Promote Breast-Feeding Even to Women Who Aren't Pregnant Yet
ASHEVILLE, N.C. -- By promoting breast-feeding to women, including even those who aren't yet pregnant, ob.gyns. may be able to help boost the number of mothers who go on to successfully breastfeed, Dr. Edward Newton said at the annual Southern Obstetric and Gynecologic Seminar.
Even when women have a positive attitude toward breast-feeding, only 74% are successful in their efforts to breast-feed. But if they are ambivalent from the start, their success rate drops to 35%, said Dr. Newton, professor and chair of obstetrics and gynecology at East Carolina University, Greenville, N.C.
Much of what makes or breaks a breastfeeding attempt occurs even before the new mother has been discharged from the hospital.
About "10%-20% of the time, a woman who says she wants to breast-feed leaves the hospital bottle-feeding," Dr. Newton said at the meeting, which was also sponsored by the American College of Obstetricians and Gynecologists.
Insofar as imprinting affects the success of breast-feeding, ob.gyns. should make an extra effort to place the baby in the mother's arms as soon as possible, which often means insisting that the child be transferred before he or she is thoroughly cleaned.
In addition, research shows that mothers who deliver without analgesia have infants who are more likely to have the correct sucking technique (72% vs. 20%), Dr. Newton noted.
But even before that first prenatal visit, ob.gyns. can play a key role.
About half of women have made a decision about whether to breast-feed by the time they come in for their first prenatal visit, a fact that underscores the importance of promoting breast-feeding during regular gynecologic visits, he said.
"Society has promoted this idea of breasts as sexual, but as gynecologists we can help women regard them differently," he said.
When a teenager comes in concerned over her uneven breast development, for example, "we can reassure her that this most likely will not hinder her future attempts to breast-feed."
As long as there is glandular tissue in both breasts and that tissue grows during pregnancy, lactation is possible.
This is in contrast to tubular breasts, which often present more problems with lactation due to their lack of glandular tissue.
Dr. Newton isn't alone in his recommendations to start counseling women about breastfeeding even before pregnancy.
The U.S. Public Health Service's Healthy People 2010 goals set at 75% the minimum percentage of new mothers who should initiate breast-feeding after delivery and at 50% the proportion of mothers still breastfeeding at 6 months.
With the the aim of meeting those objectives, ACOG recently published an educational bulletin encouraging ob.gyns. to discuss breast-feeding even before pregnancy.
The bulletin recommends that hospitals establish written policies on how to teach and foster lactation and discourages the use of gift packs from formula makers, stating that alternative gift packs without commercial backing should be offered instead.
"We can help encourage more women to breast-feed, but our promotion has to target their special needs," Dr. Newton continued.
For example, with today's prevalence of cosmetic breast surgery, patient education could have an impact on the increasing number of women who've undergone breast augmentation or breast reduction. The latter usually but not always, presents major difficulties for lactation because so much of the gland has been removed. Breast augmentation, however, rarely poses lactation problems.
"If the scar is actually on the areola this could mean there has been some destruction of nerves, which will distort lactation, but most of the time, surgeons stay away from this area of the breast," he noted.
Women with inverted nipples need to be warned that they have a threefold risk of lactational insufficiency.
Nipple rings are increasingly common and generally do not damage the lactational capacity of the breast because they pierce such a small area, he added.
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