The Effectiveness of Primary Care-Based Interventions to Promote Breastfeeding: Systematic Evidence Review and Meta-Analysis for the US Preventive Services Task Force

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

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