Medical Texts Lack Breastfeeding Information
< May. 07, 2008 > --
Doctors coaching new nursing mothers will find little practical advice to share
from some of the classic obstetrics textbooks, a new study suggests.
Some of the texts omit key information for solving
breast-feeding problems and others are inaccurate about the key steps involved,
according to a study presented at this week's annual meeting of the Academy
of Obstetricians and Gynecologists, in New Orleans.
Three of these "bibles" of obstetrics are not as
"up-to-date or nearly as complete as they should be," contends study researcher
Dr. Tony Ogburn, director of the department of obstetrics and gynecology at the
University of New Mexico.
Dr. Ogburn believes that breast-feeding has been a
neglected problem for some time, because some physicians have passed the buck -
each seeing it as the provenance of another physician specialty, or of nurses
who specialize as lactation consultants.
While doctors in urban areas may be able to defer to
lactation consultants, those who have a broader scope of practice in rural areas
will miss the training they need on breast-feeding, adds Dr. Adam Aponte, chair
of pediatrics and ambulatory care at Manhattan's North General Hospital. He was
not involved in the new research.
Breast-feeding is not as easy as people think and "needs a
lot of encouragement and support early on," he adds, and "with frustration,
mothers can switch very quickly to the bottle."
On the other hand, gentle and accurate instruction about
how to hold the baby to the breast properly can reduce some of the discomfort
some nursing mothers experience, Dr. Aponte says.
The new review covered what the authors called "the five
most popular obstetrics and gynecology textbooks based on sales." Dr. Ogburn
gives two of the textbooks in the study - the 2003 edition of
Maternal-Fetal Medicine, edited by Robert K. Creasy
and Robert Resnick, and the 2007 edition of Obstetrics:
Normal and Problem Pregnancies, edited by Steven G. Gabbe, et al. - high
marks for providing complete and accurate information on breast-feeding.
But he says doctors' "general lack of interest in
breast-feeding is reflected in three other textbooks" -
Williams Obstetrics, 2005 edition, edited by F. Gary Cunningham, et al.,
Danforth's Obstetrics and Gynecology, 2003, edited
by James R. Scott, et al., and the 2006 edition of
Beckmann's Obstetrics and Gynecology, edited by Charles R.B. Beckmann, et
al.
"There's not the focus on it or interest that there should
be," Dr. Ogburn contends.
In their review of five widely used textbooks, Dr. Ogburn,
along with colleagues at Boston University, found the omission of key
information and, in some cases, actual errors, he says.
For example, one text mistakenly advised that putting
newborns on a feeding schedule is fine, while research shows that babies should
be fed "on demand" - that is, whenever they are hungry, Dr. Ogburn says. Mothers
sometimes fear that they will not have sufficient milk if they nurse too often,
but nursing actually stimulates increased milk production, says Dr. Ogburn.
Another text also omitted a discussion of the
inadvisability of supplementing mothers' milk with formula within the first 48
to 72 hours after delivery, Dr. Ogburn adds. Suckling is crucial in this
postnatal period to stimulate the mother's breast milk. Meanwhile, nursing
infants receive colostrum (especially healthy "first" or "immune" milk) from the
mother's breast. Colostrum passes on the mother's immunity to the baby and
protects it in the first month of life, Dr. Ogburn explains. He adds that
mothers who supplement breast-feeding with formula during the first 72 hours are
less likely to breast-feed later.
Dr. Ruth Lawrence, a professor of pediatrics at the
University of Rochester who authored the breast-feeding section in one of the
praised texts, says she and others have been trying for a number of years to
increase the number of physicians who are well-informed about breast-feeding.
"Everybody knows that breast-feeding is good," Dr.
Lawrence says. "But not everybody knows how to help mother succeed."
The Centers for Disease Control and
Prevention's Healthy People 2010 goals and a policy statement from the American
Academy of Pediatrics (AAP) recommend exclusive breast-feeding for the
first six months, Dr. Ogburn says. Healthy People 2010 has set a goal for 50
percent of mothers to be nursing when their infants are six months old, compared
with the 29 percent reported in 1998.
The benefits of breast-feeding for the child range from
fewer upper respiratory infections to better bonding and lower rates of
diabetes, Dr. Ogburn notes. And the AAP says
that benefits to the mother include an earlier return to pre-pregnancy weight
and a decreased risk of breast and ovarian cancer.
Always consult your physician for more information.
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The process of breastfeeding and your milk change as
your baby grows and develops. A newborn's feeding routine may be different
than that of a breastfeeding 6-month-old. As the baby grows, the nutrients
in your milk adapt to your growing baby's needs. The anti-infective
properties also increase if you or your baby is exposed to some new bacteria
or virus.
The first weeks of breastfeeding should be considered a
learning period for both you and your baby. Do not expect to work as a
coordinated team immediately. Give yourselves plenty of time to recuperate
from labor and birth, develop a daily routine, and overcome any initial
breastfeeding difficulties.
Most full-term, healthy babies are ready and eager to
begin breastfeeding within the first half hour to two hours after birth.
Then, many sleep or act drowsy for the next two to 20 hours, so a baby may
not be very interested in breastfeeding again on his/her birthday. However,
a baby should breastfeed several times that first day. Expect to change only
a couple of wet and dirty diapers during the first 24 hours.
Although he/she may need practice with latching on and
sucking, by the second day, your baby should begin to wake and cue (show
readiness) for feedings every 1½ to 3 hours for a total of 8 to 12
breastfeedings in 24 hours. These frequent feedings provide your baby with
antibody-rich first milk, called colostrum, and tell your breasts to make
more milk.
Your baby should suckle for at least 10 minutes and may
continue for about 30 minutes on the first breast before letting go, or
"self-detaching," without help from you. When he/she finishes at one breast,
you can burp and change his/her diaper before offering the second breast.
As with day 1, you probably will change only a few wet
and dirty diapers on baby's second and third days, and do not be surprised
if your baby loses weight during the first several days. The number of
diaper changes and baby's weight will increase when your milk "comes in."
You may feel uterine cramping when breastfeeding the
first two or three days, especially if this is a second or subsequent baby.
This is a positive sign that the baby's sucking has triggered a milk
let-down, also called the milk-ejection reflex (MER). It also means your
uterus is contracting, which helps minimize bleeding.
A nurse can give you something to take before feeding
if needed for the discomfort. Some mothers briefly feel a tingling, "pins
and needles," or a flushing of warmth or coolness through the breasts with
milk let-down; others notice nothing different, except the rhythm of baby's
sucking.
Because your baby still is learning, you may experience
nipple tenderness when he/she latches on or during a breastfeeding. Other
factors also may contribute to this tenderness, but usually it is mild and
disappears by the end of the first week. If tenderness persists, develops
into pain, or nipple cracking is noted, contact a certified lactation
consultant (IBCLC).
Always consult your physician for more information.
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