All physicians will encounter women who are breastfeeding or children who are breastfed, thus education about lactation is important regardless of the physician’s chosen field.
More specifically, obstetrician–gynecologists, pediatricians, and family physicians are medical professionals whose disciplines are dedicated to the medical and surgical care of women or children, or both. These disciplines require extensive study of the physiologic, social, cultural, and genetic factors that influence health and disease, including breastfeeding medicine.
Physicians who care for women and children should have the knowledge, skills, and attitudes necessary to provide evidence-based patient care that protects, promotes, and supports breastfeeding, when possible, as the ideal method for infant feeding, and should support each woman’s informed decision about infant feeding.
At a minimum, physicians should understand the importance of lactation and human milk and the role of breastfeeding as the biologically indicated feeding method for infants and young children. Physicians should appreciate breastfeeding’s association with reduced short- term and long-term morbidities for women, infants, and children. Physicians should attain and maintain knowledge and skills in anticipatory guidance, physical assessment, support for normal breastfeeding physiology, medical management of common issues, and management of common complications in lactation. Obstetrician–gynecologists, pediatricians, and family physicians should collaborate with physicians in other specialties and with other health care personnel to deliver integrated care for the breastfeeding dyad antepartum, in the hospital, and after hospital discharge. Furthermore, physicians should be at the forefront of policy efforts to enable and encourage families to breastfeed, whether through individual patient education, changes in hospital practices (such as implementation of the Ten Steps to Successful Breastfeeding), community efforts, or legislation to ensure uniform and comprehensive breastfeeding support. Physicians who have advanced training and experience in breast- feeding management and lactation disorders also may be available to serve mother and child dyads whose complex issues may require a physician with additional breastfeeding training and expertise.
The physician often coordinates the multidisciplinary care provided to the breastfeeding dyad. However, all physicians must recognize the limitations of their own lactation knowledge and breastfeeding expertise. When appropriate, they should seek assistance from other members of the care team—understanding the training, credentials, and scope of practice of various lactation support professionals—and make referrals accordingly. Lactation support professionals have gained expertise in breastfeeding support that comes from a variety of backgrounds, including personal experience, academic education, and various professions. Some of the categories of lactation support personnel include:
Lactation Consultants
Lactation consultants provide the full range of breastfeeding care, particularly involving challenging breastfeeding situations. Referral may be appropriate for complex problems, such as establishing supply and transitioning to feeding preterm infants, inadequate infant weight gain, and anatomic or medical issues in the mother or infant that may affect breastfeeding. These professionals include International Board Certified Lactation Consultants (IBCLC), Advanced Lactation Consultants (ALC), and Advanced Nurse Lactation Consultants (ANLC).
Breastfeeding Counselors
Breastfeeding counselors have the skills to provide breastfeeding counseling; to address normal breastfeeding in healthy, term infants; and to conduct maternal and infant assessments of anatomy, latch, and positioning while providing support to families in the hospital and community settings. These include Certified Lactation Counselors (CLC), Certified Breastfeeding Specialists (CBS), and Certified Lactation Educators (CLE).
Breastfeeding Peer Counselors
Breastfeeding peer counselors have personal breast- feeding experience and additional training to meet the needs of families, focusing primarily on individual and community support. Groups include Breastfeeding USA, HealthConnect One, the La Leche League, Reaching Our Sisters Everywhere, and the Special Supplemental Nutrition Program for Women, Infants, and Children Program.
Lactation Educators
Lactation educators are qualified to support and educate the public on breastfeeding and related issues but do not perform clinical care. They are members of the Childbirth and Postpartum Professional Association.
Breastfeeding Medicine Specialists
Breastfeeding medicine specialists are physicians with advanced training or experience in breastfeeding management and lactation disorders. Most of these physicians have achieved certification with one or more of the credentials listed above.
Lactation support personnel are described in detail this table from the Lactation Support Provider Constellation.
Finally, physicians should be aware of how to find and use breastfeeding information and resources to further their own knowledge about breastfeeding medicine. The Academy of Breastfeeding Medicine, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, LactMed, the Eunice Kennedy Shriver National Institute of Child Health and Development, and the United States Breastfeeding Committee, among others, offer resources and guidance specifically for physicians.
Acknowledgements
The authors are grateful for the cooperation of all those who contributed to the development of this document.
- Academy of Breastfeeding Medicine
- American Academy of Family Physicians
- American Academy of Pediatrics
- American College of Osteopathic Pediatricians
- Association of Women’s Health, Obstetric and Neonatal Nurses
- Centers for Disease Control and Prevention
- National Hispanic Medical Association
- National Medical Association
- Reaching Our Sisters Everywhere
- United States Breastfeeding Committee - affiliated Lactation Support Provider Constellation
This resource is supported by Cooperative Agreement Number, 6 NU38OT000167-05-03, funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the Department of Health and Human Services. Copyright 2020 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
This document was developed by the American College of Obstetricians and Gynecologists’ Breastfeeding Expert Work Group in collaboration with work group members Lauren E. Hanley, MD, IBCLC and Sharon Mass, MD.