Breastfeeding

RACGP Breastfeeding Position Statement, Endorsed by Council 43/3, 9/10 December 2000

Aim
Principles
Background
Position of the RACGP
Recommended role for GPs
References
Appendix 1
Appendix 2

Aim

• To protect, promote and support breastfeeding in Australia in ways that optimise maternal and child health.
• To assist GPs to provide information and support for breastfeeding women, their babies and their families.
• To raise awareness among GPs of the important role they can play in supporting breastfeeding women.

Principles

• UNICEF (1999) recommends that babies be exclusively breastfed for about the first 6 months of life. Breastfeeding should be sustained until the baby is at least 2 years old, but beginning at about 6 months breast milk should be complemented with appropriate solid food.[1 ]
• Mothers have the right to breastfeed wherever and whenever their baby requires.
• Breastfeeding mothers in the paid work force should be supported to continue breastfeeding.

Background

• Breastfeeding provides infants with optimal nutrition; human milk is specific for human babies. Research studies have demonstrated that when infants are not fed on human milk they may be more likely to experience gastrointestinal[2] and respiratory infections[3], asthma[4], otitis media[5], urinary tract infections[6], necrotising enterocolitis[7], insulin-dependent diabetes[8], inflammatory bowel disease[9], lymphoma[10] and atopy[11]. Continued research is required to determine the full health benefits of human milk for infants.
• Breastfeeding is also beneficial for women's health. Breastfeeding women have less postpartum bleeding[12], delayed resumption of ovulation[13], improved bone remineralization postpartum[14] and less ovarian[15] and premenopausal breast cancer[16].
• Breastfeeding may facilitate mother-infant bonding, saves the family money and protects the environment.

Position of the College

• The RACGP supports the NHMRC Infant Feeding Guidelines (1996)[17]. General practitioners should have the knowledge and skills to help mothers and babies with common breastfeeding difficulties.
• The WHO International Code of Marketing of Breast Milk Substitutes (Appendix 1) seeks to ensure that infant formula is not marketed or distributed in ways that interfere with breastfeeding. The RACGP supports the WHO Code and will not accept practices that undermine the Code. Only information that is scientific and factual should be accepted by GPs from the infant formula industry. GPs should also be careful not to inadvertently undermine, by the display of artificial feeding materials, industry's public commitment not to advertise its products to the general public.
• The RACGP supports the Baby Friendly Hospital Initiative (BFHI) in Australia. This is a global UNICEF / WHO initiative based on the "Ten Steps to Successful Breastfeeding" (Appendix 2). The BFHI improves breastfeeding practices in maternity hospitals, as the basis of protection, promotion and support of breastfeeding in the community[18]. Mothers of newborn babies should receive adequate assistance to establish and maintain breastfeeding, whether in hospital or at home.
• The RACGP supports breastfeeding as a normal part of life, and will continue to facilitate education in normal lactation and common breastfeeding difficulties for GP registrars and practicing GPs.
• The RACGP supports breastfeeding women GPs and registrars in medical settings.

Recommended role for GPs

The RACGP recommends that:

• GPs support and encourage breastfeeding in the community.
• GPs promote breastfeeding as the optimal infant feeding method to pregnant women and their partners.
• GPs maximise maternal physical and emotional well being to assist new mothers in the early postpartum weeks during establishment of breastfeeding.
• GPs make mothers aware of mother-to-mother support groups, such as the Nursing Mothers' Association of Australia (NMAA).
• GPs become skilled in the diagnosis and management of common breastfeeding problems. When specialised help is needed, doctors should refer to experienced health workers, such as International Board Certified Lactation Consultants (IBCLCs), NMAA breastfeeding counsellors or other qualified workers. The NH&MRC Infant Feeding Guidelines (1996) provide information on the management of breastfeeding problems[17].
• GPs prescribe medication that is compatible with breastfeeding. If in doubt, consult a reference centre knowledgeable about drugs in lactation.
• GPs encourage exclusive breastfeeding for the first 6 months and then gradual introduction of suitable foods. Breastfeeding may continue as long as the mother and child wish to continue, and weaning should be gradual.
• GPs support and advise women who, for a variety of reasons, are unable to breastfeed their babies.
• GPs acknowledge that even partial breastfeeding is of great value.

References

1. UNICEF (1999) Breastfeeding: Foundation for a Healthy Future.
2. Howie PW et al. Protective effect of breastfeeding against infection. Br Med J 1990; 300: 11-16.
3. Raisler J et al. Breastfeeding and infant illness: a dose response relationship? Am J. Public Health 1999; 89: 25-30.
4. Oddy W H et al. Association between breast-feeding and asthma in 6-year-old children: findings of a prospective birth cohort study. Br. Med. J. 1999; 319: 815-19.
5. Scariati P D et al A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Paediatrics 1999; 99: 862 (E5).
6. Pisacane A et al. Breast-feeding and urinary tract infection. J Pediatr 1992; 120: 87-89.
7. Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet 1990; 336: 1519-23.
8. Gerstein HC. Cow's milk exposure and type I diabetes mellitus. A critical overview of the clinical literature. Diabetes Care 1994; 17: 13-19.
9. Rigas A et al. Breast-feeding and maternal smoking in the etiology of Crohn's disease and ulcerative colitis in childhood. Ann Epidemiol 1993; 3: 387-92.
10. Shu X-O et al. Infant breastfeeding and the risk of childhood lymphomas and leukaemia. Int J Epidemiol 1995; 24: 27-32.
11. Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet 1995; 346: 1065-69.
12. Chua S et al. Influence of breastfeeding and nipple stimulation on postpartum uterine activity. Br J Obstet Gynaecol 1994; 101: 804-05.
13. Kennedy KI, Visness CM. Contraceptive efficacy of lactational amenorrhoea. Lancet 1992; 339: 227-30.
14. Cumming RG, Klineberg RJ. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. Int J Epidemiol 1993; 22: 684-91.
15. Rosenblatt KA, Thomas DB. WHO Collaborative Study of Neoplasia and steroid contraceptives. Int J Epidemiol 1993; 22: 192-97.
16. Newcomb PA et al. Lactation and a reduced risk of premenopausal breast cancer. N Engl J Med 1994; 330: 81-87.
17. H&MRC Infant Feeding Guidelines (1996) http://www.health.gov.au/nhmrc/publicat/n-home.htm, and NH&MRC Children's Dietary Guidelines, Chapter on Breastfeeding (1996) http://www.health.gov.au/nhmrc/publicat/n-home.htm
18. Division of Child Health and Development, World Health Organization. Evidence for the ten steps to successful breastfeeding. WHO/CHD/98.9

Appendix 1

International Code of Marketing of Breast-milk Substitutes (the WHO Code)

Aim of the Code

The aim of this code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.

The Code includes these 10 important provisions[1]:

1. No advertising of these products to the public.
2. No free samples to mothers.
3. No promotion of products in health care facilities.
4. No company mothercraft nurses to advise mothers.
5. No gifts or personal samples to health workers.
6. No words or pictures idealising artificial feeding, including pictures of infants, on the labels of the products.
7. Information to health workers should be scientific and factual.
8. All information on artificial infant feeding, including labels, should explain the benefits of breast feeding, and the costs and hazards associated with artificial feeding.
9. Unsuitable products, such as sweetened condensed milk, should not be promoted for babies.
10. All products should be of a high quality and take account of the climatic and storage conditions of the country where they are used.

Appendix 2

"Ten Steps to Successful Breastfeeding"[2]

Every facility[3] providing maternity services and care for newborn infants should:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practice rooming-in - allow mothers and infants to remain together - 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Footnotes

1. IOCU/IBFAN. Protecting Infant Health. A health workers' guide to the international code of marketing of breast milk substitutes. Penang, Malaysia, 1987, pg 12.
2. Protecting, promoting and supporting breast-feeding: the special role of maternity services, a joint WHO/ UNICEF statement, Geneva 1989, World Health Organisation.
3. The term "facility" refers to maternity facilities, not general practices.