The Bike Analogy That Changed Everything
How I Learned to Bridge the Gap Between Evidence and Experience
When I was a young attending physician, barely a year out of residency, I was handed what felt like an impossible task: help our Connecticut hospital achieve Baby Friendly status while somehow making peace between warring factions of well-meaning healthcare providers.
I’ll be honest—I didn’t know much about the technical aspects of Baby Friendly certification. But I knew something about struggle. My own breastfeeding journey had been difficult, filled with the kind of challenges that make you deeply understand why support matters so much for new mothers.
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The Battle Lines Were Drawn
The hospital had already been working toward Baby Friendly status, but there was a problem. The lactation consultants who had been leading the charge hadn’t brought the physicians—OB-GYNs and pediatricians—to the table as partners. By the time I arrived on the scene, the battle lines were clearly drawn.
On one side were the lactation consultants, armed with evidence and passion for supporting breastfeeding mothers. On the other were seasoned physicians who genuinely believed they were advocating for their patients’ best interests. The older physicians, many of whom had trained me, held what I can only describe as a patriarchal point of view:
“We know what’s best for these women. They need to rest. This Baby Friendly nonsense about forcing exhausted mothers to keep babies in their rooms around the clock makes no sense.”
The biggest flashpoint was rooming-in. Baby Friendly status at that time required eliminating the traditional nursery and enabling babies to stay with their mothers 24/7. The evidence supported this practice—it helped mothers learn their babies’ feeding cues and established better breastfeeding patterns. But it represented a massive culture shift for physicians who had always sent babies to the nursery so mothers could sleep.
Everyone genuinely believed they were helping patients in the best way they knew how. But they were talking past each other, and I was caught in the middle.
Standing Before My Teachers
Then came the moment that still makes my stomach flip when I think about it: I was asked to give grand rounds on Baby Friendly practices. Picture this—a young attending physician, barely out of training, standing up in front of the very doctors who had taught and mentored me, trying to convince them that maybe, just maybe, I had learned something they needed to hear.
The vulnerability was overwhelming. How do you challenge established practices without making your former teachers feel defensive? How do you present evidence-based medicine to people who taught you what evidence-based medicine was?
I knew I needed more than statistics and studies. I needed something that would help everyone step outside their positions and see the situation differently.
The Bike Analogy That Changed Everything
I spent countless hours developing what I hoped would be the perfect analogy. Finally, I found it.
“A new mom preparing to breastfeed,” I told the assembled physicians, “is like a child getting ready for their first bike. Imagine little Tommy has been dreaming about this moment. He’s picked out the horn for the handlebars, the colorful tassels, his favorite bike seat, a cool helmet. He’s beyond excited.
“But then Tommy gets his bike and—predictably—he falls off. The first time, the second time, several times. We all know this is completely normal. Every kid falls when learning to ride.
“Now imagine Tommy’s parent responds by saying, ‘You know what, Tommy? We live in America. You don’t need to ride a bike. We’ll just drive you everywhere. And even though all your friends have bikes, the fact that you fell off probably just means you’re not cut out for this. We have an alternative.’
“How defeating would that be for Tommy? And how similar is that to what happens when we tell a breastfeeding mother who’s struggling in those first few days—which is completely normal—that she should just give up and use formula? We’re inadvertently adding to feelings of failure and defeat.”
I could see heads nodding around the room, but I wasn’t done.
“On the flip side, imagine if Tommy’s parents were militant about bike riding. What if they made him fall off a thousand times until his bones were broken, saying, ‘You WILL learn to ride this bike because every kid in America has to learn how to ride a bike!’ That’s not healthy either. They’re not listening to Tommy’s needs. They’re forcing and potentially traumatizing him over something that he may genuinely not be ready for.
“The nuance—and this is where our job gets complicated—is somewhere in the middle. We have to figure out what ‘enough support’ looks like. What does it mean for someone to have tried hard enough to be successful at breastfeeding? And most importantly, how do we responsibly set them up for success by removing the barriers we’ve unintentionally created?”
The Shift
Something changed in that room. The bike analogy helped everyone step outside the breastfeeding debate and see the broader principle: supportive care means providing the right environment for success while respecting individual needs and limits.
The physicians began to understand that Baby Friendly practices weren’t about forcing anything on anyone. They were about removing institutional barriers that made breastfeeding unnecessarily difficult. The lactation consultants gained new appreciation for the physicians’ genuine concern for patient wellbeing, even when it looked different from their own approach.
Finding the “Both/And” Solution
What happened next was perhaps even more important than that grand rounds presentation. We didn’t just implement Baby Friendly practices as they were written. We found ways to honor both the evidence supporting rooming-in AND the very real medical wisdom my mentors brought about maternal recovery.
We developed protocols that supported 24/7 rooming-in while also ensuring mothers got adequate rest. We trained nurses to recognize when a mother was genuinely exhausted and needed a few hours of supported sleep. We created systems where babies could stay with mothers during the day for learning feeding cues, but could be cared for by nursing staff for short periods at night when mothers needed to recover from difficult deliveries.
The lactation consultants learned to work more closely with nursing staff to identify when rest was medically necessary. The physicians learned that supporting breastfeeding didn’t mean ignoring maternal wellbeing. We found ways to remove institutional barriers to breastfeeding while still honoring the fundamental medical principle that recovering mothers need adequate rest.
Years later, as a more experienced physician, I’ve come to deeply appreciate that my mentors were absolutely right about maternal recovery. Exhausted mothers struggling with healing incisions, hormonal shifts, and sleep deprivation do need rest. The wisdom wasn’t wrong—we just needed to find a way to honor both that wisdom and the evidence about early bonding and feeding success.
What I Learned About Advocacy
That experience taught me something fundamental about healthcare advocacy: it’s rarely about being right versus wrong. It’s about finding the “both/and” solutions that honor everyone’s valid concerns while moving toward evidence-based practices that truly serve patients.
The most effective advocacy doesn’t happen when we dismiss the concerns of those who disagree with us. It happens when we find ways to bridge understanding, to help people see familiar problems through new lenses, and then work together to create solutions that address everyone’s legitimate worries.
Today, when I encounter resistance to practices I believe in, I try to remember that bike analogy. Not because it’s perfect for every situation, but because it reminds me that the goal isn’t to win arguments—it’s to find the nuanced middle ground where evidence meets compassion, where innovation honors experience, and where everyone can move forward together.
Sometimes the most radical thing you can do as an advocate is help others feel heard while gently opening the door to new possibilities. Sometimes changing minds starts with changing metaphors.
And sometimes, the most powerful tool a young doctor has isn’t authority—it’s the ability to help everyone remember what we’re really trying to do: take the best possible care of the people who trust us with their health and their stories.
