Only 22 percent of mothers in the United States are exclusively breastfeeding their babies at six months. Although most U.S. women initiate breastfeeding, more than half wean earlier than they desire and fall short of their personal goals. These are startling statistics given all the research and evidence we have that shows how beneficial it can be for both women and babies. That says to me that we, as providers, can do more to empower women with the knowledge to make this critical decision. As National Breastfeeding Month comes to a close, it seems like an appropriate time to remind us how important our guidance really is and the potential impact it could make on health outcomes.
There are many barriers to successful breastfeeding but I believe the key to overcoming them starts with education—the one factor that physicians have the most control over. Misinformation can often be the culprit when it comes to a mother making the decision not to breastfeed. Discussions about breastfeeding should be integrated into maternity care. Providers should obtain a thorough history and find out early what expectant mothers know or have heard about breastfeeding. Often times, it’s as simple as mitigating fears regarding pain associated with breastfeeding and letting mothers know that it might not come naturally at first and that, with the right support, techniques are learned and will improve over time. Providers should respect and support a woman’s informed decision whether to initiate or continue breastfeeding, as each woman is uniquely qualified to decide which feeding option is best for herself and her infant. However, pregnant mothers take their doctors’ advice seriously, so we shouldn’t underestimate our influence. By saying nothing, we imply that it doesn’t matter—and it does.
Much of what mothers learn about breastfeeding is a result of what they are inadvertently taught through their experiences in the hospital. ACOG recommends exclusive breastfeeding for the first six months with continued breastfeeding as complementary foods are introduced through the infant’s first year of life. Yet, some clinical practices and/or policies aren’t designed to support this. Something as seemingly inconsequential as delaying that initial skin-to-skin contact after birth or separating mothers from their babies during their hospital stay can have a negative impact. Also, some birth facilities or hospitals unnecessarily give supplemental feeding to breastfed newborns or support advertising for or provide samples of infant formula. This all has the potential to hamper a mother’s determination to try or continue breastfeeding.
As we strive to meet the U.S. Department of Health and Human Services’ Healthy People 2020 goals for breastfeeding, I’d like to stress how important it is for providers to give women the tools to make informed decisions about their health and the health of their babies. To that end, ACOG formed the Breastfeeding Expert Work Group in 2014 and has issued an updated Committee Opinion, as well as a recent webinar to help ob-gyns stay up-to-date on the latest clinical guidance.
Efforts to protect women’s rights, specifically the ability to breastfeed, such as paid maternity leave, onsite childcare, and break time and rooms for expressing milk have been hard-fought and are still ongoing. We must continue to uphold the spirit and intention of those efforts by being defenders of the first important choice a mother will make in the life of her baby.