ACOG has released 2018 guidelines on Optimizing Support for Breastfeeding as Part of Obstetric Practice.
The American College of Obstetricians and Gynecologists’ Breastfeeding(BF) Expert Work Group released guidelines to provide additional guidance for obstetrician-gynecologists and other obstetric care providers to better enable women in unique circumstances to achieve their goals to breastfeed children.
Enabling women to breastfeed is a public health priority because, on a population level, interruption of lactation is associated with adverse health outcomes for the woman and her child, including higher maternal risks of breast cancer, ovarian cancer, diabetes, hypertension, and heart disease, and greater infant risks of infectious disease, sudden infant death syndrome, and metabolic disease. Breastfeeding confers medical, economic, societal, and environmental advantages.
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The guidelines emphasize that obstetrician-gynecologists and other obstetric care providers should support women and encourage policies that enable women to integrate breastfeeding into their daily lives and in the workplace.
Following are the major recommendations:
- Clinical management of lactation is a core component of reproductive health care.
- Because lactation is an integral part of reproductive physiology, all obstetrician-gynecologists and other obstetric care providers should develop and maintain skills in anticipatory guidance, support for normal breastfeeding physiology, and management of common complications of lactation.
Support for Breastfeeding Women
- Women are strongly encouraged to breastfeed and the American College of Obstetricians and Gynecologists supports each woman’s right to breastfeed. Exclusive breastfeeding is recommended for the first 6 months of life, and continuing it as complementary foods are introduced during the infant’s first year of life, or longer, as mutually desired by the woman and her infant.
- The advice and encouragement of the obstetrician-gynecologist and other obstetric care providers are critical in assisting women to make an informed infant feeding decision and should be free from coercion, pressure, or undue influence.
- Obstetrician-gynecologists and other obstetric care providers should support each woman’s informed decision about whether to initiate or continue BF, recognizing that she is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding, or formula feeding is optimal for her and her infant.
- When taking an obstetric history, obstetrician-gynecologists and other obstetric care providers should specifically ask about any breast surgeries, prior breastfeeding duration, and any previous BF difficulties.
- To breastfeed is an option for women who have undergone double mastectomy and reconstruction by feeding with a supplemental feeding tube device at the breast.
- Women who experience BF difficulties are at higher risk of postpartum depression and should be screened, treated, and referred appropriately.
- Most medications and vaccinations are safe for use during breastfeeding.
- Obstetrician-gynecologists and other healthcare providers should consult lactation pharmacology resources for up-to-date information on individual medications because inappropriate advice often can lead women to discontinue breastfeeding unnecessarily.
- Obstetrician-gynecologists and other obstetric care providers should support women who have given birth to preterm and other vulnerable infants to establish a full supply of milk by providing anticipatory guidance and working with hospital staff to facilitate early, frequent milk expression starting within 1 hour of delivery, if possible.
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- Obstetrician-gynecologists and other obstetric care providers should support women and encourage policies that enable women to integrate breastfeeding into their daily lives and in the workplace.
- The World Health Organization’s “Ten Steps to Successful Breastfeeding” should be integrated into maternity care to increase the likelihood that a woman will initiate and sustain breastfeeding and achieve her personal breastfeeding goals.
- Policies that protect the right of a woman and her child to breastfeed in public and that accommodate milk expression, such as insurance coverage for breast pumps, paid maternity leave, on-site childcare, break time for expressing milk, and a clean, private location for expressing milk, are essential to sustaining breastfeeding.
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