I’m grateful for a community of physicians who care deeply about breastfeeding

Last week, more than 400 health professionals gathered in San Francisco for the Academy of Breastfeeding Medicine’s 23^rdInternational Conference. The conference drew participants from 25 counties and 41 US states, including 259 physicians from medical specialties ranging from neonatology to breast surgery.

Members of Dr. Milk at ABM 2018

We kicked off with two pre-conference courses, “What every physician needs to know about breastfeeding (WEPNTK)” and “What every physician needs to know about breastfeeding II.” WEPNTK covers the anatomy and physiology of breastfeeding that many of us missed in medical school. WEPNTK II covered more advanced clinical issues, like maternal risk factors for low milk supply, management of tongue tie, therapeutic ultrasound for mastitis, and postpartum depression.

ABM is unlike any other medical conference that I attend because the audience spans multiple medical specialties and brings together clinicians from around the world. The conference committee faces the daunting task of selecting speakers that address the interests of both subspecialists and general practitioners across the translational continuum from basic science to public policy. And as an international conference, our speakers are selected to include perspectives on breastfeeding policy and public health from around the globe.

Those policy issues were front and center in conference presentations. Shelly Sundberg of the Gates Foundation presented on global efforts to increase enforcement of the WHO Code of Marketing, including the World Health Organization’s NetCode. Dr. Maria Cristina Cornelio‐Bernardo, chair of the breastfeeding committee for the Philippine Pediatric Society, presented a national framework for enabling breastfeeding. Dr. Asti Praborini, a pediatrician from Indonesia, shared her protocol for hospitalizing mom and baby to resolve nipple confusion. And Dr. Yuwen Ren, a physician from China and chair of the Shanghai YUREN Breastfeeding Promotion Center, described her 3500 mile walk from Beijing to Tibet with her colleague, Dr. Jie Wang. During their journey, she and Dr. Wang came to understand the ways that financial pressures have forced rural mothers to seek jobs in cities, separating them from their infants after the first month of life.

In the US context, Kiran Saluja, Executive Director of the PHFE WIC Program, discussed how the largest WIC agency in the United States addresses barriers to breastfeeding and works to address implicit bias and lack of cultural competence among providers, both inside and outside WIC. For example, CinnaMoms hosts breastfeeding support groups in five PHFE WIC centers:

In 2015, our vision was to increase breastfeeding rates among African American women at the PHFE WIC Program. We created support groups that extended beyond our WIC services to provide encouragement and a safe space to chat about historical feeding practices, perceptions of breastfeeding, familial feeding experiences, and the health benefits of breastfeeding. We discuss interesting topics that spark conversations about maternal and postpartum health, support systems, and cultural beliefs while enjoying nutritious foods.

Conference speakers also shared strategies for clinical management. Sarah Reece-Stremtan presented, “Anesthesia, Opioids, and Breastfeeding, Oh My! A Closer Look at Two ABM Protocols,” reviewing our protocols on Analgesia and Anesthesia for the Breastfeeding Mother and Peripartum Analgesia and Anesthesia for the Breastfeeding Mother. Two surgeons,Anna Meyer, a pediatric otolaryngologist, and Katrina Mitchell, a breast surgeon, reviewed the evidence and shared clinical pearls on assessment and management of ankyloglossia and breast complications, respectively.

Dr. Meyer discussed the limitations of the existing literature on frenotomy, and made an eloquent plea for “best care” for mother-infant dyads. She called for a holistic approach to breastfeeding support, including communication skills training for all providers and elimination of monetary incentives for procedures. She suggested a “breastfeeding home” for every mother-baby dyad:

• Psychosocial support
• Accessibility prioritized
• Incorporate diversity and inclusion practices
• Pre/post-natal mindfulness training/groups
• ENT/IBCLC/pediatrician/ped dentist/OT/PT/SLP/social worker/psychologist collaboration

Dr. Mitchell similarly invoked a holistic approach, sharing the story of a mother who presented to her for evaluation of mastitis. She was engorged and her baby was feeding poorly: Mitchell helped mom put baby to breast and saw that the infant had a severely infected thumb and was septic. She immediately arranged transfer of the baby to the emergency department for treatment. In a talk packed with clinical pearls for management of breast infections, masses and abscesses, she explained that she gives the mothers in her office a gift bag with a “Thanks Mom!” certificate to hang on the wall.

I’ve been attending ABM meetings for more than a decade, and as a women’s health physician, I sometimes find myself getting restless during discussions of the nuances of human milk fortification after infants are discharged from the neonatal intensive care unit; I suspect my neonatology colleagues might similarly become impatient during talks on surgical management of breast abscesses. We are hungry for clinical pearls that can improve the care of the patients we see every day, and that hunger can obscure the relevance of presentations outside our personal silo. But the beauty (and the challenge) of breastfeeding medicine is that good care requires “both/and,” rather than “either/or.”

Among thought-provoking talks on clinical care and basic science, we also found time for new friendships and celebration. ABM welcomed 17 new Fellows in to the Academy, celebrating their commitment to leadership as breastfeeding medicine specialists. The meeting also brought Members of Dr. Milk, Dr. M.others I.nterested in L.actation K.nowledge, face-to-face for clinical brainstorming and comradery. This Facebook group has more than 16,000 members, comprised of three groups: 1) Physician mothers who are pregnant, breastfeeding, or expressing breast milk for their children; 2) Physicians who want to learn more about breastfeeding to help their patients, and 3) Physician mothers who have experience breastfeeding and expressing breast milk for their children. The group’s members are deeply passionate – and we also appreciate the value of laughter and a tub of ice cream after a long day of learning and policy debate. Looking back on my first days as an Ob/Gyn intern and mom of a breastfeeding three-month-old 18 years ago, I have a visceral sense of how helpful it would have been to have Dr. Milk as a sounding board and support network.

As we celebrate Thanksgiving here in the US, I’m grateful to be part of a community that cares deeply about bringing together physicians to protect, promote and support families so that they are able to meet their breastfeeding goals. Next October, we’ll gather in the United Kingdom for our first International Conference outside of North America. We’ll be meeting at the University of Central Lancashire in Manchester, October 16-19, 2019. I very much hope to see you there.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician and president-elect of the Academy of Breastfeeding Medicine. You can follow her on Twitter at @astuebe. 

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.