You all know the statistics or at least have a sense of the scope of the problem. While 85% of mothers in this country intend to breastfeed their infants exclusively for at least 3 months, only slightly more than 30% achieve this goal. Among the dozens of reasons for this unfortunate shortfall is what some experts view as inadequate support by primary care physicians and their offices. In the May 2017 Pediatrics, two members of the American Academy of Pediatrics Section on Breastfeeding offer a clinical report that hopes to remedy this situation (“The Breastfeeding-Friendly Pediatric Office Practice.” Pediatrics. 2017 May. 139[5]:e20170647 ). It is a document that begins with an excellent review of the background and epidemiology of breastfeeding in the United States and a survey of the current initiatives targeted at improving our dismal performance. What follows is an extensive set of 19 evidence-based recommendations for the pediatric outpatient practice that hopes to “meet or exceed the AAP recommendations.”
One certainly can’t fault the authors for their thoroughness, but therein lies the problem. Their list of 19 recommendations (I’m surprised that they couldn’t find one more to make a nice round number) includes everything from the obvious of allowing and encouraging mothers to breastfeed in the office waiting room to the difficult challenge of monitoring the “breastfeeding initiation and duration rates in the pediatric practice” that is probably already overburdened with a data hungry and clunky EMR system. Buried in the last third of this flurry of guidelines is No. 14 that begins “Train staff to follow telephone protocols to address breastfeeding concerns.” From my experience, it is at this critical patient-telephone-office interface that most practices fail to be truly breastfeeding friendly, and, as a result, salvageable nursing experiences crash.
A large part of the problem is the failure of the point person in the office, usually the receptionist, to realize that a tearful call from a new mother who is struggling with breastfeeding is an emergency, one that demands a response in minutes … not hours. Even when the call is eventually routed to someone with a compassionate voice who will call back with the right answers, if that process takes just an hour or two, that is enough time for a mother with a screaming and hungry newborn to reach for a bottle of formula.
There are very few babies who will refuse that first bottle of formula; in fact, most will avidly take it. It’s only natural, an instinct for survival. The crying will stop, and the sleep-deprived, anxious, and frazzled new mother can relax with the knowledge that her baby isn’t going to starve to death. This scenario is less likely if the hospital and pediatrician’s office have been careful to avoid providing sample packs of formula. However, there are convenience stores and inexperienced, impatient, and vulnerable husbands, grandmothers, aunts, and neighbors who are more than willing to make that short trip on what they see as a rescue mission. In too many cases the relief that comes with this bottle of formula closes the book on breastfeeding.
I urge you to read this exhaustive clinical report in Pediatrics because it is very likely you will come across some things that you can include in your office practice to make it more breastfeeding friendly. However, remember that a call from a new mother struggling with breastfeeding is time sensitive. Even if you and your staff have the right advice, this is not a situation of “better late than never.”
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.”
