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Wednesday Mar 04, 2015

Breastfeeding: What Every FP Should Know but Didn't Learn in Med School

I've always encouraged the new moms in my practice to breastfeed their babies because a mountain of evidence suggests that the practice leads to better outcomes for both mother and child. When I go back to work at the end of this month, I'll have an even greater respect for the moms who endure the frustration, fatigue and pain (even with a good latch) associated with breastfeeding because I've been doing it myself for three months. But I also will have more empathy for the women who aren't able to do it because it has been well worth the effort.

My daughter was born around the same time that a few of my physician friends also had babies. Although we learned about breastfeeding in medical school and residency, we all agree it's been more difficult than we imagined. That admittedly small consensus made me wonder how many physicians acknowledge -- or are even aware of -- how challenging it is for some of our patients.

My maternity leave, which included this trip to California, has gone by fast. Breastfeeding has helped me develop a strong bond with my daughter.

A few of my friends have struggled with low milk supply, leaving them feeling anxious and, unfortunately, inadequate at times during the already delicate postpartum period. Meanwhile, I've experienced mastitis -- complete with fever and exhaustion -- as well as oversupply issues, which came with its own host of problems.

At first, I didn't understand why my daughter was fussing, pulling away and even choking. After only a few minutes, she would fall asleep and not be interested in nursing for a few hours. It turned out she was trying to drink from the equivalent of a fire hydrant. To correct this, I pumped for a little bit each time before nursing my baby, so she could benefit from the slower, higher fat content hindmilk instead of the faster flowing foremilk that was filling her up too quickly (and making her extra gassy). Now that she's a bit bigger and my body has figured out how to correct for its overshoot mistakes, we're a much happier team.

Despite the early frustrations, there have been so many moments of absolute wonder. To personally experience the biology we all learned about was truly awe-inspiring. Oxytocin is a remarkable hormone, and nothing compares to the feeling of developing that special bond with a little human being that you created. I made a point to be mindful and present as often as I could. With all the stresses of being a new mom, it can be easy to forget to enjoy these fleeting moments.

Being a patient has been a learning experience for me, and I'm going to feel more confident in my ability to help my own patients with this issue when I go back to work. We have lactation consultants in my clinic system, but we don't have one at my specific clinic. For the moms who need immediate help or aren't able to make an extra trip to see a consultant, I'm going to be better able to troubleshoot and make suggestions.

Most women know what a baby on a breast looks like, but the correct latch is so much more complicated than many women realize. Now I have personal experience to guide me through exactly what to look for when a baby is latching -- or not -- and what signs indicate the baby is swallowing. I also know better how to instruct partners and support people about ways they can help mom and baby while they work out their intricate breastfeeding dance, from holding the baby's hands out of the way to bringing mom a tall glass of water.

And the fun doesn't end at latching. There is an entire world of breastfeeding equipment -- electric pumps, hand pumps, nursing bras, hands-free bras, nursing pads, breast compresses, nipple cream, etc. -- that I knew little about before. Knowing firsthand what the reputable brands are and what to look for in a particular product will be helpful when making recommendations to my patients.

It's important that all family physicians -- whether you provide maternity care or not -- are knowledgeable on this topic because we can help our patients who want to breastfeed be successful. If you or your practice could use some free help with breastfeeding, it's worth noting that the AAFP recently launched a new breastfeeding toolkit that includes evidence-based clinical information, coding tips, patient education materials and more.

Here in the Bronx, talking to moms about breastfeeding can be a challenge. Teenagers account for roughly 90 of every 1,000 pregnancies -- or roughly 1,800 babies -- each year. That's the highest teen pregnancy rate among New York's five boroughs.

Many of these patients are single moms still living with their own moms. They're teenagers and young adults trying to wake up every two to three hours to nurse a baby, and they are not necessarily getting a lot of support with breastfeeding at home. The majority of them don't know anyone in their community who has experience breastfeeding. Many of them also have easy access to free formula. But many are good moms trying to make good decisions.

So what am I going to do?

Despite the challenges, I still believe in the old adage, "Breast is best." It's a wonderful bonding experience for moms and babies, and the positives far outweigh any negatives. So I will continue to encourage breastfeeding as much as possible. I'll refer to lactation consultants when I need to, offer my own knowledge and experience when appropriate, and be understanding of the women who opt for formula.

I'll be back at work soon enough. One benefit of working in a family medicine clinic is that I'm surrounded by people who also believe in the benefits of breastfeeding and are dedicated to supporting the cause. Fortunately, my clinic is planning to change my schedule to help me and my family. Instead of one long lunch break, I'll get a few 15-minute breaks spread throughout the day so I can pump. I'm already practicing pumping with my hands-free bra so I will be able to chart and pump at the same time.

Every new mom should have the same type of encouragement, support and understanding.

Margaux Lazarin, D.O., M.P.H., provides comprehensive family health services, including osteopathic manipulation, at a community health center in the Bronx, N.Y. She is actively involved in teaching residents and medical students to deliver evidence-based care to underserved communities.

Posted at 10:35AM Mar 04, 2015 by Margaux Lazarin, D.O.

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