Ob-Gyns Support Breastfeeding Decisions for All Mothers

January 25, 2016

Washington, DC — Although most women in the United States initiate breastfeeding, more than half wean earlier than they desire and fall short of their personal goals. Recognizing the prominent role obstetrician-gynecologists can play in helping women reach their breastfeeding goals, the American College of Obstetricians and Gynecologists (ACOG) released a revised Committee Opinion, "Optimizing Support for Breastfeeding as Part of Obstetric Practice," to educate providers on how to support women in making breastfeeding decisions; how to act as resources for breastfeeding women; and how to provide women with high-quality, evidence-based support.

Breastfeeding and lactation are a core part of reproductive health care and ob-gyns are uniquely positioned to enable women to achieve their infant feeding goals due to their expertise in women's health and as advocates for women.

ACOG recommends exclusive breastfeeding for the first 6 months of life, or longer as mutually desired by mother and baby. Continued breastfeeding as complementary foods are introduced through the first year of life, or longer, is also recommended. ACOG recommendations are consistent with those of many other medical and nursing organizations, such as the American Academy of Pediatrics; the Association of Women's Health, Obstetric and Neonatal Nurses; and the World Health Organization.

"Moms deserve better support, and obstetric providers can and must help, both by assisting their patients and by advocating for policies and practices that enable women to achieve their goals," stated Alison Stuebe, MD, lead author of the Committee Opinion.

Conversations about breastfeeding should start early in pregnancy, the revised Opinion states. A breastfeeding history should be obtained as part of prenatal care and any concerns or risk factors for breastfeeding should be communicated to the infant's provider. However, all providers should respect and support a woman's informed decision whether to initiate or continue breastfeeding as each woman is uniquely qualified to decide which feeding option is best for herself and her infant.

The Committee Opinion also clarifies ACOG's position on breastfeeding in the community. The College supports policies that protect the right of the woman and her child to breastfeed. Paid maternity leave, on-site childcare, break time, and a location other than a bathroom for expressing milk are essential to sustaining breastfeeding.

Because cesarean birth is associated with lower breastfeeding rates, women who have a cesarean delivery may need extra support to establish and sustain breastfeeding. According to the recommendations, one feasible way to support breastfeeding in the operating room is skin-to-skin contact, as it is associated with reduced need for formula supplementation.

For more information, please visit ACOG's resource page on breastfeeding.

Committee Opinion 658, "Optimizing Support for Breastfeeding as Part of Obstetric Practice," is published in the February issue of Obstetrics & Gynecology.


Other recommendations issued in the February Obstetrics & Gynecology:

Committee Opinion #653, "Concerns Regarding Social Media and Health Issues in Adolescents and Young Adults"
Although there are many positive aspects of social media for adolescents and young adults, there are also risks. Adolescence is a time of significant developmental changes, during which adolescents exhibit a limited capacity for self-regulation and an increased risk of susceptibility to peer pressure and experimentation. Social media can be harmful, and obstetrician–gynecologists may screen their adolescent and young adult patients for high-risk sexual behaviors, especially if sexualized text communication (sexting), exposure to pornography, online dating, or other risk-taking behaviors are present. Victims of cyberbullying and those who engage in sexting are at increased risk of sexually transmitted infections and pregnancy. The effect of social media may be considered in the differential diagnosis of myriad health problems during adolescence. Referrals to mental health care providers or providing outside resources may be indicated. A multidisciplinary approach to address these issues can include the obstetrician–gynecologist, guardians, and school officials and personnel. Knowledge of resources, including those within the schools and community, allows the obstetrician–gynecologist to provide support to adolescents facing these issues.

Committee Opinion #654, "Reproductive Life Planning to Reduce Unintended Pregnancy"
Approximately one half (51%) of the 6 million pregnancies each year in the United States are unintended. A reproductive life plan is a set of personal goals regarding whether, when, and how to have children based on individual priorities, resources, and values. A lack of reproductive life planning, limited access to contraception, and inconsistent use of contraceptive methods contribute to unintended pregnancy. The American College of Obstetricians and Gynecologists strongly supports women's access to comprehensive and culturally appropriate reproductive life planning and encourages obstetrician–gynecologists and other health care providers to use every patient encounter as an opportunity to talk with patients about their pregnancy intentions and to support initiatives that promote access to and availability of all effective contraceptive methods.

Committee Opinion #655, "Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Infections in Obstetrician–Gynecologists"
To prevent transmission of bloodborne pathogens, it is important that health care providers adhere to standard precautions, follow fundamental infection-control principles, and use appropriate procedural techniques. All obstetrician–gynecologists who provide clinical care should receive the hepatitis B virus vaccine series. The Society for Healthcare Epidemiology of America has established guidelines for the management of health care providers who are infected with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV). The guidelines categorize representative obstetric and gynecologic procedures according to level of risk of bloodborne pathogen transmission and include recommendations for health care provider clinical activities, based on these categories and viral burden. It is important to note that when no restrictions are recommended, careful supervision should be carried out as highlighted. These recommendations provide a framework within which to consider such cases; however, each case should be independently considered in context by the expert review panel.

Committee Opinion #656, "Guidelines for Diagnostic Imaging During Pregnancy and Lactation"
Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding.  Ultrasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. With few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary in addition to ultrasonography or magnetic resonance imaging or are more readily available for the diagnosis in question, they should not be withheld from a pregnant patient. Breastfeeding should not be interrupted after gadolinium administration.

Committee Opinion #657, "The Obstetric and Gynecologic Hospitalist"
The term "hospitalist" refers to physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities may include patient care, teaching, research, and inpatient leadership. The American College of Obstetricians and Gynecologists supports the continued development and study of the obstetric and gynecologic (ob-gyn) hospitalist model as one potential approach to improve patient safety and professional satisfaction across delivery settings. Effective patient handoffs, updates on progress, and clear follow-up instructions between ob-gyn hospitalists and patients, nurses, and other health care providers are vital to maintaining patient safety. Hospitals and other health care organizations should ensure that candidates for positions as ob-gyn hospitalists are drawn from those with documented training and experience appropriate for the management of the acute and potentially emergent clinical circumstances that may be encountered in obstetric care.

Practice Bulletin #161, "External Cephalic Version"
In the United States, there is a widespread belief that the overall cesarean delivery rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean delivery, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.

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