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The Breastfeeding Friendly Medical Office

team-based lactation care May 11, 2023
Baby and mother at a breastfeeding friendly doctor's office

According to the Academy of Breastfeeding Medicine protocol #14, a breastfeeding friendly practice is “A physician’s practice that enthusiastically promotes and supports breastfeeding through the combination of a conducive office environment and education of healthcare professionals, office staff, and families.” Establishing a breastfeeding friendly medical office is one intervention that can help improve breastfeeding duration and exclusivity.

Health Care Providers Can Make or Break a Breastfeeding Journey

Knowing your baby is gaining weight well and thriving is a goal for every parent! And every primary care provider wants to support the family. Imagine a 7-day-old baby who is up every one to two hours at night feeding. After breastfeeding for 45 minutes and falling asleep at the breast, they cry if their parents put them down. Not only is the family sleep-deprived but they are concerned about their newborn getting enough milk. The advice they receive from their health care provider could make or break their breastfeeding journey:  

  • They could be offered a visit in the office where a feeding could be observed along with immediate support provided by a lactation consultant and breastfeeding knowledgeable PCP (team-based visit).  At that visit they would receive education on latching, establishing milk supply, and perhaps instructed on hand expression and refeeding expressed breast milk with follow-up the next day to make certain the baby is gaining appropriately. or…
  • They could speak to triage staff that do not know how to support breastfeeding. While they are referred to see a lactation consultant “if they want,” it will be a week before an appointment is available. Because their PCP does not have any same day appointments, they are told to  supplement with formula and supplied with free formula from the office until they can be seen. When they see their PCP in a week, the infant is gaining well and receiving a bottle of formula after breastfeeding.  As the baby has gained, no further questions on “how is breastfeeding going” or guidance on addressing milk supply or pain is offered. The PCP, like many other pediatricians, does not believe the benefits of breastfeeding outweighs the challenges nor do they have knowledge on how to guide the family to address the milk supply or pain concerns, so they do not explore the difficulties further. The family weans by six weeks because supply has decreased and the baby is frustrated with latching. 

Become an Advocate: Help Families Navigate Breastfeeding Challenges

In this case, the feeding frequency, long feeds, and continued fussiness raises concern for inadequate breastmilk intake. It could be because of a shallow latch, or perhaps delayed onset of milk production because of maternal gestational diabetes, c-section, or infant ankyloglossia. Given low milk supply, or perceived low milk supply, is one of the most common reasons for early weaning from breastfeeding and with up to 44% of some families in the United States experiencing delayed onset of lactogenesis, we need to be prepared. Our job as PCPs is to help families navigate the first weeks postpartum.  We are in a position to help establish a thriving breastfeeding relationship, and to support milk supply, latching and infant weight gain. We can either be an advocate in their breastfeeding journey or a barrier. Creating a breastfeeding friendly medical office helps us become advocates. 

American Academy of Pediatrics (AAP) Breastfeeding Supportive Pediatric Practice

The AAP policy to establish a breastfeeding-friendly pediatric office provides practical guidance, summarized into 14 key points. Following implementation, practices have seen increased breastfeeding duration and exclusivity.  As studies have shown the benefits of improved breastfeeding support, more state governments increase recognition and support for these changes. 

In general a breastfeeding supportive practice needs to: 

  • Provide ongoing breastfeeding support:

Families need to receive support both preventatively and when they are having difficulties. While the most common time for difficulties is the weeks after delivery, ongoing anticipatory guidance is needed throughout the journey: at all well visits and at common periods of transition, such as returning to work.

  • Avoid creating barriers:

Families experience multiple barriers for continued breastfeeding, and while we cannot remove all barriers, we can certainly help remove some by improving access to timely support, educating ourselves on the current breastfeeding recommendations, guiding families on latching basics and hand expression, and learning how to manage the most common difficulties like pain and delayed lactogenesis. We can create a breastfeeding supportive environment by encouraging breastfeeding in the waiting rooms and during visits, training our staff on basic breastfeeding support and triage skills, and linking families with community resources. 

  • Avoid promoting infant formula:

In 2022, the Lancet series reviewed the results of a multi-country study commissioned by the World Health Organization and the United Nations Children’s Fund: How the marketing of formula milk influences our decision on infant feeding. In 2019 annual sales in the formula industry was $55 billion. The industry spends 3 to 5 billion dollars per year in marketing, which includes efforts to influence health care practices. The executive findings from this study include an assessment that the “Industry systematically targets health professionals – whose recommendations are influential – to encourage them to promote formula milk products.” We can do our part to not support aggressive marketing practices, eliminate the distribution of free formula gifts in our offices, and make certain all educational resources are noncommercial, while appropriately supporting families in the use of formula when medically indicated. 

Team-based LC/PCP Care as a Foundation

Remember, team-based lactation consultant/primary care visits help integrate breastfeeding support into the routine office visit, increase access, and enable families to receive breastfeeding supportive information throughout their breastfeeding journey. 

We have a choice! We can advocate for our breastfeeding families on a daily basis and remove barriers by improving access to evidence-based, clinically appropriate lactation support. By integrating lactation support into your practice, you are one step closer to helping your families get the support they need while improving the system of care for families.

Let’s promote, support, and  create an environment to sustain breastfeeding at every primary care practice!

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