Breast-feeding traditions can't be ignored by anyone in the family ...
Cultured milk
Valerie King, M.D., M.P.H., talks to all her patients about breast-feeding, no matter their gender or their age.
King talks to her younger female patients about the importance of breast-feeding during their well-woman visits. "I want them to be thinking about breast-feeding before they get pregnant," King said.
She tells them research shows women who breast-feed or who were breast-fed have a smaller chance of developing breast cancer.
"I want to avoid the fast-food menu approach to infant feeding," said King. "The choice between breast and bottle is not equal. I want to teach everyone that babies should go to the breast early and often."
For her older female patients, King asks them whether they were breast-fed or whether they breast-fed their children. And she asks whether they encourage their children to breast-feed.
"Grandmothers have a lot of pull in some communities," said King. "I talk to them about the benefits of breast-feeding with hope that they will pass it on to the mothers of their grandchildren."
King will mention breast-feeding when she sees male patients too, especially if their child is in the office for an ear infection or gastroenteritis.
"I mention that they might consider breast-feeding for their next baby to help avoid this type of problem," King said.
The Academy urges its members to acquire and maintain the scientific and practical knowledge related to breast-feeding so they can provide sound guidance to mothers and families regarding its value. The AAFP acknowledges that human milk is the optimal form of nutrition for infants except in instances of specific contraindications to its use.
The American Academy of Pediatrics recently issued guidelines asking women to breast-feed their babies for at least a year.
"Unfortunately, in our culture, breast-feeding isn't something people talk about. They don't see it from a young age. It's not generally done in public, and it's not promoted enough," King said.
What mothers-to-be do hear is misinformation from aunts, sisters, mothers, friends and relatives. Mothers-to-be are told about how much breast-feeding hurts and how they were bottle-fed and came out fine.
Another mixed message new moms receive is from their partners. King said in the United States, breasts are viewed in a highly sexualized way.
"We use breasts to sell cars and chicken wings," said King. "Breasts aren't portrayed as something to feed babies."
When some women want to breast-feed, their partners -- who see the breasts as their property -- get jealous of the infant taking over.
"In the community I live in, the norm for many Latinas is to both breast- and bottle-feed. It starts in the hospital and goes on for a year or more. These women will breast-feed all day long and are happy to do so, so why are they using bottles too?" said King. "It took me a long time to find out why, but for many of them the deal was when the partner comes home, the breasts are his. The bottle comes out when the partner gets home."
Women who work outside the home are often concerned that they won't be able to breast-feed. King helps them strategize the best way to go about it.
"I ask them what their workplace is like. Of course, it's more difficult for women who do not have a private office or who are in a factory-type, blue-collar job to find a place to pump at work," King said.
And if the patient can't pump at work, King recommends that they breast-feed the baby before and after work, with formula feedings in between.
"It's still better for the baby than formula-only feeding," she said. "And for many women, breast-feeding when they get home is a wonderful way to slow down and reconnect with the infant."
FPs can encourage breast-feeding in several ways. Besides talking to their patients about it, they should ensure that their reception area and exam rooms are "breast-feeding-friendly" with posters and pamphlets available to all. And there should be a comfortable place for women to breast-feed.
"The message from us and from our offices should be that breast-feeding is best for mothers and babies," said King.
Family physicians should also serve as a resource, having available a list of phone numbers for the local La Leche League chapter, lactation consultants and the local Women, Infants and Children program.
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.