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Breastfeeding Advocacy Basics

by MDr. Misty Mirmaniisty Virmani, MD FAAP

Breastfeeding is a beautiful and often difficult process that requires both mother’s and baby’s healthcare providers to be well educated in the basics of breastfeeding. Successful breastfeeding also requires well-developed community resources and family support. The University of Arkansas for Medical Sciences is promoting breastfeeding as an important public health initiative by partnering with various state health organizations to improve community breastfeeding resources and by targeting institutional education and policies toward improving breastfeeding outcomes.

We all know that breastfeeding is good for babies and for mothers too. Breastfeeding reduces overall infant mortality by 21%. (1) According to the American Academy of Pediatrics position statement on breastfeeding, exclusive breastfeeding is recommended for the first six months of life then thereafter until at least a year with complementary foods. (2) The WHO recommends breastfeeding for at least the first two years of life. (3) Evidence in literature indicates that breastfeeding reduces Sudden Infant Death Syndrome (SIDS) by 36-50% (50% is with six months of breastfeeding). (2) (4) Breastfeeding reduces Type 1 and Type 2 Diabetes incidence by 30 and 40% respectively and additionally reduces risk of ear infection, severe diarrhea, pneumonia, asthma, eczema, and inflammatory bowel disease.(2) (5)

Breastfeeding for more than six months reduces the risk of cancers like acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) by 20 and 15% respectively. (2) (5) Breastfeeding of any duration decreases risk of obesity by 24%. (2) (5) Additionally, in our high risk premature infants, breast milk decreases their risk of necrotizing enterocolitis (NEC), a devastating and frequently fatal intestinal disease, by a whopping 77% if they receive only breast milk throughout their hospitalization. (2) We also know that the more a mother breastfeeds her infant, the more she lowers her risk of premenopausal cancers of the ovaries.

So how do we advocate for our patient and educate ourselves and our patients?

Breastfeeding advocacy starts the moment a woman tells her doctor she is pregnant. Breastfeeding is the intended method of feeding and should be expected for all babies. Formula should only be utilized with medical indications for the use of formula instead of breast milk. I recommend starting with asking, “Have you thought about how you are planning on breastfeeding?” as opposed to the usual question of, “Are you going to breastfeed or bottle feed?” which implies equivalent values placed on breastfeeding and formula feeding. Presenting the information in the format of risks of not breastfeeding or risks of formula feeding generates a more encouraging response from mothers in their choice to breastfeed their baby. (5) Encourage women to identify advocates within their social networks who have breastfed or who encourage breastfeeding: their mothers, aunts, sisters, friends, co-workers, etc. Spend time at each prenatal visit talking about breastfeeding. Some topics include: support networks, countering myths and negativity, risks of formula feeding, positioning and latch, expectations after delivery, colostrum benefits, going back to work, pumping basics, long term effects of breastfeeding, and many more. Encourage attendance at a breastfeeding class early in the pregnancy; the classes offered by UAMS are FREE!

What conditions are contraindications to breastfeeding?

Some women and infants shouldn’t breastfeed but thankfully that list is very short. In the United States, because we have safe formula preparations available, HIV is a contraindication to breastfeeding and feeding mother’s own milk. Mother’s with HTLV 1 or 2 or active brucellosis should not breastfeed or provide breast milk. Active tuberculosis that has not been adequately treated is a contraindication to direct breastfeeding; however, those mothers can pump breast milk and allow someone else to feed their infants until they have completed two weeks of adequate therapy and/or have negative sputum cultures. Certain medications and treatments such as chemotherapeutic agents, radioactive isotopes and radiation therapy, antimetabolites and antiretroviral medications are absolute contraindication until the medications have stopped and cleared maternal circulation. Active herpes lesions on the breast are a contraindication to direct feeding at that breast. Substance abuse and alcohol abuse are relative contraindications to breastfeeding but the risks of formula vs. risk of exposure to the substance must be weighed by the clinician. Infant indications to avoid or limit breastmilk are galactosemia (absolute), phenylketonuria and maple syrup urine disease (modified maternal diet plus supplementation). (2)

What conditions are not contraindications to breastfeeding?

Hepatitis B and C are not contraindications to breastfeeding. Mastitis is most definitely not a contraindication, in fact it is a reason to feed or pump more frequently on the affected side. Breast abscess is likewise not a reason to stop breastfeeding, it may be painful to feed but emptying the breast is very important in the healing process and the breast milk will not harm the baby. Jaundice is almost never a reason to stop breastfeeding and supplement with formula. Poor infant weight gain, if severe, may require some supplementation, but it is rare that breast milk is inadequate in nutrients even despite poor maternal nutrition and health. Slow weight gain can usually be solved by increasing feeding frequency, which increases maternal milk supply.

What do I do when I don’t have the answer?

Lactation consultants at UAMS are available to answer questions and to see patients as outpatients.Breastfeeding advocacy means that we as the healthcare team make the effort to be fully informed about the basics of breastfeeding. In this manner we can better educate and support both the women and families that come to us for help and the communities we serve to make breastfeeding a priority for the community as a whole. Better breastfeeding means healthier children and ultimately a healthier state, which is good for all of us.

References:

  1. breastfeeding and the Risk of postneonatal Death in the united states. aimin chen, MD, phD, Walter J. Rogan, MD. 5, s.l. : pediatrics, May 2004, pediatrics, Vol. 113, pp. e435-39.
  2. policy statement: breastfeeding and the use of human Milk. american academy of pediatrics. 2012, pediatrics, pp. e827-841.
  3. World health organization. infant and young child Feeding. Who programmes: Maternal and infant health: Document centre. [online] Who, 2009. [cited: Feb 26, 2014.] http://whqlibdoc.who.int/publications/2009/9789241597494_eng.pdf.
  4. Does breastfeeding Reduce the Risk of sudden infant Death syndrome? M.M. Vennemann, t. bajanowski, b. brinkmann, g. Jorch, K. yücesan, c. sauerland, e.a. Mitchell. 2009, pediatrics, pp. e406-410.
  5. the Risks of not breastfeeding for Mothers and infants. stuebe, alison MD. 2009, Reviews in obstetrics and gynecology, pp. 222-231.
  6. breast-feeding and cognitive development: a meta-analysis. James W anderson, bryan M Johnstone, and Daniel tRemley. 1999, american Journal of clinical nutrition, pp. 525-535