USPSTF: Evidence Shows Interventions Encourage Breastfeeding

Draft Recommendation Says Interventions Increase Initiation and Duration of Breastfeeding

April 29, 2016 04:55 pm Chris Crawford

Breastfeeding benefits mothers and their infants, as infants who are breastfed are at reduced risk for certain infections as well as chronic conditions such as asthma, obesity and diabetes. For new moms, breastfeeding is associated with a lower risk of breast and ovarian cancer and type 2 diabetes.

These statements are based on evidence(www.uspreventiveservicestaskforce.org) that the U.S. Preventive Services Task Force (USPSTF) reviewed before releasing its draft recommendation statement(www.uspreventiveservicestaskforce.org) April 26 on primary care interventions to support breastfeeding. The task force recommended interventions during pregnancy and after birth to support breastfeeding -- a "B" recommendation(www.uspreventiveservicestaskforce.org)

The USPSTF said effective primary care interventions include educating pregnant women and their families about breastfeeding and directing these patients to resources for assistance with breastfeeding and mother support groups.

Story highlights
  • The U.S. Preventive Services Task Force (USPSTF) released its draft recommendation statement April 26 on primary care interventions to support breastfeeding.
  • The USPSTF said effective primary care interventions include educating pregnant women and their families about breastfeeding and directing these patients to resources for assistance with breastfeeding and mother support groups.
  • The USPSTF commissioned a systematic evidence review to update its 2008 recommendation on primary care interventions to promote breastfeeding, which also was a B recommendation.

The task force also noted in a news release(www.uspreventiveservicestaskforce.org) that it recognizes breastfeeding is not the right choice for every mother and suggested physicians should be mindful of this when implementing interventions to support breastfeeding.

Update of 2008 Recommendation

The USPSTF commissioned a systematic evidence review to update its 2008 recommendation on primary care interventions to promote breastfeeding, which also was a B recommendation.

This update focused on the effectiveness of breastfeeding support interventions on breastfeeding initiation, duration and exclusivity. The task force conducted a literature review on child and maternal health outcome studies published since the previous review to make sure no major changes have occurred in the past eight years.

The population of interest included mothers of full- or near-term infants as well as members of the mother-infant support system (partners, grandparents or friends). The review defined primary care interventions to include any activities initiated, conducted or referred by primary care physicians.

Family Physician Weighs In

Anne Montgomery, M.D., M.B.A., of La Quinta, Calif., chaired the working group that developed the AAFP's breastfeeding position paper. She told AAFP News that she recommends family physicians talk about breastfeeding at well-woman visits, starting with adolescent patients, as appropriate.

Questions for these patients should include: What do you know about breastfeeding? Are you planning to have babies? If so, have you thought about how you will feed them? What can I tell you about breastfeeding's health effects and other benefits?

Montgomery said family physicians should use an open-ended question when they ask pregnant women early in pregnancy how they plan to feed their babies. "This shouldn’t be an either-or choice -- not, 'Are you going to breastfeed or formula feed?' but rather, 'How do you plan to feed your baby?'" she said.

If the patient answers "breastfeed," Montgomery said family physicians should ask them how they would like to be supported in this choice, if they know anyone who has breastfed and how they think their support people will feel about it. Then breastfeeding education should be included throughout prenatal care.

However, if the patient responds "formula feed," she said family physicians should explore why the patient is making this choice and make sure the choice is fully informed.

"Talk to them about whether they might be able to start with breastfeeding and get some colostrum to their babies even if they don’t think they can continue after they leave the hospital," Montgomery said. "Note that when I was doing maternity care, I had a 100 percent breastfeeding initiation rate and a handful of women who weren't going to breastfeed changed their mind after they actually tried it."

And although breastfeeding initiation rates are pretty good in many parts of the country, she described continuation rates as "pretty dismal."

"So I also explore with moms what barriers they may face," Montgomery said. "Are they returning to work? Does their husband/wife/partner or their mother support them breastfeeding?" I educate them that breastfeeding initially can be uncomfortable as their body gets used to it but tell them nipples should never be damaged and encourage them to get help right away for breastfeeding challenges."

To further support breastfeeding, she suggested family physicians consider avoiding sending formula gift packages home with new mothers and avoid marketing formula in the office in any way.

And when mothers face a complication breastfeeding, family physicians should assist them or point them in the right direction for help.

"Family physicians who don't feel comfortable providing this care themselves should have a relationship with a lactation consultant and/or a breastfeeding medicine physician for referrals/consultations," Montgomery said.

Next Steps

The USPSTF is providing an opportunity for public comment on this draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) until May 23.

The AAFP is reviewing the USPSTF's draft recommendation and will release its own recommendation after the task force publishes its final recommendation statement.

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AAFP Resources Encourage FPs to Promote, Support Breastfeeding
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