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Opinion: Pediatricians Need to Get With the Breastfeeding Program

Apr 6, 2010 – 5:00 AM
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Lisa Holewa

Lisa Holewa Contributor

(April 6) -- When my first daughter was born, I was a little taken aback when our very old-school pediatrician demanded to know whether I would breast- or bottle-feed her. This seemed like an intrusive question from a doctor who made it abundantly clear that I should be breastfeeding. And yet, as my newborn and I struggled through the whole strange new dance of latching on and suckling, I persisted mainly because I knew my doctor would pester me again with that same question at our follow-up visit. And I wasn't about to admit failure.

Given my own experience, I naturally assumed that every pediatrician was trained to help babies and mothers succeed at nursing -- guiding them through the difficulties and answering questions. But many aren't, and as we learned this week, the cost in health and dollars is significant.

A study published Monday in the journal Pediatrics indicates that nearly 900 babies would be saved each year, along with $13 billion, if 90 percent of women breastfed their babies for their first six months – something that only about 13 percent of moms do today. The study, by Dr. Melissa Bartick, an internist and instructor at Harvard Medical School, looked at the prevalence of 10 common childhood illnesses; the costs of treating those diseases, including hospitalization; and the level of disease protection other studies have linked with breastfeeding.

This study is just the latest pointing to the benefits of breastfeeding. And, indeed, the federal government and the American Academy of Pediatrics (AAP) have officially recommended breastfeeding over bottle feeding for many years. The federal government even established national breastfeeding goals as part of its Healthy People 2000 initiative; the Healthy People 2010 initiative aims for 50 percent of women to breastfeed exclusively for six months.

Yet, despite these efforts, many pediatricians amazingly know little or nothing about breastfeeding, and fewer still are trained to help and encourage new moms through this challenging time.

One 2004 AAP survey of pediatricians showed that 40 percent did not feel knowledgeable about breastfeeding. More than a third of pediatricians responding to the survey said they didn't receive any education about breastfeeding while in medical school or during residency. Worse, the number of pediatricians who said that the benefits of breastfeeding outweighed the difficulties and inconvenience actually declined, when compared with a similar survey done in 1995. Just last year, the AAP issued an official endorsement of World Health Organization and UNICEF's 10 Steps to Successful Breastfeeding, noting it was particularly important in light of its efforts to promote breastfeeding education for medical residents.

My old college roommate, Dr. Jenny Thomas, is a pediatrician who, like many of her colleagues, learned exactly nothing about breastfeeding in medical school and residency. She did, however, take part in classroom "taste tests" of leading infant formulas (no breast milk allowed), and she could recite formula ingredient lists and the purpose of each additive. She never encountered a nursing mother until she was a medical resident and accidentally walked into a new mom's hospital room while the woman was breastfeeding. When she had her first baby, during her residency, she quit nursing after six weeks.

Dr. Thomas is now a leading breastfeeding expert and advocate -- and one of the few pediatricians who is also a board-certified lactation consultant -- and she is the chief of the chapter breastfeeding coordinators for the AAP's Section on Breastfeeding. She teaches fellow pediatricians the proper coding for insurance companies so they can be reimbursed fairly for their breastfeeding guidance. And she discusses how more doctors can make breastfeeding guidance a profitable segment of their practices.

The medical community has to take a more active role in educating pediatricians about breastfeeding and encouraging doctors to be more actively involved in helping their patients succeed at it.

Why? Because the biggest danger to new nursing moms may not be the disapproving mother-in-law, a challenging work schedule or ugly stares from passers-by. Instead, the failure of our nation's struggling new nursing moms may fall on the shoulders of the medical professionals themselves. And, as the study published Monday suggests, all of us are paying the price for this failure.

Lisa Holewa is a former Associated Press reporter and parenting book author. She is collaborating on a breastfeeding guide with Dr. Thomas.


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