Duke family medicine physician Andrea Dotson, MD, MSPH, IBCLC, FAAFP, was among the first cohort of 103 physicians across the U.S. and Canada to achieve a new certification from the North American Board of Breastfeeding and Lactation Medicine (NABBLM) in October 023.

“For the first time ever, we have board certification, which is a great way of recognizing that there is a need for physician-level care of breastfeeding infants and lactating parents,” says Dotson. “This is real, evidence-based medicine we’re practicing and providing our patients.”

As a family medicine physician, Dotson has a long history of providing obstetric, gynecologic and infant care. Yet, it was her own personal experience that led her to pursue additional training in lactation and infant feeding. “A lot of us walk into our own personal experience thinking this is something that’s a natural process and it’s very straightforward, but that’s not always the case,” she says.

Dotson completed the continuing education and training required to become an International Board-Certified Lactation Consultant (IBCLC), which was once the highest-level credential for healthcare professionals specializing in lactation. IBCLCs come from many backgrounds, from nursing and nutrition to speech therapy, and they offer comprehensive breastfeeding support and education related to latching, pumping, feeding schedules and proper positioning. They also can address common challenges that may arise, including breast engorgement and clogged milk ducts.

According to Dotson, there are many medical complexities that can arise before or during breastfeeding in both parent and infant that require care beyond that provided by an IBCLC and necessitate physician intervention. These include, but are not limited to:

• Low milk supply
• Complex nipple pain
• Post-mastectomy feeding
• Complications resulting from cleft palate or tongue-tie
• Risks associated with a parent’s medication regimen or pre-existing condition like HIV

Combining her medical background and lactation expertise with the more advanced NABBLM training, Dotson provides the full range of care for lactation complications, from counseling and diagnostics to medication management and treatment. She also collaborates with a vast network of skilled specialists at Duke, including surgeons, pediatricians, physical therapists, speech pathologists and others, to provide more advanced therapies that facilitate normal breastfeeding, such as cranial sacral therapy and frenotomy.

At every stage of care, Dotson works closely with IBCLCs and referring providers to ensure continuity and open communication. “Approximately 80% of my referrals come from IBCLCs directly, which means patients have already been optimized by someone who has a really important skill set,” says Dotson. “I strive to get patients to a point where they can return to their IBCLC or provider. I am always happy to collaborate. The goal is to utilize all the resources that are available so that we can best serve our patients.”

To receive optimal care, Dotson says lactating patients should be referred early. “Often, I'm seeing patients when it's really late. I end up being the last stop out of desperation, and that’s really challenging,” she says. “I'd rather see patients much sooner—as soon as you have a question you don’t know the answer to or you have a patient with a risk factor, even in the prenatal period.”

Dotson stresses that there’s more the medical community can do to help ensure lactating parents have the resources and information they need to breastfeed successfully. “If you’re seeing a patient in the OB, pediatric or internal medicine clinic … anyone can refer,” she says. “The responsibility falls on all of us to support the feeding experience.”