Obstetrician-gynecologists need to respect and support a woman's decision on initiating or continuing breastfeeding, according to a new opinion issued by The American College of Obstetricians and Gynecologists.
The opinion replaces one issued in February 2007 and states that although the college "strongly encourages" women to breastfeed, each woman "is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding, or formula feeding is optimal for her and her infant."
"Although most women in the United States initiate breastfeeding, more than one half wean earlier than they desire," the opinion stated. "In addition, substantial disparities persist in initiation and duration of breastfeeding that effect population health. Maternity care policies and practices that support breastfeeding are improving nationally; however, more work is needed to ensure all women receive optimal breastfeeding support during their maternity stay. Given this mismatch between women's intentions for and experience of breastfeeding, the previous version of this Committee Opinion was revised to address how obstetricians-gynecologists and other obstetric care providers can enable women to achieve their infant feeding intentions."
Specifically, ACOG recommends that women breastfeed exclusively for the first 6 months and continue breastfeeding as foods are introduced through the first year of life, or longer. These recommendations align with those from other organizations, including the American Academy of Pediatrics, the Association of Women's Health, Obstetric and Neonatal Nurses and WHO.
ACOG cited that interruption of lactation is associated with various adverse outcomes, including, "higher maternal risks of breast cancer, ovarian cancer, diabetes, hypertension and heart disease, and greater infant risks of infectious disease, sudden infant death syndrome and metabolic disease."
"Moms deserve better support, and obstetric providers can and must help, both by assisting their patients and by advocating for policies and practices that enable women to achieve their goals," Alison Stuebe, MD, lead author of the committee opinion, said in a press release.
Obstetricians-gynecologists should obtain a breastfeeding history during prenatal care to identify concerns and risk factors that may make breastfeeding difficult. ACOG explicitly states that providers must ensure patient comprehension and keep any conversations free from "coercion, pressure or undue influence." Any concerns should be communicated to the infant's health care provider, according to the revised opinion.
ACOG also urged providers to support women who have given birth to preterm infants by providing education and guidance and also coordinating with hospital staff to initiate early and frequent milk expression. The organization noted that human milk feeding is associated with a reduced risk of infectious morbidities such as necrotizing enterocolitis.
Women who deliver via Cesarean birth are less likely to breastfeed, according to ACOG, and may need additional support. Skin-to-skin contact may help in this situation, as it is associated with reduced formula supplementation, they wrote.
ACOG also stressed the importance of helping women manage breastfeeding issues such as infections, low supply and pain by coordinating care and discussion contraception, even if a woman is not ovulating due to breastfeeding.
Additionally, the congress recommended that obstetricians-gynecologists monitor women who experience breastfeeding difficulties, as they are at higher risk of postpartum depression. Such patients should be screened, treated and referred appropriately, ACOG stated.
Finally, the college clarified its position on breastfeeding in the community, saying that policies that "protect the right of the woman and her child to breastfeed" are "essential to sustaining breastfeeding." Some of these policies include paid maternity leave, on-site childcare, break time and a location other than a bathroom for expressing milk.
"Obstetric care provider offices and hospitals can set an example through supportive policies for lactating staff, accommodations for nursing patients, awareness and educational materials and staff training," the opinion stated. – by Chelsea Frajerman Pardes
Optimizing support for breastfeeding as part of obstetric practice. Committee Opinion No. 658. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e86–92.