Breastfeeding Awareness A Plea to Physicians for Education and Action By Jeanne Batacan, CMA, ICCE, CD, CLC,
August was Breastfeeding Awareness Month, and August 1-7 was World Breastfeeding Week. On Saturday, August 6 at 10:30 a.m., in more than 294 locations and time zones across the globe, women and their children came together and breastfed simultaneously as part of the Big Latch On. One of those locations was in Campbell, CA, and yet, it went unnoticed and unreported. This apparent apathy about breastfeeding is partially due to lack of physician support and the general lack of education on human lactation in our medical schools. The Surgeon General Regina M. Benjamin provides us with some of the best scientific information available on how to improve health and reduce the risk of illness and injury. The Surgeon General’s Call to Action to Support Breastfeeding contains specific steps to follow to make breastfeeding accessible. www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding. pdf Breastfeeding advocates struggle to fill the educational gap between physicians and the latest updates in breastfeeding medicine. One way physicians can fill the gap is by subscribing to the bi-monthly journal of Breastfeeding Medicine, www.liebertonline.com/bfm. Physicians should also become familiar with the AAP Policy Statements, http://aappolicy.aappublications.org/cgi/content/full/ pediatrics;115/2/496#SEC8. In part, they state the “role of pediatricians and other health care professionals in protecting, promoting, and supporting breastfeeding [is]:
Education: • Become knowledgeable and skilled in the physiology and the current clinical management of breastfeeding. • Encourage development of formal training in breastfeeding and lactation in medical schools, in residency and fellowship training programs, and for practicing pediatricians.
Use every opportunity to provide age-appropriate breastfeeding education to children and adults in the medical setting and in outreach programs for student and parent groups.
Clinical Practice: • Promote hospital policies and procedures that facilitate breastfeeding. • Work actively toward eliminating hospital policies and practices that discourage breastfeeding (e.g., promotion of infant formula in hospitals including infant formula discharge packs and formula discount coupons, separation of mother and infant, inappropriate infant feeding images, and lack of adequate encouragement and support of breastfeeding by all health care staff) • Encourage hospitals to provide indepth training in breastfeeding for all health care staff (including physicians) • Have lactation experts available at all times PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506 (doi:10.1542/peds.2004-2491) This would include gifts of formula or literature by formula companies given out of medical offices as well. In fact, hospitals and offices that offer free formula to breastfed infants are in violation of the International Code of Marketing of Breast-milk Substitutes, www. who.int/nutrition/publications/code_english. pdf, as well as not complying with the U.S. Baby-Friendly Hospital Initiative designation protocols. According to the Academy of Breastfeeding Medicine (ABM), www.bfmed.org, recent studies indicate that formula feeding in the U.S. causes substantial numbers of excess infant deaths. The risk of post-neonatal (29–365 days of age) mortality is about 27% higher among infants who are never breastfed compared to infants who are ever breastfed. On this basis, nearly 1,000 infant deaths in the U.S. alone occur each year. This does not take into account the rates of infant morbidity due to formula feeding.
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What are some of the risks of NOT breastfeeding? Among full-term infants: • Surgery for acute otitis media • Hospitalization for lower respiratory tract diseases in the first year • Asthma (no family history) • Childhood obesity • Type 2 diabetes mellitus • Acute lymphocytic leukemia • Acute myelogenous leukemia • Sudden infant death syndrome Among preterm infants: • Necrotizing enterocolitis ■■ The gastrointestinal (GI) tract of a normal fetus is sterile ■■ The type of delivery has an effect on the development of the intestinal microbiota ■■ Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens ■■ Intestinal permeability decreases faster in breastfed babies than in formula-fed infants ■■ Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy ◆◆ Vaginally-born infants are colonized with their mother’s bacteria ◆◆ Cesarean-born infants’ initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serve as vectors for transfer (See full report with references at www. nababreastfeeding.org/images/ Just%20One%20Bottle.pdf) Implications for all babies – it is important that babies are colonized with their mother’s bacteria. It is imperative that serious consideration of policy be made regarding any unnecessary separation of mothers and babies
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