Open conversations may increase breast-feeding practice

Adetola Louis-Jacques
Adetola Louis-Jacques

CDC data suggest that the percentage of babies who start out breast-feeding is now 83% among babies born in 2014, up from 73% in 2004. The agency suggests that number should, and could, go even higher.

“There is more work to be done. Although more women are breast-feeding and breast-feeding for longer, disparities remain,” the CDC states on its website. “Addressing such challenges will require coordination and collaboration at all levels — from families, to health care providers, to communities — so that every baby gets the best start in life.”

Adetola Louis-Jacques, MD, an assistant professor of maternal-fetal medicine at the University of South Florida and member of the American Congress of Obstetricians and Gynecologists’ breast-feeding expert work group, suggested that open conversations could potentially get more women to breast-feed and help address their specific concerns.

“One of the first things medical professionals can do is to avoid stereotypes. Breastfeeding should be discussed with patients regardless of their race, socioeconomic status or how many children they have. It is not helpful to assume she will not breast-feed and thus not even start the conversation,” Louis-Jacques said in an interview. “We have to avoid these biases and have conversations about breast-feeding with applicable patients. We need to start by asking, not assuming, and doing all that we can to help.”

To help primary care physicians help their patients, and in conjunction with National Breastfeeding Month, Healio Family Medicine asked Louis-Jacques and Kathleen Green, MD, a board-certified obstetrician/gynecologist at University of Florida Health, about the benefits of breast-feeding, possible misconceptions regarding the practice, as well as other conversations that primary care doctors can have with their patients, to see if breast-feeding is right for them. - by Janel Miller

Question: What are some of the benefits of breast-feeding that primary care physicians may not be aware of?

Kathleen Green
Kathleen Green

Green: Breast milk is the perfect nutrition and has tons of antibodies which help protect infants from getting sick. Studies show that breast-fed babies are less likely to get ear infections, respiratory infections, and chronic conditions like asthma. Breast-feeding also has benefits for mom, such as decreased breast cancer risk and quicker return to pre-pregnancy weight. Breast-feeding burns an estimated 500 calories a day ... and is also much cheaper than formula.

Louis-Jacques: Other benefits to moms include lower risks of developing ovarian cancer, endometrial cancer, hypertension, diabetes and cardiovascular diseases (CVD). For the baby, the risk for SIDS, necrotizing enterocolitis, childhood leukemia and lymphoma, and metabolic diseases are lower in those who are breast-fed.

Question: What are some of the more common medications and diseases that might make breast-feeding contraindicated?

Green: Mothers with HIV, untreated tuberculosis, abuse of street drugs, herpes of the breast should not breast feed. Breast modification – most commonly reduction, but sometimes enhancement as well – can make it difficult to produce enough milk. Hypothyroidism and PCOS can also sometimes result in low milk supply. When it comes to medications, radiation or chemotherapy drugs and estrogen-containing birth control pills can cause a decrease in milk supply. In addition, some psychiatric medications may be safer than others. Infants with galactosemia, a rare condition where the child requires a special diet, also cannot be breast fed.

Question: Are there any myths associated with breast-feeding?

Green: One: Breast-feeding is easy: In reality, breast-feeding is hard because the mother and baby are both trying to figure things out. It is normal for the mother to feel clueless and uncomfortable in the beginning. Breast-fed babies often feed every 30 minutes to every hour for a couple weeks to increase the breast milk supply. It is normal for babies to be constantly on the breast or fall asleep at the breast.

Two: “I don't have enough milk.” This is often the biggest fear for mothers because the baby is constantly eating. The child is on the breast to help establish the milk supply. The infant’s stomach is also very tiny so they have to eat frequently to fill up their stomach. Most babies lose weight after birth and it can take up to 2 weeks to return to birth weight. It's not because the mother doesn't have enough milk; it’s natural for babies to lose weight.

Three: Breast-feeding should be painless. Although breast-feeding hurts in the beginning because baby is sucking very hard to get very little out, the pain typically goes away in a couple weeks.

Louis-Jacques: A lot of people also say breast-feeding is natural, and though it is, it is not always intuitive for mothers. It can be challenging at the beginning and sometimes it can take someone watching the latch or showing the parent how to latch to ensure it is done correctly.

Question: What conversations should a doctor have, and not have, with their patients when discussing breast-feeding?

Green: “Are you planning on breast-feeding?” is a good question to start with. I typically ask patients if they were able to breast-feed their first child if it is not their first pregnancy. I ask, “Were you able to meet you breast-feeding goals with your first child?” “What difficulties did you encounter?” “Do you think your partner or family and friends will be supportive with your desire to breast-feed?” I think the most important thing to start the conversation about breast-feeding is to list all the benefits. Let patients know that breast-feeding is hard in the beginning, that it takes a good 4-6 weeks to really get the hang of it and there are plenty of resources and support available.

Louis-Jacques: Primary care physicians should not take an all or none attitude. Patients who have significant medical problems such as diabetes or obesity, may not produce as much milk as others, or produce milk as early as you might think. It’s important to keep these things in mind when talking to patients so that they don’t feel as though they’ve failed after trying so hard. It is also good to inform mothers that those with adverse pregnancy outcomes have higher risks of developing chronic diseases; women with preeclampsia have a steeper trajectory to CVD and women with gestational diabetes have a much higher likelihood of developing diabetes mellitus within 5 years. Breastfeeding could be discussed as a preventative tool in these scenarios.

Also, some moms may choose to mix feed or not breastfeed at all after they have been fully informed based on their life circumstances. These decisions should be respected. Primary care physicians can help support policies that make it easier for mons to breastfeed such as paid family medical leave, onsite childcare, break time and a site other than a bathroom for milk expression.

Green: A lot of women feel a lot of guilt if they aren't able to successfully breast-feed, so never tell a woman she just didn't try hard enough or tell a woman that she won't be able to breast-feed at all. A woman may have an increased risk of low milk supply, but they can still try and supplement. Also, never tell a woman to pump after drinking alcohol. If a woman is able to drive, she can breast-feed. There’s also no need to pump and dump after dental procedures or surgery. As long as a woman is awake, she can breast-feed.

Further reading:

American Congress of Obstetricians and Gynecologists Webpage on Breast-feeding https://www.acog.org/About-ACOG/ACOG-Departments/Breastfeeding Accessed Aug. 22, 2017.

CDC’s Webpage on Breast-feeding https://www.cdc.gov/breastfeeding/ Accessed Aug. 22, 2017

Disclosure: Neither Green nor Louis-Jacques report any relevant financial disclosures.

Adetola Louis-Jacques
Adetola Louis-Jacques

CDC data suggest that the percentage of babies who start out breast-feeding is now 83% among babies born in 2014, up from 73% in 2004. The agency suggests that number should, and could, go even higher.

“There is more work to be done. Although more women are breast-feeding and breast-feeding for longer, disparities remain,” the CDC states on its website. “Addressing such challenges will require coordination and collaboration at all levels — from families, to health care providers, to communities — so that every baby gets the best start in life.”

Adetola Louis-Jacques, MD, an assistant professor of maternal-fetal medicine at the University of South Florida and member of the American Congress of Obstetricians and Gynecologists’ breast-feeding expert work group, suggested that open conversations could potentially get more women to breast-feed and help address their specific concerns.

“One of the first things medical professionals can do is to avoid stereotypes. Breastfeeding should be discussed with patients regardless of their race, socioeconomic status or how many children they have. It is not helpful to assume she will not breast-feed and thus not even start the conversation,” Louis-Jacques said in an interview. “We have to avoid these biases and have conversations about breast-feeding with applicable patients. We need to start by asking, not assuming, and doing all that we can to help.”

To help primary care physicians help their patients, and in conjunction with National Breastfeeding Month, Healio Family Medicine asked Louis-Jacques and Kathleen Green, MD, a board-certified obstetrician/gynecologist at University of Florida Health, about the benefits of breast-feeding, possible misconceptions regarding the practice, as well as other conversations that primary care doctors can have with their patients, to see if breast-feeding is right for them. - by Janel Miller

Question: What are some of the benefits of breast-feeding that primary care physicians may not be aware of?

Kathleen Green
Kathleen Green

Green: Breast milk is the perfect nutrition and has tons of antibodies which help protect infants from getting sick. Studies show that breast-fed babies are less likely to get ear infections, respiratory infections, and chronic conditions like asthma. Breast-feeding also has benefits for mom, such as decreased breast cancer risk and quicker return to pre-pregnancy weight. Breast-feeding burns an estimated 500 calories a day ... and is also much cheaper than formula.

Louis-Jacques: Other benefits to moms include lower risks of developing ovarian cancer, endometrial cancer, hypertension, diabetes and cardiovascular diseases (CVD). For the baby, the risk for SIDS, necrotizing enterocolitis, childhood leukemia and lymphoma, and metabolic diseases are lower in those who are breast-fed.

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Question: What are some of the more common medications and diseases that might make breast-feeding contraindicated?

Green: Mothers with HIV, untreated tuberculosis, abuse of street drugs, herpes of the breast should not breast feed. Breast modification – most commonly reduction, but sometimes enhancement as well – can make it difficult to produce enough milk. Hypothyroidism and PCOS can also sometimes result in low milk supply. When it comes to medications, radiation or chemotherapy drugs and estrogen-containing birth control pills can cause a decrease in milk supply. In addition, some psychiatric medications may be safer than others. Infants with galactosemia, a rare condition where the child requires a special diet, also cannot be breast fed.

Question: Are there any myths associated with breast-feeding?

Green: One: Breast-feeding is easy: In reality, breast-feeding is hard because the mother and baby are both trying to figure things out. It is normal for the mother to feel clueless and uncomfortable in the beginning. Breast-fed babies often feed every 30 minutes to every hour for a couple weeks to increase the breast milk supply. It is normal for babies to be constantly on the breast or fall asleep at the breast.

Two: “I don't have enough milk.” This is often the biggest fear for mothers because the baby is constantly eating. The child is on the breast to help establish the milk supply. The infant’s stomach is also very tiny so they have to eat frequently to fill up their stomach. Most babies lose weight after birth and it can take up to 2 weeks to return to birth weight. It's not because the mother doesn't have enough milk; it’s natural for babies to lose weight.

Three: Breast-feeding should be painless. Although breast-feeding hurts in the beginning because baby is sucking very hard to get very little out, the pain typically goes away in a couple weeks.

Louis-Jacques: A lot of people also say breast-feeding is natural, and though it is, it is not always intuitive for mothers. It can be challenging at the beginning and sometimes it can take someone watching the latch or showing the parent how to latch to ensure it is done correctly.

Question: What conversations should a doctor have, and not have, with their patients when discussing breast-feeding?

Green: “Are you planning on breast-feeding?” is a good question to start with. I typically ask patients if they were able to breast-feed their first child if it is not their first pregnancy. I ask, “Were you able to meet you breast-feeding goals with your first child?” “What difficulties did you encounter?” “Do you think your partner or family and friends will be supportive with your desire to breast-feed?” I think the most important thing to start the conversation about breast-feeding is to list all the benefits. Let patients know that breast-feeding is hard in the beginning, that it takes a good 4-6 weeks to really get the hang of it and there are plenty of resources and support available.

PAGE BREAK

Louis-Jacques: Primary care physicians should not take an all or none attitude. Patients who have significant medical problems such as diabetes or obesity, may not produce as much milk as others, or produce milk as early as you might think. It’s important to keep these things in mind when talking to patients so that they don’t feel as though they’ve failed after trying so hard. It is also good to inform mothers that those with adverse pregnancy outcomes have higher risks of developing chronic diseases; women with preeclampsia have a steeper trajectory to CVD and women with gestational diabetes have a much higher likelihood of developing diabetes mellitus within 5 years. Breastfeeding could be discussed as a preventative tool in these scenarios.

Also, some moms may choose to mix feed or not breastfeed at all after they have been fully informed based on their life circumstances. These decisions should be respected. Primary care physicians can help support policies that make it easier for mons to breastfeed such as paid family medical leave, onsite childcare, break time and a site other than a bathroom for milk expression.

Green: A lot of women feel a lot of guilt if they aren't able to successfully breast-feed, so never tell a woman she just didn't try hard enough or tell a woman that she won't be able to breast-feed at all. A woman may have an increased risk of low milk supply, but they can still try and supplement. Also, never tell a woman to pump after drinking alcohol. If a woman is able to drive, she can breast-feed. There’s also no need to pump and dump after dental procedures or surgery. As long as a woman is awake, she can breast-feed.

Further reading:

American Congress of Obstetricians and Gynecologists Webpage on Breast-feeding https://www.acog.org/About-ACOG/ACOG-Departments/Breastfeeding Accessed Aug. 22, 2017.

CDC’s Webpage on Breast-feeding https://www.cdc.gov/breastfeeding/ Accessed Aug. 22, 2017

Disclosure: Neither Green nor Louis-Jacques report any relevant financial disclosures.