Breastfeeding Medicine

Physicians blogging about breastfeeding

Archive for the ‘physician training’ Category

How often does breastfeeding come undone?

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One afternoon in my lactation clinic, I saw two mothers who came to see me because they couldn’t make milk. One was pregnant with her second child, and the other was considering a third pregnancy. Each described how they had looked forward to breastfeeding, taken classes, put their babies skin-to-skin and birth, offered the breast on demand, and then waited, for days, and then weeks, for milk that never came in. As the second mother came to the end of her story, she said, “No one ever told me this could happen. Have you ever heard of a woman not being able to make milk?”

“Yes,” I said. “There’s one in the very next room.”

The dogma is that inability to breastfeed is rare – “like unicorns,” one blogger wrote – but I was seeing an awful lot of unicorns in my clinic. I couldn’t help but wonder – how often does breastfeeding come undone? Read the rest of this entry »

Written by astuebe

March 27, 2014 at 4:23 pm

How ABM enables mothers and babies to breastfeed

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We know that in the first six months of life infant nutrition is very important for growth and development, but it doesn’t just end there. These early decisions about how babies are fed have an ongoing impact throughout childhood and into adulthood. Therefore, finding opportunities to optimize infant feeding during this period is crucial to ensure infants are able to reach their potential.

Exclusive breastfeeding for the first six months of life is the most appropriate method of infant feeding, yet many babies are not exclusively breastfed at all, or only for a limited time. This is in spite of the fact that most mothers are aware that breastfeeding is the best option for their babies, and the majority initiate breastfeeding immediately after birth.

Mothers who have the support of family, physicians, nurses and health workers are more likely to continue to breastfeed when they run into unexpected breastfeeding problems or are uncertain of what they should do. If these problems are complex, or the mother has specific medical issues, having a physician with breastfeeding knowledge and expertise is even more important. However, many physicians have not had the training or experience to provide the help and assistance mothers need. Read the rest of this entry »

Written by wbrodribb

March 21, 2014 at 6:13 am

Caring about breastfeeding in prenatal care

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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.

Written by EBS, MD, MS

December 2, 2013 at 11:10 am

Establishing the Fourth Trimester

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Lisa Selvin’s provocative article, “Is the Medical Community Failing Breastfeeding Moms?” has elicited a wide range of reactions from the breastfeeding community. Some have argued that the piece, which focuses on unmet needs of mothers who encounter physiologic problems with breastfeeding, “sensationalizes” breastfeeding, making it sound so treacherous and difficult that mothers should avoid it altogether.

I would argue that there’s a very fine line between “sensationalizing” and “truth in advertising.” Reproductive biology is imperfect — some couples can’t conceive, and some pregnancies end in miscarriage or stillbirth. The silence around these losses and the isolation that women have historically experienced has probably worsened the suffering for many women. On the other hand, emphasizing these risks and creating a culture of fear harms the majority of mothers who will have successful pregnancies and births. Read the rest of this entry »

Written by astuebe

January 4, 2013 at 12:45 pm

Announcing our Newest Protocol: ABM Clinical Protocol #10: Breastfeeding the Late Preterm Infant (34 0/7 to 36 6/7 Weeks Gestation) (First Revision June 2011)

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I am pleased to announce our newest protocol has been published in Breastfeeding Medicine: ABM Clinical Protocol #10: Breastfeeding the Late Preterm Infant (34 0/7 to 36 6/7 Weeks Gestation) (First Revision June 2011).  This is a revision of the previously entitled ABM Clinical Protocol #10: ‘‘Breastfeeding the Near-Term Infant (35 to 37 Weeks Gestation)”.  As this protocol starts out explaining:

“At the time this protocol was first written ‘‘near-term’’ infant was commonly used to describe infants born in the few weeks before the 37th week of gestation. In July 2005 a panel of experts assembled by National Institute of Child Health and Human Development designated infants born between 34 0/7 to 36 6/7 weeks of gestation as late preterm to emphasize the fact they are really ‘‘preterm’’ and not ‘‘almost term’’ and establish a uniform designation for this group of infants.  This definition, however, includes infants born 1 week more premature (34 0/7–34 6/7 weeks) than the previous Academy of Breastfeeding Medicine protocol for the ‘‘near term infant’’ that encompassed infants born at 35 0/7 weeks to 36 6/7 weeks. In addition, infants born at 37 0/7–37 6/7 weeks may be at risk for breastfeeding problems and associated risks, and, therefore, the following guidelines may be applicable to these infants as well”.   Breastfeeding Medicine 2001; 6(3):151-156.

This protocol is the perfect example of what we as the Protocol Committee hope can happen as we update and revise our Clinical Protocols on a 5 year basis.  Unless the evidence has changed dramatically, the plan is to attempt to update the references and the data in such a way as to follow the general outline of the original protocol.  The reasoning is that those of you who are used to using a particular protocol will think everything is changed if you see a completely differenct document, when maybe only one or two things have actually been changed.  If the format remains generally the same, you will be able to easily see what has been updated and what has changed since the last version, and easily be able to update your own practice.  Sometimes this is not possible if either practice really has changed extensively, or author styles and interpretation of the data are so different that there is just no way around it.  But this protocol is an excellent example of how some of the evidence has changed, starting with the basic definition of the population, and there are many more references available ( 13 cited in 2004 versus 52 in 2011) but the basic outline has been followed, enhanced, and expanded to make an even better protocol than the original was.

As the ABM Protocol Chair, I speak for my Committee and for the ABM Board of Directors when I say we are very proud of these Clinical Protocols and our Statements, all of which can be found on our website.  The Clinical Protocols are also accepted and published by the National Guidelines Clearinghouse, sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health & Human Services, which has very stringent requirements for acceptance to their website.

So please check out this newest protocol, and keep your eye open for our next one, the brand new Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

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

Written by kmarinellimd

June 6, 2011 at 7:45 am

ABM Protocol and Statement Updates!

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Today I wear my dual hats as ABM Protocol Chair and ABM Blogger.  It came to the attention of the Protocol Committee that there were typos/errors in a couple of our ABM protocols after publication.  Two protocols have been corrected in the on-line copies for Breastfeeding Medicine previously, and have now been updated on the ABM website as of today. 

Here are the corrections that have been made:

1.  Protocol #3—Supplementation—Volume 4, Number 3:

  Table 3, page 178  under “Time” the second line was originally printed 24-28 hours; correction is 24-48 hours.

2.  Protocol #7—Model Hospital Policy—Volume 5, Number 4:

  Page 176 and in the listing of the Ten Steps.  Step #6: only the US version require that hospitals purchase their formula.  The original published text stated: 

   6.  Give newborn infants no food or drink other than breast milk, unless medically indicated. (A hospital must pay fair market price for all formula and infant feeding supplies that it uses and cannot accept free or heavily discounted formula and supplies.)

Now it correctly and in keeping with the original, international Ten Steps says:

  6. Give newborn infants no food or drink other than breast milk, unless medically indicated.

I will let you know if any future changes occur in published protocols or statements. 

And by the way, the just published issue of Breastfeeding Medicine contains ABM’s second Statement, Educational Objectives and Skills for the Physician with Respect to Breastfeeding.  Check it out in the latest Journal (Breastfeeding Medicine. April 2011, 6(2): 99-105).  Our first ABM Statement, Position on Breastfeeding (Breastfeeding Medicine 2008;3(4):267-270), can be found under the “About Us” tab on our web page right now.  As we now have two statements, and several more on the way, we are setting up a “Statements” section on our Protocol page to make them easy to find all in one place.  Please be a little patient with us!  Our newest statement will be on our website soon!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

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

Written by kmarinellimd

April 11, 2011 at 5:04 pm

Physician Mothers: How do we fare with breastfeeding?

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A recent study published in the Breastfeeding Medicine by Sattari et al looked at breastfeeding intentions of female physicians.  They looked at breastfeeding behavior of these women at 3, 6, and 12 months.  Not surprisingly, of the 50 women surveyed, 100% of these physicians had intentions of long-term breastfeeding.  However, as the results showed, the rates of exclusivity/any breastfeeding declined as the women were followed. Although the sample size was small, it brings to light many of the issues women physicians face when going back to work.

Physicians know the benefits of breastfeeding, and it’s interesting to see that most plan on breastfeeding.  The authors point out that not only does breastfeeding benefit the mother and her baby, but our personal stories can usually help a patient.  In my case, breastfeeding didn’t come easy.  My personal struggles to provide breastmilk for my 3 children have helped me counsel mothers in my pediatric practice.  But ironically, even though I work in a field that should obviously support breastfeeding, this wasn’t my experience.  I struggled with finding the time and space to express milk—and yes, I did pump in a bathroom stall!! Ironically, it was after my 3rd child, when I was working in a Pediatric emergency room, that I was given the most support: nurses told me in the middle of my shift to go pump, with my director even offered me a hospital-grade pump!!

This study highlights that specialty and stage of career can and do affect breastfeeding longevity.  Attendings are generally in the best position to alter their schedule to accommodate pumping breaks, as opposed to residents.  During residency and fellowship, I had many friends who chose to breastfeed only for the 6 weeks of their maternity leave, or found, after returning to work, that the long hours and stress of call nights severely diminished their supply.  A primary care specialty is more likely to be favourable, compared with a surgical specialty where women struggle to find time to pump during the day.  The authors point out that the logistics of timing of surgeries and proximity of lactation rooms make it difficult for women in surgical subspecialties to express milk.  I’ve seen this among my friends as well—regardless of stage of career.  One friend mentioned that due to the timing of the cases and fear of missing an interesting case, she would have to choose between eating or pumping since there wasn’t enough time to do both.

Although the study didn’t address this, I suspect that many women in surgical specialties still have to deal with the fact that they may still be in a male-dominated specialty, and bringing up the topic of time and space for expressing breastmilk would not be well-received.

As the RRC has instituted a decline in resident work hours, this may work favorably for women doctors who choose to continue to breastfeed.  However, every woman, every specialty, and every institution is different.  What works for one may not work for another.  But I have to ask: with the passage of the new health reform bill and the increasing popularity of the Business Case for Breastfeeding, can these programs catalyze change within our medical specialties?

There is a light on the horizon. As a breastfeeding community, our efforts to educate and advocate have put the terms breastfeeding, expressing breastmilk, and workplace in the forefront.  10, 5, or even 3 years ago, we wouldn’t even be having this discussion.  My hope is that with this increasing attention, women in the medical field will feel that they have more options to continue nursing after returning to work—regardless of specialty, work hours, or stage of career.

I ask my medical colleagues: what were your experiences, and what changes can make to support our own?

Natasha K. Sriraman is a general pediatrician and a professor of Pediatrics at Children’s Hospital of The King’s Daughters/Eastern Virginia Medical School in Norfolk, VA.

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

Written by NKSriraman

January 4, 2011 at 11:29 am