hands off. Yeah, we didn’t know that option. Let’s try it. And lo and behold, we found very quickly it works.

 

00;07;34;28 – 00;07;51;05

Dr. Mona

Well also in the pandemic, we’ve realized that a lot of things had to turn to virtual. So you had started this obviously before the pandemic, but in the pandemic, with the lack of being able, you know, especially in those early months, being able to go inside homes or have that hands on, you had to pivot to, more virtual.

 

00;07;51;10 – 00;07;52;12

Dr. Mona

But I had asked also.

 

00;07;52;12 – 00;07;53;06

Amanda Gorman

About the rates.

 

00;07;53;06 – 00;07;56;10

Dr. Mona

What rates are we seeing, for breastfeeding right now in the United.

 

00;07;56;10 – 00;08;31;29

Amanda Gorman

States? Yeah. So the irony is we have the highest initiation rates in decades. We got 86% of families initiating breastfeeding, weaning right after delivery. Baby’s first intake is breast milk. That is huge because that’s across all populations uninsured, insured out of pocket, private pay, rural, urban. That’s huge. Unfortunately, two out of three of those families are not even able to make it to what’s minimally recommended, which is to exclusively breastfeed for six months.

 

00;08;32;01 – 00;08;54;14

Amanda Gorman

And you know, as I say it, I think today’s generation population cost God really six months because that’s how hard it’s become. The status quo has made it impossible to get to this point. But point is so important because that’s where we actually see true impacts on health, not only babies health, but moms health. And we’re talking short term impacts and long term impacts.

 

00;08;54;14 – 00;09;19;25

Amanda Gorman

So moms are less likely to stay in the hospital as long. If they’re breastfeeding. They’re less likely to return to the hospital for complications like maternal hemorrhage, babies less likely to return for jaundice, or failure to thrive. Baby will have lower infection rates. Ear infections, cold viruses during that time period, lower ear infections, which turns into lower rates of speech therapy, which turns into lower rates of ear tubes.

 

00;09;19;27 – 00;09;43;09

Amanda Gorman

And then not even to mention the longer term diabetes, obesity, cardiovascular disease, breast cancers. We need these families to get there as a form of preventive care. It’s no different than an apple a day, but unfortunate Nately we’ve got major barriers affordability. Traditionally, this has been extremely difficult to get insurance companies to pay for. That’s something this collaborative has tackled greatly.

 

00;09;43;09 – 00;10;05;01

Amanda Gorman

And one of the things I’m most proud of is that we work very hard to get these services covered, which they should be, and legally, they’re mandated to be the access issue. You can’t just call and get a lactation consultant. So when moms are in pain, when baby is hungry, we’re going to terminate breastfeeding. It’s not viable for most of these families because they have no other options.

 

00;10;05;03 – 00;10;40;07

Amanda Gorman

We then got the whole employer issue. Moms are going back to work. Yeah, really poor family leave. The worst family leave globally here. And so moms, unfortunately they don’t feel they’re going to get the adequate support at work. They’re scared about doing the whole transport, pumping out reading. Kids are going to daycare where they’re less likely to be adequately shared with things like pace bottle feeding, you know, so you have techniques and styles that are forcing that over feeding, but intake to be heightened, which means our production for pumping needs to be high.

 

00;10;40;07 – 00;11;00;14

Amanda Gorman

It’s very complicated. In the end, there’s very little support. So that’s an early termination risk for families. And then you’ve got just kind of this sociological scene. We are having babies later and we have smaller families, which means I was not raised with moms and aunts and uncles who breastfed. I didn’t see it as a kid. I was 79 years old kid.

 

00;11;00;17 – 00;11;23;20

Amanda Gorman

I didn’t live near aunts, uncles and cousins. I didn’t watch it being done. And when I had my baby, I lived in San Francisco. My mom was in new Jersey. She wasn’t there. So there’s just the sociological factors, you know, it’s not easy. And then when we go to the people, we need to go to our pediatrician. They go, well, here, list, you can call them, but it’s not available from the providers who we rely on for our care.

 

00;11;23;23 – 00;11;40;25

Dr. Mona

Yeah, the access issue is a huge one, and I love that you’re mentioning that you know, I am an I bcl c. So I got this after I had my son. I had a horrible experience with an I bcl c in my hospital that I was like, I need to go into this and learn more and be more informed to be able to help my patients.

 

00;11;40;28 – 00;12;00;15

Dr. Mona

That being said, even though I am an IBC, you’ll see my practice doesn’t allow me the time to have a lactation session. So I am able to help the families in the office, but I can’t have a 40 minute hour breastfeeding conversation because we have to go over we. We have to go over safety. We have to go other things.

 

00;12;00;19 – 00;12;26;00

Dr. Mona

And so it is a systemic issue from our end, too. I mean, pediatricians should be educated. And I believe that every pediatrician and every OB, but definitely every pediatrician should have an IB, TLC training associated with it, or maybe even a CLC or something in lactation education so that we can educate more informed choices on breast bottle. Because I am a supporter of both.

 

00;12;26;00 – 00;12;49;16

Dr. Mona

I love breastfeeding education, but I also know that some families that 14% that didn’t want to initiate breastfeeding, there are families who don’t want to or it doesn’t work out for them. And so I love to have that. But we can’t do that as practitioners unless we have the real true knowhow and licensing to do so. I have two follow up questions you mentioned about affordability.

 

00;12;49;21 – 00;13;09;23

Dr. Mona

I think there is a misconception about affordability with people say, oh, breastfeeding is free, but you just brought up perfectly that it isn’t technically free. Obviously, there’s hours put into it, which a lot of families that I take care of, it’s lower socioeconomic status. These moms are going back to work and have multiple children. They don’t have the time sometimes to breastfeed.

 

00;13;09;23 – 00;13;30;14

Dr. Mona

That bottle feeding is, from a time perspective, better for those families. But then also in terms of affordability pumping, I mean, I’m starting to buy everything for my second baby. I’m like looking at the price of pumping bags like the milk storage bags, but also the pump. And if you don’t have health insurance, you don’t get that covered.

 

00;13;30;21 – 00;13;40;14

Dr. Mona

Is that what you’re saying? Also with that affordability is that that obviously access to lactation consultant, but also all the different pieces that make breastfeeding happen?

 

00;13;40;17 – 00;14;01;01

Amanda Gorman

Yeah, absolutely. Those costs are pretty. Penny. Yeah. Should be covered like diabetic syringes. Yes. And we’re getting there. But you know unfortunately we have generations who who have missed out and will continue to miss out until we do get there. And I think you bring up a great point. And you know, at nest where we are not best is best.

 

00;14;01;02 – 00;14;28;26

Amanda Gorman

We’re not fed as best. You know, our job is to provide the evidence based information to families, allow them to make their informed choices, and then our job is to help them get there. And if that’s I’m winning today because I’ve decided to win, our job is to help them win safely. You know, with the conversation around breast and formula, it’s such a polarized conversation, and especially as we saw the formula shortage comp last year, and we were approached quite a bit to comment on breast versus formula.

 

00;14;28;26 – 00;15;07;08

Amanda Gorman

And I said, I’m not touching that with a ten foot pole. That’s not what we are here to do. We’re not here to act as converts. You know, we have a very highly, highly educated generation in terms of their health care. You know, that is not our job, but even yourself. You know, I think the AARP, the American Academy of Pediatrics put out as fall little survey or study that they had done on, you know, pediatricians who actually said, you know, we don’t actually advocate as much as subconsciously, we don’t advocate as much because of our own experience coming back to work and trying to navigate pumping that we haven’t been as successful.

 

00;15;07;08 – 00;15;23;17

Amanda Gorman

And we find that that implicit kind of bias goes into our practice. So there are so many barriers that really, you know, the people who are out there saying breast is free and risk versus formula, I don’t think really understand that the choice isn’t really that easy.

 

00;15;23;19 – 00;15;26;01

Dr. Mona

And the choice isn’t always in the person.

 

00;15;26;01 – 00;15;26;14

Amanda Gorman

Like I think.

 

00;15;26;14 – 00;15;55;04

Dr. Mona

When you look at a woman who wants to breastfeed, a lot of times the mentality could be and I I’ve heard this, I’ve heard this from women in my office that, oh, well, you took the easy way out. You didn’t try hard enough. And it’s not that when there’s a systemic issue and I the second question I or comment that I had was about that maternity leave comment that you made, that I see this a lot, that I have a lot of women coming into my office, a lot of my friends in America who have to go back at three months postpartum.

 

00;15;55;04 – 00;16;11;23

Dr. Mona

Right? You don’t get a full maternity leave, you get three months. And oh my gosh, it’s not enough time. Okay? Like every country should have at least six months. Six months minimum because that is important for the first six months of the baby’s life, but also for that new mom or new dad or new caregiver for bonding all of that.

 

00;16;11;23 – 00;16;35;06

Dr. Mona

But breastfeeding, I mean, some women, it takes them 3 to 4 months to even get in the groove. And then now you’re saying, okay, bye, I’m going to go do pumping taking of supply. I mean, I see this all the time and the stress adds to that, right? The stress, like you mentioned, of having to find a room, many offices, many places still do not have the adequate resources for a pumping space.

 

00;16;35;06 – 00;16;59;08

Dr. Mona

I think the Pump Act just went into play that, you know, mandates that, hey, employers have to have these things, but it’s going to take time for employers to actually catch up and say, you know what? We support this. There is even in pediatrics, I’m going to be honest, I work at a pediatric practice. When I talk to my old employer about wanting to breastfeed and pump, there was a conversation of, well, I you still have to make sure that you see your patients.

 

00;16;59;11 – 00;17;21;16

Dr. Mona

We don’t really have a room for you. And this is in a pediatric office. I didn’t have a designated area for me. They would have put like a little room divider while I sit and pump, and that’s stressful. Like for me, I was like, oh, I don’t know if I want to do that. I subsequently ended up not breastfeeding for other reasons, but I’ve already had stress about that.

 

00;17;21;16 – 00;17;43;11

Dr. Mona

I was like, I have to come back at three months postpartum, full time doctor schedule, seeing 40 patients a day, having to go and pump and look at my kids picture for like 20 minutes, hoping that I can get some milk going. And that is a very stressful experience in your understanding. You know, we talked about the initiation rates are there, but by six months it dropped significantly.

 

00;17;43;14 – 00;17;50;28

Dr. Mona

Do you feel like that’s happening because of the accessibility affordability, or do you think the mat leave thing is a big part of this?

 

00;17;51;00 – 00;18;11;08

Amanda Gorman

Oh, I had to. Malley is a huge part of it. Yeah, I think in general postpartum anxiety levels are up because of all these things that we’ve just talked about. But also like you said, breastfeeding is, you know, it kind of hate the word journey, but it’s a continuum. And there are serious points of transition. And so what is working?

 

00;18;11;09 – 00;18;33;20

Amanda Gorman

What’s finally clicking at three weeks is completely upended at six weeks. And then we’ve got tubing and we’ve got starting solids, and then we have the oh my gosh, I have to start to use this pump and figure out how to appropriately use this pump. I mean, there’s nothing significant about 12 weeks that should make it the. Yeah, return, you know, and then we’ve got our own maternal care.

 

00;18;33;20 – 00;18;52;18

Amanda Gorman

You know, women are devoid of their own care from 0 to 6 weeks. And there’s a lot going on with our bodies, a lot going on that we’re trying to learn and deal with. So absolutely. Then that leave has a huge impact. And frankly, the word from least a lot of the excuse I talk about is the pump act.

 

00;18;52;20 – 00;19;23;03

Amanda Gorman

That’s not going to do much because we’ve got all these other barriers. You know, it is. So burden is yes, it is addressing a big barrier. However, it’s only one. So absolutely. And you know, our approach on the preventive front is to really mirror what we see in pediatrics. We have a periodicity chart. We see babies at certain intervals because that’s what the evidence shows makes healthier babies when we see them at, you know, one month to month 4 or 6, that’s what we know is going to produce healthy babies.

 

00;19;23;03 – 00;19;48;05

Amanda Gorman

So we had Nash, we set up a very similar preventive periodicity recommendation, because we’re able to offset and prepare mom for what’s coming and curtail all those problems and those concerns. And when mom is educated more on what’s coming, she can better prepare. We help her transition. And we also do more precise risk assessment because every family has a different situation.

 

00;19;48;10 – 00;20;07;07

Amanda Gorman

You may be going back to work at 12 weeks. You may have three other kids, right? Shooting on demand is great and with the first, but not when you have three other kids you’re shuffling around. You may be living with your mother in law, who stacking cans of formula and secretly feeding the baby formula behind your back. I mean, or you may have had a mastectomy and therefore your situation looks very different.

 

00;20;07;07 – 00;20;26;23

Amanda Gorman

So there’s a lot, but absolutely no mat leave and family support even for the partner parent. Because if you don’t get a baby to breastfeed and they are sick more often, you know employers are going to see higher absentee rate. Yeah. From the leading parent or the partner parent. You know, someone’s got to take the kid in someone’s home.

 

00;20;26;25 – 00;20;47;16

Dr. Mona

It’s such that, like you said, multifactorial issue here. That is really stressful. I mean, and I’m happy we’re having this conversation because, like, going back to the comments we’ve already made that so many times I hear mothers feel so guilty about ending their journey that they didn’t try hard enough. And they get that commentary from social media accounts.

 

00;20;47;16 – 00;21;05;17

Dr. Mona

Maybe they have a mother in law who’s so pro breastfeeding. It was like I breastfed all my kids until they were three years old, and you’re not able to. And then on that flipside, you feel like, what am I doing wrong when it really well, we’ve already discussed in so many situations. It is systemic stuff that is barrier for that mom.

 

00;21;05;20 – 00;21;22;11

Dr. Mona

To be able to breastfeed as long as she may desire and stress is a part of it. I know stress is such a broad term, but like the stress of not having support postpartum, the stress of being able to afford a lactation consultant and going back to work and leaving your baby, and then all the things that you mentioned, the access affordability mat leave.

 

00;21;22;19 – 00;21;42;16

Dr. Mona

So how can we make an impact to get these things change? You know, I know your you know, Nest Collaborative is working on this, but what do we do from here? Like how would we as an individual advocate if we want to be a breastfeeding parent, or even if we don’t, to help those who do want to breastfeed patients?

 

00;21;42;16 – 00;22;10;27

Amanda Gorman

Clearly from education, I think we as providers and clinicians have an obligation to start getting the data, to start really looking at the data and the outcomes on new interventions, whether that’s prevention or the pump back, because that’s what unfortunately or fortunately, we need to start moving the needle on the regulators. Whether that’s health care regulatory are and player regulatory that I see is our job.

 

00;22;10;27 – 00;22;39;07

Amanda Gorman

That’s I think person to person and parent to parent is patient and respect and no judgment. Acknowledging the difficult starting the conversations and being gentle on ourselves and communicating that to the community to be gentle on parents. Parenting looks very different now than it did 15 years ago, certainly than it did 20 plus years ago. You know, on the clinical side, we need more clinical outcomes.

 

00;22;39;07 – 00;22;59;20

Amanda Gorman

We need more research because that’s where hospitals and health systems and payers, that’s what forces them to adopt new pathways, but also speaking out and making a splash. You know, I am proud of what we’ve done, especially with payer reimbursement, is we’ve held them to it. And, you know, I think that we talked earlier, you know, I am not an ibkr C.

 

00;22;59;20 – 00;23;17;10

Amanda Gorman

And so the position I took in our company was to fight the fight. It is ridiculous to hand a healing mother with a newborn an engorged breast, a Super Bowl, and to tell them to give Aetna a call in between feeds and see if you can get them to pay for this. Because I’ll tell you the answers now.

 

00;23;17;13 – 00;23;35;29

Dr. Mona

Yeah. In your ideal world, what would be systemic changes that you would say, like in America we need X, Y and Z now, like if you were running for political office and could change the course of America to promote breastfeeding, what would you want? For every mom who decides to breastfeed?

 

00;23;36;02 – 00;23;57;28

Amanda Gorman

I’m giggling because there’s no way I will ever be running for anything pop up politically. You know, whatever. You know, we’re capitalistic society and, those are the constraints that that’s what we’re working. Yes. Right. And that is not going to change for a while if it ever does. So yeah, we need the payer reimbursement. We need adequate coverage.

 

00;23;57;28 – 00;24;17;13

Amanda Gorman

We need if we’re going to maintain a focus on prevention in this country, then we need to understand the repercussions fully. Everyone, all stakeholders need to understand the repercussions. And the repercussions is just one sicker generation and still sicker generations, right? We have parents and babies and it’s impacting their health long term. We need to understand the implications on costs.

 

00;24;17;15 – 00;24;42;17

Amanda Gorman

It’s estimated that inadequate rates of breastfeeding in the US today cost more than $18 billion a year in health care costs. That could be mitigated if we could get these families to six months pay. A reimbursement is first and foremost. Now, again, is that ever going to happen with snap coming at, you know, the mandate of employers? I think not only to be supportive, but we need to extend leave and truly start to support parents making these pathways easier.

 

00;24;42;20 – 00;25;05;02

Amanda Gorman

I wish we could improve the demand on primary care providers. Right now. It’s really easy to say, like you said, let’s get the ABCs in every pediatric office. But pediatric providers are seeing 40 patients a day and still trying to maintain adequate salaries to cover their families. I needed it. We’ve got a health care problem in this country, and I hate that I’m all I’m doing is identifying more problems.

 

00;25;05;02 – 00;25;23;26

Dr. Mona

I don’t know, but it’s true. You’re right. I mean, there is so much that needs to happen. And I think you said it perfectly like the bottom line is when you live in a capitalistic society and I know we’re getting into more politics and stuff like that, but it’s important to understand every issue that we have goes down to the line that America wants people back into work place quicker.

 

00;25;23;28 – 00;25;38;11

Dr. Mona

So we know that in order to get health insurance, that’s kind of the better. And health insurance, you have to have a job, right? So if you don’t have a job, toughness, you you have to go out in the marketplace or you get bad. So now they’re already from a capitalist standpoint, making you go to work to get health insurance.

 

00;25;38;18 – 00;26;02;17

Dr. Mona

And the number two, and for all these working women that have babies, most states in this country, not all, but most states are requiring you to go back to work. And it’s like you can’t have both with the other countries. European countries, the United Kingdom, I know for a fact. And even Canada, our neighbors to the north are able to have resources where you can stay out and still get your salary.

 

00;26;02;23 – 00;26;20;07

Dr. Mona

And it’s such a sad reality that we are dealing with this. And I do believe that we are making noise and screaming and but it’s sometimes feels like you’re screaming into the void and just like, hey, I need help. I need help. Oh, don’t worry, you have this and that. It’s like, no, like, this needs to change. You know, I’m having a daughter.

 

00;26;20;09 – 00;26;41;20

Dr. Mona

If she decides that she would like to be a mother, or my son decides that he wants to be a father one day, I want them to have leave. Not like my husband, who only gets two weeks unpaid, or me who gets three months unpaid. And then I have to pay my employer the time that I’m gone because I don’t get FMLA, I have to pay them for my health insurance.

 

00;26;41;22 – 00;27;03;00

Dr. Mona

Like it’s so bonkers that I’ll be out of work and I have to pay my company $1,000 a month so that I can have health insurance. It’s so backwards, and I’m a privileged person saying that. And I think about all of my patients who do not have privilege of health insurance, who do not have privilege of money. They decide to maybe hire a lactation consultant if I need it.

 

00;27;03;07 – 00;27;18;22

Dr. Mona

And it’s such a tragedy, like it’s such a tragedy, not just for breastfeeding, but for everything that goes into these families lives. And I’m so glad that we could talk about this and just, you know, barely touch the surface. But in an important way to start this conversation.

 

00;27;18;25 – 00;27;41;13

Amanda Gorman

Yeah. And I hope, you know, I hope for health care consumers, they’re utilizing the educational opportunity, too, because I feel like patients are very blinded to kind of the other the underbelly of health care that the business of health care that without giving insurance companies or skin in the game when it comes to preventive and cost savings, they’re going to continue to look at their bottom lines.

 

00;27;41;13 – 00;27;59;01

Amanda Gorman

And their bottom lines, unfortunately, come before health care status of their patients. And that is got to flip that, you know, and I know we have this. We’ll do our next thing on value based care. You know we have this you know we’re looking and we think we can save the world the value based care. But there’s problems to that too.

 

00;27;59;02 – 00;28;05;04

Amanda Gorman

Yeah. We just you’re right. We need more leadership. But I would never take the podium on the gospel.

 

00;28;05;04 – 00;28;22;08

Dr. Mona

I mean, I ask people like, I have my platform. People are like, oh, we you should totally run for political office. I’m like, there is no way I have zero desire to join that. There’s a lot of stuff that happens in that political aspect that, you know, donors and things like that. I’m like, no, I want to speak authentically and this is why I created my podcast.

 

00;28;22;14 – 00;28;36;17

Dr. Mona

There is nobody telling me what to say. I get to say how I feel, and this is how I feel. And yes, it aligns with some politicians, but this is how I feel. Amanda, thank you so much for joining me. What would be your final message for everyone listening today?

 

00;28;36;20 – 00;28;59;11

Amanda Gorman

I think it’s the most be gentle on your friends who are going through their own delivery birth process postpartum. Don’t scare them, but let them know that you know that decisions are okay. Obviously let them known as collaborators, available. We love starting prenatal relationships because we feel like we’re really setting parents up for the highest chance of success.

 

00;28;59;13 – 00;29;07;01

Amanda Gorman

But yeah, Gabriella, really good educational sources. Talk to your providers and be gentle on your community.

 

00;29;07;04 – 00;29;17;25

Dr. Mona

Yes, and I am so grateful you joined me today. You obviously spoken about this collaboration, but where can people stay connected? Find you, find more information about this collaborative.

 

00;29;17;28 – 00;29;39;00

Amanda Gorman

Nest collaborative.com. We’re on Facebook and Instagram. At Nest Collaborative. We don’t tweet a ton, but that’s nest collab. But we have a podcast that’s not actively recording. But it’s very, very useful, which is called Breastfeeding Unplugged, which I recommend for all new parents. It’s fun and I like you, really enjoyed doing that and hope to pick it up again sometime soon.

 

00;29;39;00 – 00;29;54;26

Dr. Mona

Oh, I love it! Yes, podcasting content creation is a whole other world of excitement and time, so I hope that you do get back into it. But I will be linking that resource in this collaborative.com as well as the social media handles. And thank you again for joining me today.

 

00;29;54;29 – 00;30;00;26

Amanda Gorman

Yes, absolutely. And I wish you all the best with a little lady to show up soon. So congratulations.

 

00;30;01;01 – 00;30;20;17

Dr. Mona

And for all of our listeners, you are probably listening to this after Baby is here. I I’m batch recording episodes and that’s no secret for my listeners on the show. And I’ll tell you, if I end up breastfeeding or not, I’m very open about my journey, and I am very aware of the fact that if I don’t breastfeed, a lot of it is going to be resources driven.

 

00;30;20;17 – 00;30;35;10

Dr. Mona

I know it, you know, I have a partner who’s going to leave me to go back to work at two weeks. I have a three year old son. I’m not going to have much help. I’m trying to take it all in stride and say, I want to do this thing for us, but I understand my circumstances and I’m going to do my best.

 

00;30;35;10 – 00;30;52;21

Dr. Mona

And I hope everyone listening remembers that same thing. Follow your goals. It’s okay to pivot. Like you said, if you need to, we can do that. But thanks again for joining us. And if you like this conversation, make sure you leave a review or rating. That is how the podcast continues to grow and also share it on social media or with a friend.

 

00;30;52;26 – 00;30;58;07

Dr. Mona

I’m sure you all resonate so deeply with the conversation that me and Amanda had today, and thanks for joining us.

 

00;30;58;12 – 00;31;14;05

Dr. Mona

Thank you for tuning in for this week’s episode. As always, please leave a review. Share this episode with a friend. Share it on your social media. Make sure to follow me at PedsDocTalk on Instagram and subscribe to my YouTube channel, PedsDocTalk TV. We’ll talk to you soon.