We Need to Talk About Breastfeeding - Annals of Internal Medicine: Fresh Look Blog


Wednesday, December 19, 2018

We Need to Talk About Breastfeeding

I just put my son down to bed after a longer-than-usual nursing session. He’s teething, and a teething ring just doesn’t provide the same comfort mommy does. Nursing sessions used to take forever, and then he became more efficient, so now I actually cherish these longer sessions. Nursing is our bond, one only he and I can have, and it makes both of us happy. It is not lost on me how lucky I am. New mothers have issues with nursing for multitudes of reasons. There’s a reason why those of us in the nursing moms’ club call it “liquid gold.” We hydrate, we take supplements, we attach ourselves to pumps, we don’t care what our bodies look like (that whole “you’ll lose a ton of weight when you nurse” thing is a myth, at least to me) just so we can feed our little ones.

I have learned more about breastfeeding from social media groups than I ever did in medical school or in training. I definitely know how to work up galactorrhea and treat prolactinoma, but I didn’t see a breast pump until I haphazardly assembled my own after my son was born. This journey has been made easier by my son’s knowledgeable pediatrician and my excellent gynecologist and the lactation consultants I worked with along the way. However, as an internist, why didn’t I know anything about breastfeeding until I had a baby of my own?

As I wait for my son to wake up for his next feed (sleeping through the night is also a myth, at least to me), I decided to see what my go-to journal has to say about breastfeeding. I searched “breastfeeding” on Annals.org. I found several articles about gestational diabetes, medications, and safety in lactation, but the last major article about breastfeeding is from 2008: “Interventions in Primary Care to Promote Breastfeeding: An Evidence Review for the U.S. Preventive Services Task Force” (1). We learn from the article that breast milk is beneficial to infants and that interventions to promote breastfeeding lead to longer and successful breastfeeding relationships between mom and baby. This I knew. You do not need an MD to know that “breast is best.”

Internal medicine journals probably are not the place to seek our education to promote breastfeeding, which makes me wonder: As an internist, do I have a role in promoting breastfeeding? Is this something the average internist even needs to be informed about? To me, the answer is yes. We are the doctors to adults, women are adults, fertile women are adults, and lactating women are adults. Those who breastfeed do have other medical issues. Lactating mothers are told to pump and dump because of medications or mammograms unnecessarily. There is a dearth of knowledge among us internists on how to care for the complex needs of the nursing mother. Perhaps other specialties, pediatrics for example, are better suited to deal with the ins and outs of breastfeeding, however, as internists we should at least have the knowledge on what to do. And perhaps most important, if we knew the complexities involved in breastfeeding, we would create a professional environment that would make it easier for physician moms to have successful breastfeeding relationships with their children.

I am disappointed in myself that I only started caring about breastfeeding when I became a mother. I wish I had sought out knowledge sooner. And I hope my journal of choice will be a better source in educating me to be there for my patients.

  1. Chung M, Raman G, Trikalinos T, Lau J, Ip S. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:565-82. [PMID: 18936504]


  1. I think the other element that we as internists can help our patients understand is the reality of breastfeeding. The breast-is-best campaign is noble, but also poses a disservice to women who struggle to breastfeed, leaving them feeling incredibly ashamed and guilty, as if they've failed their children. Much of the studies used to tout the superiority of breastfeeding are not well controlled, well adjusted studies. The few studies that do adequately compare children breastfeeding versus using formula actually show very minimal long term statistical differences other than the rate of infectious diseases during the first couple of years of life. Breastfeeding absolutely offers a wonderful bonding experience but that bonding and depth of relationship can be formed between mothers and fathers with their babies without breastfeeding. We should support breastfeeding and enable our patients to do so as much as possible, but we should also help the majority of mothers who are not able to breastfeed beyond a couple months realize how well they can continue caring for their babies rather than agonizing over the end of breastfeeding.

  2. I love this article. Thank you for writing it, Dr. Syed!

  3. I have mixed feelings about this. As an internist who managed to breastfeed for over a year without supplementing even once, I feel that the pendulum has swung so far in the direction of promoting breastfeeding that women who choose not to breastfeed or are unable to for whatever reason feel shamed and seriously inadequate, often exacerbating postpartum depression. I provide primary care for women with HIV, and they are devastated when they are told not to breastfeed and are anxious as to how to explain this to others who do not know their HIV status. So, while I think promoting breastfeeding as an internist is important, I think it is also critical that we provide expectations that breastfeeding can be very challenging and the most important thing is to ensure baby is healthy and growing, no matter the source of nutrients.


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