In 2022, you might have never envisioned that the United States of America would be among other countries struggling to feed its babies. As of the first week of May, more than 40 percent of formula brands are out of stock, and many families are desperately searching high and low, near and far, to find substitute options. In the background of this chaos, I cannot help but consider how we can better address breastfeeding on the physician side of this. Though it would not be a timely solution in this current catastrophe, for others, it might have been a game-changer in many ways had the support from the healthcare team been in place.
As professionals, we are all keenly aware of the many benefits that accompany breastfeeding for both the mother and the child’s overall health. However, are we aware of how our systemic inadequacies negatively impact the probability that families who want to breastfeed will be successful? This is not to say in any way that we should pressure families to breastfeed, but for those who desire to do so, can we examine ways we can better serve them?
Let’s consider that as physicians, we get minimal education on breastfeeding. So, when patients present with challenges, many of us often do not feel equipped to confidently address specific concerns. Additionally, we cannot omit the reality that we may choose to breastfeed our children but if this occurs during our residency training years, there are often no policies in place for protected time to support pumping. Consequently, this barrier decreases the chances that many residents will be able to mirror the very same healthy habits that we recommend for our patients.
Lastly, it is widely known that minority populations are among the lowest breastfeeding rates. But it is this same population that has the highest rates of many of the chronic diseases that are seen in lower incidences among those who choose to breastfeed. Yet, as physicians, we are missing the mark of utilizing this as one protective factor for an already vulnerable population.
So, how do we begin to take small yet impactful steps towards change? Well, we all know that the PDSA (Plan, Do, Study, Act) cycle is a well-known concept utilized for rapid quality improvement. Might it be useful to cognitively link the letters of this concept of “quality improvement” with some ideas that might help families reach their feeding goals proactively?
P: Prepare. In our institutions, we can better prepare learners across all specialties with breastfeeding knowledge. It can be through lectures, rotations, or even training sessions interwoven into their didactic sessions.
D: Diversify. Breastfeeding rates are the lowest among minority populations for many reasons. But we can help change this statistic by delivering culturally competent care and actively listening to families to better address the unique barriers that dissuade them from seeing breastfeeding as an option.
S: Support. For many, the biggest obstacle is the lack of established support options for when challenges arise. Whether from family, friends, the medical home, or support groups, we can start the conversation by reassuring families that they are not alone and that resources exist. We can then identify and share these resources with all families.
A: Advocate. We know that access is typically the greatest barrier for minority populations, often due to the need for policy change. So, though daunting for some and intimidating for others, consider what you can do at any level — your clinic/hospital, local, state, or national — to eliminate the obstacles that prevent families from meeting their feeding goals.
So, though there are many nuances and complexities that have gotten us to this place, there are equally simple and effective ways that we can each begin to take powerful steps towards helping normalize breastfeeding and enhancing our own knowledge. These educational gaps and the countless stories of unmet feeding goals of my patient families and trainees motivated me to become an IBCLC. Though your interest may be different from mine, I hope the commonality remains optimal health outcomes for all families and lifelong learning for ourselves.
Marche’ T. Smith is a pediatrician.
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