I think that the issue of mothers who feel guilty regarding breastfeeding should be addressed. Breastfeeding is now seen as a medical issue and thinking of it from this view, the lack of available patient information is appalling. An informed decision requires that the information to make a decision be easily available (I'm a huge fan of pamphlets and the like).
This is the policy (with whatever appropriate corrections-- this is just gleaned from my memories and breastfeeding discussions...) I'd like to see regarding breastfeeding (this policy from someone like the La Leche League, who seem pretty reasonable as an organization and have the best information I've found on breastfeeding with allergies):
While we agree that in most circumstances that breastmilk is the ideal milk for a child, we believe that the unqualified mantra of "breast is best" can cause more harm than than good. Although adequate information is provided on the benefits of breastfeeding, there is not enough information readily available on:
-medical contraindications
-postnatal health problems and their effects on breastfeeding
-common medicines and their safety
-practical as well as emotional support available.
We would like to briefly explain our position on each of the above.
Medical Contraindications:
Not all women should breastfeed. There are clear contraindications to breastfeeding as well as situations where the health of the mother comes before any possible benefits to the child. It is in the best interest of professionals and prospective mothers to discuss this information beforehand. It would also be helpful for prospective mother to have ready access to information on what conditions can and cannot be supported during breastfeeding. Our position is that many mothers who feel they cannot breastfeed because of a chronic condition are able to do so but do not, due to their doctors' lack of knowledge and that many who medically should not breastfeed feel unnecessarily guilty. Neither is good for promoting breastfeeding.
Postnatal Health Concerns:
Leaving breastfeeding related issues to the last point, it is true that postnatal women have a variety of concerns which effect breastfeeding. One of the major illnesses of the postnatal period is postnatal depression. There are many antidepressants which can be safely used while breastfeeding and most women can be treated while continuing to breastfeed. However, it is important to realize that the mother's health is of paramount importance and the consequences of not successfully treating PND outweigh any benefits for both mother and infant that continuing breastfeeding might confer. It is also advisable to give particular advice to women who smoke and/or drink alcohol about how best to proceed with breastfeeding.
Common medicines and their safety:
Many times mothers neglect their own health and comfort based upon misinformation about the safety of common medicines (eg ibuprofen, allergy medicines). An available pamphlet about the most commonly used medicines and their safety in breastfeeding would be helpful, as would ready access to information about other medications and their effects. Providing the first point of contact at your practice with a reference book such as "Medications and Mothers' Milk" by Thomas Hale would be immensely helpful.
Support
Many women who attempt to breastfeed fail through lack of practical and emotional support. Health care professionals who recommend breastfeeding to prospective mothers must discuss the both the practical and emotional support available before the baby is born. Practical support is most necessary while baby and mother are in the hospital and in the week after the birth or until breastfeeding is established. Emotional support is necessary throughout breastfeeding, no matter whether the mother has a child of 2 weeks or two years. It is also worth mentioning here the discouraging effect of a common fallacy: that breastfeeding does not hurt if it is done correctly. While it is necessary to thoroughly check for other causes, sometimes breastfeeding does hurt, even if being done correctly and there is no illness. Failure to breastfeed due to lack of support should be seen as a failure of the health professionals responsible for the mother and child's health and not as a failure of the mother.
What we recommend for all healthcare professionals who are responsible for pregnant women is this:
In the first discussion of breastfeeding with the mother, take a full medical history to determine if breastfeeding is appropriate. If it is and the mother makes the decision to breastfeed, in a future visit, closer to the time of birth, discuss the logistics of breastfeeding in her situation. First, thoroughly discuss any information particular to her situation (allergies, smoking, possible PND). Give her information to deal with common concerns and challenges (for example a list of common problems and treatments: mastitis, cracked nipples, etc as well as when to seek medical attention, eg for thrush). Also, talk about what to expect from her hospital in terms of support for breastfeeding and who will be her contact for practical support during each stage of breastfeeding. Provide a list of local organizations and websites for emotional support.
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or something like that, but changing any inaccuracies and having a kicker as a closing paragraph.