Where are the healthcare providers in The LetDown?

Have healthcare providers let mothers down?

Audrey breastfeeding in the LetDown

Photo courtesy of ABC TV

It’s hard not to sympathize with Audrey’s (“Aud”) character in The LetDown played by actress and director, Alison Bell. She’s raw, authentic, and the challenges she faces as a new mother are so appreciable that, as a viewer, you feel as if you should reach out and offer your own assistance. Through the course of season one, Audrey finds guidance through a rather amusing mothers’ group she attends regularly, each mother (and one father) with their own distinct character, opinions, and unique challenges (including the instagram star and comedian, Celeste Barber). Bell explains in an interview that she had her first child during the production of the show, and fellow writer, Sarah Scheller, had two children of her own going into the production. They were able to incorporate their personal experiences into the plots including their outlook on their own mother’s group experiences, both having contrasting opinions.

 

A mother's group discussion scene in The LetDown

Photo courtesy of Daniel Asher Smith/Netflix

The show’s clever humor has a subtle way of brightening up the seriousness of the considerable difficulties the parents face in their new identity. One of the main challenges depicted in the film is Audrey’s difficulty breastfeeding. When she initially attempts to breastfeed her rosy-cheeked, blue-eyed baby, “Stevie”, at her first mother’s group meeting, she is suddenly surrounded by these mothers and the instructor giving their seemingly unwelcome advice with mention of proper latch technique, engorgement, breast pumps, expression, etc.

 

The Mother’s Group Instructor

The mother's group instructor, Ambrose, looking sternly as she offers breastfeeding advice

Photo courtesy of Netflix

The instructor is the first to scrutinize Audrey’s breastfeeding technique, exclaiming, “Audrey, no, no, no, no…she [Stevie] needs the whole areola…” followed by “…here is a breast that should have been drained hours ago” while peering over Audrey’s shoulder (1). Audrey appears visually overwhelmed and uncomfortable and abruptly leaves the group.  

The Drug Dealer

The drug dealer offering breastfeeding positioning advice to Audrey in the LetDown

Photo courtesy of Netflix

Even the local drug dealer offers advice to Audrey as she is trying to get little Stevie to latch on a nightly drive, explaining that she should position Stevie in the “clutch” or “football hold” position. However, before he can explain further, one of his clients shows up and he hurriedly shoos Audrey away.

The football hold position as described by the drug dealer in the LetDown

Photo courtesy of The Breastfeeding Atlas

 

The Mother-in-Law

Audrey's mother-in-law in the LetDown who also provides her input on Audrey breastfeeding

Photo courtesy of Netflix 

Audrey’s mother-in-law is also one to offer unwanted support in breastfeeding, telling Audrey to make sure she evens out feeding Stevie on both breasts and doesn’t overfeed.

Where are the healthcare providers?

Although overwhelming, the mothers group, drug dealer, and mother-in-law have decent advice, but, as a viewer, you have to wonder, where are the healthcare providers? Shouldn’t they be the ones offering Audrey support?

Healthcare providers including pediatricians, OB/GYNs, physicians, and lactation consultants are all remarkably left out of the entire first season of The LetDown. Is it possible that mothers may not rely on their healthcare providers for advice or support when it comes to breastfeeding? A study conducted in 1994 discovered breastfeeding orientation and support from healthcare professionals including doctors, nurses, and nutritionists was not correlated with the decision to breastfeed whereas breastfeeding support provided by prenatal classes and lay people had a significant increase in the odds of breastfeeding (2).

Perhaps they feel that this is something every lactating mother has gone through and that they should be able to persevere and get through the difficulties without medical assistance. Mothers may also see more relevance in relying on other mothers, judging current or past personal experience as more valuable than the potential help they would receive from a medical professional (see intern Brittany’s blogpost for more info on the value of peer to peer counseling). Another study found that women were four times as likely to speak to their family and friends about breastfeeding and overall feeding methods than they were a healthcare provider (3). In a more recent study conducted in 2017 of American mothers it was observed that not only does social support influence breastfeeding but that the source of the support significantly impacted breastfeeding duration. Mothers who sought out more frequent support from breastfeeding groups and grandmothers experienced longer breastfeeding duration whereas support from physicians was associated with shorter breastfeeding duration (4)But is leaving healthcare providers out of the show a fair representation of the status quo? Do healthcare providers need to step up their game when it comes to breastfeeding support in the critical prenatal and postnatal periods? Is it that mothers in the community may not be aware of all their available resources, including healthcare professionals?

The writers of the show could have incorporated providers by showing Audrey going to prenatal appointments with her OB/GYN or postnatal scenes with a pediatrician and discussing her concerns about breastfeeding Stevie. 

Prenatal Discussions

At prenatal appointments they could have discussed Audrey’s opinions and/or concerns about breastfeeding, her current health status, previous surgical history, looked at her nipple shape to see if there may be any outright challenges with breastfeeding, and covered normal breast changes that occur during the prenatal period.

Hospital Discussions

The LetDown could have incorporated a hospital discharge scene where Audrey was counseled through a comprehensive breastfeeding plan, discussing how often to feed Stevie, fluctuations in Stevie’s weight and what to look for, how to handle engorgement and breast massage techniques.

Pediatric Discussions

Pediatric appointments could have included a pediatrician observing one of Audrey’s breastfeeding sessions, monitoring Stevie’s growth and feeding behavior, correcting infant positioning and latch if necessary, and discussing pumping strategies. 

Incorporation of the LSM

The writers could have also implemented a lactation consultant scene in the mom’s group. Similar to how a professional came in and taught the mothers CPR with his mannequins or the instructor teaching massage technique, a lactation consultant could have done a presentation using a Lactation Simulation Model (LSM) to demonstrate proper latch, positioning, and other breastfeeding techniques. The wearable LSM by LiquidGoldConcept could have been used by the nurse instructor or by a guest lactation expert in educating the mothers without having to directly criticize the participants and foster an environment more conducive to expanding everyone’s knowledge as well as avoiding a judgemental outlook on the individual.

A visual representation fo the CPR session in the mother's group of the LetDown

Photo courtesy of Netflix

Seeing as the show inserts comedy in all the scenes, it would seem conceivable that a physician’s visit or guest lactation consultant scene could be quite humorous, especially with the addition of the wearable lactation simulation model. Such a scene has the capability to draw attention to what mother’s believe is lacking in those environments and the plausible reasons they turn to other outlets of support. Hopefully season two will include components of Audrey interacting with healthcare providers since she is (SPOILER) pregnant again! 

The cover photo for the LetDown on Netflix

Photo courtesy of Netflix

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