What doctors don't know about breast-feeding

See if you can answer the following questions.

True or false? A new mother concerned about having a low milk supply would probably do best to supplement her infant's diet with formula.
True or raise? A newborn who develops jaundice should be bottle-rather than breast-fed.
True or false? A woman who develops a breast infection (mastitis) should discontinue breast-feeding and switch to formula.
The answers are upside down at the bottom of this column, but what's more important than whether you got all three right is that physicians are getting them wrong, according to the responses of more than 3,000 doctors surveyed by researchers at the University of North Carolina. And not just any doctors. We're talking about those who care for new mothers and their babies: pediatricians, obstetrician/gynecologists, and family doctors.

In some instances, such as when dealing with questions about jaundice, between half and two thirds of the physicians chose the wrong advice. Furthermore, about one in four did not know that exclusive breast-feeding through the first four months of life is the most beneficial form of nutrition, and almost a third were unaware that breast-feeding reduces the incidence of ear infections and gastrointestinal problems in babies.

It's not surprising. While the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, and the American Academy of Family Physicians all encourage the promotion of breast-feeding by doctors, very few of those surveyed had ever seen an actual breast-feeding demonstration during their residencies.

The news comes at a particularly discouraging time; breast-feeding among American women is declining. Back in 1984, 60 percent of mothers breast-fed, but today only 50 percent of new mothers are breast-feeding. And fewer than one in every five is doing it until the baby is at least five months old.

Obviously, new mothers who choose to bottle-feed, for whatever reason, should be supported in their decision. While breast-feeding is the preferred form of infant nutrition, what's most important is that a mother feel relaxed and comfortable about the way she gives her child food so that she can bond with it in a close, warm, and emotionally nourishing way. Yet many women are "on the fence" about whether to breast-feed, and a lack of physician support can push them toward formula.

The solution, of course, is to incorporate bedside-based breast-feeding training into residency programs as well as continuing education workshops for those pediatricians, OBGYNs, and family physicians who have already completed their residencies. But where does that leave women who are thinking about breast-feeding now and need some support in making their decision? Fortunately, several organizations provide help for both expectant mothers and those who have started nursing.

International Lactation Consultant Association This group will put you in touch with an internationally board-certified lactation consultant in your area. Consultants, who can provide breast-feeding information and advice either before or after a mother gives birth, have at least 2,500 hours of professional breast-feeding counseling experience and have passed a qualifying exam given by the International Board of Lactation Consultant Examiners. A single visit costs about the same as a visit to a pediatrician but can last from one to two hours. Call (708) 260-8874.

LaLeche League International LaLeche League holds monthly group meetings headed by accredited LaLeche leaders. To find out where and when such meetings are held in a particular locale, a new or expectant mother can dial 1-800-LALECHE. She can also order, by calling that number, a free "information packet" for new mothers as well as written material on everything from premature babies to sore nipples. And she can speak to a counselor for answers to questions as well as help in solving breast-feeding problems.

Health Education Associates This organization sells--at cost--more than 30 pamphlets on breast-feeding, with titles on everything from "Fathers Ask Questions about Breastfeeding" to "Combining Breast & Bottle Feeding" to "Drugs & Medicines in Breast Milk." Single copies, including shipping, sell for 50 cents each, although all 32 breast-feeding titles are available at a special rate of $9.00. For a free catalog listing all titles, send a stamped, self-addressed business-size envelope to: Health Education Associates, Inc, 8 Jan Sebastian Way, Unit 13, Sandwich, MA 02563. Or call (508) 888-8044.

Childbirth Graphics This company sells breast-feeding booklets and pamphlets with titles such as "Nursing Your Baby for the First Time," "Breast-feeding and Returning to the Workplace," and "20 Great Reasons to Breastfeed Your Baby." Prices range from $1 to $2. To order a free catalog (the breast-feeding booklets and pamphlets are featured on pages 44 through 47) call 1-800-299-3366.

ANSWERS

False. Between a third and a half of the physicians who answered this question suggested water or formula supplementation, but that is a proven cause of breast-feeding failure during the first two weeks of life. The best course is to continue breast-feeding exclusively--as well as more often--if the infant is healthy; the milk supply will "match" the baby's hunger.
False. The best way to take care of an otherwise healthy newborn with jaundice is not to discontinue breast-feeding but to breast-feed even more frequently.
False. In many cases, the infection is mild enough to continue breast-feeding without interruption. In fact, an infant's sucking out milk will relieve pressure in the infected area, and the baby will not get sick because the infection does not occur in the milk-producing glands themselves. In addition, antibiotics used to treat mastitis are generally safe for the baby.

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