The American College of Obstetricians and Gynecologists has issued an updated Opinion from their Committee on Obstetric Practice on the role of obstetric care providers in supporting breastfeeding. In it, ACOG states that the offices of obstetric providers such as ob-gyns should be a resource for breastfeeding women including clinical management, triage of common nursing challenges, and referrals to or availability of certified lactation professionals. ACOG notes that this level of support should be available through the first year and beyond for those who choose to continue nursing. The Opinion also states that many of the health benefits of breastfeeding increase the longer nursing continues.
In this update, ACOG provides more specifics on how providers are expected to support breastfeeding in their practice, at hospitals, and in the community. It even goes so far as to note how essential policies, such as paid maternity leave, availability of breaks and space to pump, and onsite childcare, are to breastfeeding success. Overall the Opinion highlights and expands the role of obstetric care providers in the initiation and continuation of breastfeeding:
“The advice and encouragement of the obstetrician–gynecologist and other obstetric care providers are critical in assisting women to make an informed infant feeding decision.”
This new Opinion replaces a previous 2007 document which stated that ACOG “strongly supports breastfeeding” and that ob-gyns and other maternity care providers “should provide accurate information on breastfeeding to expectant mothers and be prepared to support them.” The updated guidelines emphasize the importance of appropriate care for breastfeeding by ob-gyns saying,
“Clinical management of lactation is a core component of reproductive health care.”
“Because lactation is an integral part of reproductive physiology, all obstetrician–gynecologists and other obstetric care providers should develop and maintain knowledge and skills in anticipatory guidance, physical assessment and support for normal breastfeeding physiology, and management of common complications of lactation.”
Providers are now expected to know and do much more than provide accurate information and be ready to provide support for breastfeeding as the previous document stated. Additional care guidelines outlined in this new Opinion include:
- Obtain a woman’s breastfeeding history during prenatal care
- Communicate concerns or risks related to breastfeeding to the baby’s care provider
- Engage family members in discussions regarding infant feeding to address their questions or concerns
- Facilitate early and frequent milk expression in the case of preterm or “vulnerable” infants
- Breastfeeding difficulties are correlated with a higher risk of postpartum depression and appropriate screening, treatment and referral are recommended
- Skin-to-skin is associated with reduced need for formula supplementation and is feasible in the operating room following cesarean birth
ACOG has previously stated that care providers should support breastfeeding beyond providing appropriate care and information. Specifically, they suggest:
- Providers support women as they integrate breastfeeding in their daily lives, including at work
- OB-GYNs be in the forefront of policy efforts to enable women to breastfeed including education, hospital policies, community efforts and legislation
- The offices of obstetric care providers should be a resource for breastfeeding through the first year of life and beyond
The Committee Opinion also provides a list of the Top Ten Hospital Practices to Encourage and Support Breastfeeding and discourages the distribution of formula distribution via “gift packs” noting that it is a barrier to establishing breastfeeding.
ACOG states that care providers should support an informed decision regarding breastfeeding and that women are “uniquely qualified to decide” if they breastfeed and for how long.
Overall, ACOG recommends:
- Exclusive breastfeeding for the first six months
- Continued breastfeeding thereafter so long as mutually desired by mother and baby
It seems that providers will be taking a page or two from doulas on how to support breastfeeding! We know how important it is to find out a woman’s background when it comes to nursing – her previous experience, level of knowledge, cultural influences and her concerns. Including her partner and other families members in the discussion is key; and it is encouraging to see ACOG recognize that, while women are the ones who nurse, partner and family support is key to breastfeeding success, however the woman defines it. Doulas also understand the importance of being a resource for nursing mothers and referring to certified lactation professionals when needed. That doulas were not mentioned as a resource for women in establishing breastfeeding is, of course, unfortunate. Overall, external supports received very little mention in the Opinion beyond recommending certified lactation consultants and including families members in discussions of feeding choices. Childbirth education is well known to increase breastfeeding rates and was also not mentioned. It is encouraging that ACOG recognized workplace and cultural challenges to breastfeeding in the U.S., and we can hope that future recommendations will address a wider range of support resources for nursing families including doulas.
— Adrianne Gordon, CD(DONA), MBA, Blog Manager