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Sunday, October 17, 2010

Breastfeeding as Part of the Curriculum

I came across this blog from a nursing mom who is a doctor in Davao City. In her post entitled "Breastfeeding and Medical School", she shared that what was taught in medical school was the difference between cow's milk and breastmilk and how to lecture on breastfeeding. "HOW TO BREASTFEED" was not at all taught. I think that this is the reason why most pediatricians pay lip service to breastfeeding by simply telling moms "mag-breastfeed kayo" without really showing moms how to do it -- they themselves don't know how either!
Meanwhile, over in PhdinParenting's Post on the AAP Conference sponsored by big formula companies, commentators noted how pediatricians were not at all trained in nutrition - which I believe is also a reason why most of them believe that formula is equivalent or closely approximates breastmilk.
Interestingly, a July 2010 article in Pediatrics Magazine entitled "Residency Curriculum Improves Breastfeeding Care" had the following conclusion:
A targeted breastfeeding curriculum for residents in pediatrics, family medicine, and obstetrics and gynecology improves knowledge, practice patterns, and confidence in breastfeeding management in residents and increases exclusive breastfeeding in their patients. Implementation of this curriculum may similarly benefit other institutions.
I am unsure if the release of that article resulted in this development - but the American Academy of Pediatrics has a breastfeeding initiatives website and more importantly, has recognized the need to further train physicians to support breastfeeding moms and has established a Breastfeeding Residency Curriculum. Given that our own Philippine Pediatric Society, Inc. is highly influenced by the AAP, I'm hoping that a similar curriculum be developed and applied to the local medical schools as well. I checked the PPS website and found a Committee on Breastfeeding chaired by 2 doctors with an immediate project of polishing breastfeeding guidelines for health care providers.

What is interesting about the conclusion in the Pediatrics Journal and the proposed guidelines is that they are meant not only for pediatricians but for all health care providers. I can't emphasize how important it is to find not only a breastfeeding friendly pediatrician but a BF friendly OB-gyne as well. I've heard too many stories from moms who were told by their ob-gynes that since they had mastitis, they had to stop breastfeeding or were told to stop breastfeeding due to medicines being given to them (without bothering to check MIMS if the medicines were safe for lactation or if an alternative safe medication can be given)!

In 2009, the Academy of Breastfeeding Medicine released Protocol No. 19 - Breastfeeding Promotion in the Prenatal Setting, which I think is a must reading not only for ob-gynes but also for moms who are shopping for ob-gynes. The protocol outlines how ob-gynes can transform their clinics into one supportive of breastfeeding moms and likewise provides guidelines for examining moms during specific periods of their pregnancy.

Remember my POLL in August on whether mandatory breastfeeding should be made a law? Results below:

Yes! While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby. - Amy Spangler
4 (9%)
No! Breastfeeding is a personal choice - Bethany Frankel
8 (18%)
A mandatory breastfeeding information law would be better
20 (46%)
A mandatory breastfeeding curriculum for pediatricians and ob-gynes would be better.
29 (67%)
A stricter restriction (with steeper penalties) on formula milk marketing would be better.
24 (55%)

The top answer was a mandatory curriculum in medical school. Obviously, too many of my readers have been "victims" of uninformed medical providers and I'm sure most (if not all moms) would have had an experience with a non-breastfeeding friendly health provider - whether their ob-gyne, pediatrician or nurse! It is time to change the medical school curriculum!

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