January 2001 • Volume 7 Number 1
Join renewed campaign to promote breast-feeding
BY SHERI PORTER
Despite years of studies proving the benefits of breast-feeding for babies and moms, experts are still trying to convince the public that "breast is best."
As part of a renewed educational effort, the Department of Health and Human Services released its HHS Blueprint for Action on Breastfeeding last fall. The plan recommends that infants should be exclusively breast-fed for six months and that, ideally, breast-feeding should continue through the first year of life. Announcing the plan, Surgeon General David Satcher, M.D., Ph.D., said, "Low breast-feeding rates documented in the HHS Blueprint are a serious public health challenge, particularly in certain minority communities."
Satcher, a family physician, referred to statistics revealing racial and ethnic disparities. In 1998, only 45 percent of black American women breast-fed their newborns, and the figure dropped to 19 percent after the babies were 6 months old. By contrast, figures for American mothers as a whole were higher, with 64 percent breast-feeding after delivery, but only 29 percent still nursing six months later.
What's going on? For one thing, many physicians sorely lack breast-feeding expertise. Addressing this problem, the HHS plan calls for increased training for health care providers, including continuing education requirements.
But the lack of physician expertise in this area isn't new. A 1995 study co-authored by Gary Freed, M.D., and published in the Journal of the American Medical Association found, "overall, physician involvement in breast-feeding promotion was endorsed by 90 percent of respondents, yet only half rated themselves as effective in counseling breast-feeding patients." Back in 1993, Freed wrote in JAMA, "It is indeed time to teach what we preach."
Position paper due next summer The AAFP's Commission on Public Health, chaired by Leah Raye Mabry, M.D., of Pleasanton, Texas, is developing a breast-feeding position paper with input from an 11-member advisory committee. FPs, including Alicia Dermer, M.D. (see story on this page), are working on the paper, to be published next summer. Mabry, who also chairs the breast-feeding advisory committee, called breast-feeding a "natural wonder." She said the purpose of the paper is to "provide the family physician with an understanding of breast-feeding and its impact on the infant and the family." Wherever possible, Mabry said, "content will be evidence-based and supported by experts." The commission received funding for this project from the HHS Maternal and Child Health Bureau.
Alicia Dermer, M.D., of the family medicine department at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick, couldn't agree more. Dermer presented a session on the family physician's role in encouraging and facilitating breast-feeding at the Conference on Patient Education Nov. 16-19 in Albuquerque, N.M.
Physicians have a responsibility to promote breast-feeding, Dermer said, because it's a critical public health issue: "Any time a physician misinforms a woman and has her wean, that decision has a direct health impact on her baby and, potentially, on her."
Tap your enormous power of influence, Dermer said. "Use teachable moments in the practice to normalize breast-feeding -- make it part of what you teach every day in interacting with patients."
What you don't say counts, too. "The omission of a statement has a powerful effect. If physicians don't talk about breast-feeding, people may assume it's not that important," said Dermer.
But winning a woman over to breast-feeding is only the beginning. Keeping new moms nursing can be just as challenging. Encourage your breast feeding moms with positive feedback, said Dermer. "When mom brings the healthy 4-month-old in for a check-up and says he hasn't been sick at all, smile and say, 'Wonderful ... it's because you're breast-feeding.'"
Discourage bottle-feeding by making your office a formula-free zone. "That's not to say we can't prescribe formula if someone needs it, but we shouldn't give out samples and literature from formula companies," Dermer said.
She makes her office breast-feeding-friendly, and her growing practice proves it, as nursing moms flock to her for the support they weren't getting elsewhere.
"In fact, there is another reason to learn about and support breast-feeding. As mothers become more educated, they want a supportive doctor who won't constantly tell them they should be weaning -- and they're going to vote with their feet," said Dermer.
Strategies to promote breast-feeding
- Educate yourself.
- Make it clear that breast-feeding is the norm.
- Hang pictures of nursing moms in your office.
- Post a sign, "You are welcome to breast-feed here."
- Discuss breast-feeding whenever the topic is relevant.
- Train your staff to present a consistent, positive message about breast-feeding.
- Help patients work through breast-feeding challenges.
- Utilize resources such as the HHS Blueprint available at http://www.4woman.gov/Breastfeeding/index.htm and AAFP's Physicians' Breastfeeding Support Kit available at http://www.aafp.org/shop/926 or by calling (800) 944-0000 (request #R926, free).
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