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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Re: Breastfeeding should not be a "quota thing"; one size does not fit all
One patient's experience
Breastfeeding should not be a "quota thing"; one size does not fit all
Physicians Lack Breastfeeding Knowledge
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Shera C. Jackson, Lubbock, USA Graduate Student in Human Development and Family Studies at Texas Tech University
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I have a problem with the statement, "There are some women who should not breastfeed, especially those who suffer from postpartum depression and who are experiencing major stress from breastfeeding." It is wrong to say these women should not breastfeed. They in fact should breastfeed but should be treated for postpartum depression and provided with professional lactation help. If they choose not to breastfeed that is fine but to make a blanket statement that all women with postpartum depression should not breastfeed is wrong. The person who made this statement has generalized an entire group of women based off one person and her own grief. It is terribly sad but to make an all inclusive statement with no research to back it up is unprofessional and detrimental to other women and their infants. Competing interests: None declared |
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Elaine H Menard, Rochester, USA former breastfeeding mom to three children
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I breastfed all three of my children. My older two were breastfed for an extended time---well over two years---and my youngest was breastfed for 15 months. I have found quite a range of experience in the family physicians I have encountered over the past seven years. All of them have expressed that they believe breastfeeding is best whenever possible. I do believe that most physicians, despite the brief training received in medical school, understand very little about the actual process of lactation. There are cases where it is better for a mother not to breastfeed her infant. On the other hand, there are also cases where breastfeeding should be strongly encouraged. Rather than act as someone who knows all, it might be better for a physician to admit that s/he does not know everything there is to know about breastfeeding. Along with this, a physician should be well- acquainted with the community resources for supporting mothers who choose to breastfeed and might be experiencing problems. These would be lactation consultants, groups like the La Leche League, or the local hospital support group for mothers. A woman should be encouraged to access these resources and be handed the information before she leaves the office. It might also be helpful to follow up on the office visit with a nurse call to see how things are going 24-48 hours later. In addition, mothers who have concerns about how well their baby is gaining should be allowed to come to the office and weigh their baby. Surely such a feat can be accomplished without disrupting office flow and bankrupting the patient in the process. A mother who is having problems with a baby who is gaining poorly or who appears to be feeding poorly might well jump at free formula samples. When used appropriately, formula is suitable. It can, however, interfere with a woman's ability to produce milk in the quantity necessary for her infant. Many problems can be resolved with sensitive and judicious help. Unlike some problems, correcting breastfeeding issues is often a hands-on process. It requires sensitivity and discretion. Those early weeks are especially important for establishing a mother's supply. Free formula packs do discourage breastfeeding. How easy is it for an exhausted parent to reach for formula and a bottle in the middle of the night? This is when physician support becomes critical. Once the early weeks are over, breastfeeding often settles into a rhythm that is beneficial for mom and baby. What better prescription than to sit and relax with baby. Mothers will bond with their babies no matter how they choose to feed. A physician should be quick to reassure that the mother's bond will not suffer if a woman uses a bottle or some combination of breast and bottlefeeding. On the other hand, breastmilk is always going to be superior to formula. It is specifically bioengineered. For the mom who is wavering between making the choice to start breastfeeding or who is wavering between the choice to stop breastfeeding, support from her family physician is crucial. Competing interests: None declared |
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Helena M. Bradford, Mt. Pleasant, SC USA Chairman, Ruth Rhoden Craven Foundation for Postpartum Depression Awareness
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I am increasingly concerned about the "push" for moms to breastfeed. This should not be a "quota thing". Whether to breastfeed or not is a very personal decision and one where there should be no coersion. I understand there are many benefits derived from breastfeeding and I have no problem with women choosing to breastfeed. But those benefits do not outweigh making a mother who chooses not to breastfeed feel as if she is guilty of child neglect. There are some women who should not breastfeed, especially those who suffer from postpartum depression and who are experiencing major stress from breastfeeding. My daughter was one of those moms. Problems experienced with breastfeeding exacerbated the severity of her PPD. That, along with very poor medical treatment resulted in her suicide almost 4 years ago. Breastfeeding is terrific for some women, but not ALL women. It is even helpful to some women suffering from PPD when it is problem-free. Please be very careful about the amount of stress placed on moms to breastfeed! I repeat, this should not be a "quota thing". Thank you for all the beneficial articles shared in this newsletter. They have been very helpful to our work in postpartum depression awareness. We would love for you to visit our website at www.ppdsupport.org Sincerely, Helena Bradford Ruth Rhoden Craven Foundation for Postpartum Depression Awareness Competing interests: None declared |
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Christine E. Henrichs, MD Faculty Development Fellow UPMC St. Margaret
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To the editor: I appreciate Dr. Guise and colleagues' work to find primary care-based interventions that improve the initiation and duration of breastfeeding.1 I can easily accept that educational programs are effective in this endeavor. There is another variable which is currently lacking and if optimized could combine with educational programs to yield even higher results. This variable is the knowledge of the physician. Breastfeeding is endorsed by most physicians, yet many physicians lack the knowledge needed to adequately counsel women in this area. A national survey of 5035 primary care physicians found significant deficits in the knowledge of the clinical management of breastfeeding.2 It is not enough for physicians to be able to list the advantages of breastfeeding. They must also be able to instruct women in the mechanics and to handle common breastfeeding problems. If a woman who desires to breastfeed encounters problems and cannot find physician support, she is much more likely to discontinue. Family physicians are inadequately trained for their role in breastfeeding. In the aforementioned survey, 50% of all practicing physicians reported their training of breastfeeding counseling inadequate and only 55% of senior residents could recall one instance of precepting related to breastfeeding. A group in Wisconsin developed a breast feeding curriculum for family medicine residents that, when implemented, greatly improved clinical diagnostic skills and comfort when dealing with the topic of breastfeeding.3 Formal curriculums like this one must be integrated into our training programs if we desire physicians to have a positive impact on the statistics of breastfeeding. 1. Guise J, Palda V, Westhoff C, Chan BKS, Helfand M, Lieu TA. The effectiveness of primary care-based interventions to promote breastfeeding: systematic review and meta-analysis for US preventative services task force. Annals of Family Medicine 2003;1(2):70-8. 2. Freed GL, Clark SJ, Sorenson J, Lohr JA, Cefalo R, Curtis P. National assessment of physicians' breast-feeding knowledge, attitudes, training, and experience. JAMA 1995;273(6):472-6. 3. Haughwout JC, Eglash AR, Plane MB, Mundt MP, Fleming MF. Improving residents' breastfeeding assessment skills: a problem-based workshop. Family Practice 2000;17:541-6. Competing interests: None declared |
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