Caring about breastfeeding in prenatal care

In an effort to ensure the health of both mother and baby, most pregnant women make multiple visits for prenatal care. Few behaviors impact health outcomes for mother and baby more than breastfeeding, so one would expect these prenatal care visits to include extensive breastfeeding guidance.

In a recent study, researchers audiorecorded 172 first visits for prenatal care at a large academic medical center to assess the nature of breastfeeding discussions.
Overall, less than a third of visits (to 36 obstetric residents, 6 midwives, and 5 nurse practitioners) included any discussion of breastfeeding, and only 2% included an explicit recommendation that breastfeeding is superior to artificial feeding. Midwives were more likely to discuss breastfeeding, but only 42% (vs. 10% of obstetricians) assessed pregnant women’s prior exposure to or experience with breastfeeding.

As most mothers make decisions about how they are going to feed their infants before their babies are born, prenatal care providers have the potential to play an important role in educating women about the maternal and infant health risks associated with not breastfeeding. Unfortunately, at least at this hospital, few women seem to be getting the message that their prenatal clinician actually cares about breastfeeding. Efforts are needed to make sure that training programs across the country effectively convince prenatal care providers to care about infant feeding.

Eleanor Bimla Schwarz, MD, MS is a clinician and researcher at the University of Pittsburgh, Departments of Medicine, Epidemiology, and Obstetrics, Gynecology and Reproductive sciences.

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

Breastfeeding for me and my health

Mothers who did not breastfeed their children are at significantly higher risk of developing type 2 diabetes later in life than moms who breastfed, reports a study published in the September issue of the American Journal of Medicine. 

The study included 2,233 women between the ages of 40 and 78 who were members of a large integrated health care delivery organization in California. Strikingly, one of every four mothers who had never breastfed had developed type 2 diabetes. Mothers who had not breastfed were almost twice as likely to develop diabetes as women who had breastfed or women who had never given birth.  These long-term differences were notable even after considering age, race, physical activity and other factors which affect risk of diabetes such as alcohol and tobacco use.   In contrast, mothers who breastfed all of their children were no more likely to develop diabetes than women who never gave birth.  In other words, breastfeeding is part of the way mothers’ bodies recover from pregnancy. When this process is interupted, and an infant is fed something other than it’s mother’s milk, a mother’s body suffers.

While prior studies have shown that the longer a mother breastfeeds the lower her risk of developing diabetes, this study found that even a single month of breastfeeding had marked effects on a mother’s future risk of developing diabetes.  This means that is all the more important that we find ways to support moms’ early efforts to breastfeed, and that we encourage moms to breastfeed for at least their baby’s first month of life.  Hospitals and workplaces that fail to provide this support are jeopardizing the health of both mothers and their children and producing significant costs to our society.   It was recently estimated that if 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 infant deaths.  Unfortunately, only 56 percent of mothers studied reported they had ever breastfed an infant for one or more months.

Mothers who were not able to breastfeed their children may want to discuss with their primary care provider whether dietary changes or increasing physical activity may now be advisable.  Similarly, clinicians need to consider women’s pregnancy and lactation history when advising women about their risk for developing type 2 diabetes in the future.

Eleanor Bimla Schwarz, MD, MS is a clinician and researcher at the University of Pittsburgh, Departments of Medicine, Epidemiology, and Obstetrics, Gynecology and Reproductive sciences.

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

An analysis that is missing half the equation

I was pleased to see Melissa Bartick’s effort to appraise US policy-makers of the economic costs of suboptimal breastfeeding. However, any analysis that is missing the effects of lactation on maternal health will grossly underestimate the true costs to the US of suboptimal breastfeeding.