Many Ob-Gyn Textbooks Lack Good Info on Breast-Feeding

TUESDAY May 6, 2008 -- Doctors coaching new nursing mothers will find little practical advice to share from some of the classic obstetrics textbooks, a new study suggests.

Some of the texts omit key information for solving breast-feeding problems and others are inaccurate about the key steps involved, according to a study presented at this week's annual meeting of the Academy of Obstetricians and Gynecologists, in New Orleans.

Three of these bibles of obstetrics are not as "up-to-date or nearly as complete as they should be," contended study researcher Dr. Tony Ogburn, director of the department of obstetrics and gynecology at the University of New Mexico.

Ogburn believes that breast-feeding has been a neglected problem for some time, because some physicians have passed the buck -- each seeing it as the provenance of another physician specialty, or of nurses who specialize as lactation consultants.

While doctors in urban areas may be able to defer to lactation consultants, those who have a broader scope of practice in rural areas will miss the training they need on breast-feeding, added Dr. Adam Aponte, chair of pediatrics and ambulatory care at Manhattan's North General Hospital. He was not involved in the new research.

Breast-feeding is not as easy as people think and "needs a lot of encouragement and support early on," he added, and "with frustration, mothers can switch very quickly to the bottle."

On the other hand, gentle and accurate instruction about how to hold the baby to the breast properly can reduce some of the discomfort some nursing mothers experience, Aponte said.

The new review covered what the authors called "the five most popular obstetrics and gynecology textbooks based on sales." Ogburn gave two of the textbooks in the study -- the 2003 edition of Maternal-Fetal Medicine, edited by Robert K. Creasy and Robert Resnick, and the 2007 edition of Obstetrics: Normal and Problem Pregnancies, edited by Steven G. Gabbe, et al. -- high marks for providing complete and accurate information on breast-feeding.

But he said doctors' "general lack of interest in breast-feeding is reflected in three other textbooks" -- Williams Obstetrics, 2005 edition, edited by F. Gary Cunningham, et al., Danforth's Obstetrics and Gynecology, 2003, edited by James R. Scott, et al., and the 2006 edition of Beckmann's Obstetrics and Gynecology, edited by Charles R.B. Beckmann, et al.

"There's not the focus on it or interest that there should be," Ogburn contends.

In their review of five widely used textbooks, Ogburn, along with colleagues at Boston University, found the omission of key information and, in some cases, actual errors, he said.

For example, one text mistakenly advised that putting newborns on a feeding schedule is fine, while research shows that babies should be fed "on demand" -- that is, whenever they are hungry, Ogburn said. Mothers sometimes fear that they won't have sufficient milk if they nurse too often, but nursing actually stimulates increased milk production, he said.

Another text also omitted a discussion of the inadvisability of supplementing mothers' milk with formula within the first 48 to 72 hours after delivery, Ogburn added. Suckling is crucial in this postnatal period to stimulate the mother's breast milk. Meanwhile, nursing infants receive colostrum (especially healthy "first" or "immune" milk) from the mother's breast. Colostrum passes on the mother's immunity to the baby and protects it in the first month of life, Ogburn explained. He added that mothers who supplement breast-feeding with formula during the first 72 hours are less likely to breast-feed later.

Aponte agreed that standard medical text books should address breast-feeding more thoroughly. "Textbooks are so academic and so focused on the academic portion of medicine," he explained. "This is sort of softer, this is less scientific."

Dr. Ruth Lawrence, a professor of pediatrics at the University of Rochester who authored the breast-feeding section in one of the praised texts, said she and others have been trying for a number of years to increase the number of physicians who are well-informed about breast-feeding.

"Everybody knows that breast-feeding is good," she said. "But not everybody knows how to help mother succeed."

The federal government's Healthy People 2010 goals and a policy statement from the American Academy of Pediatrics recommend exclusive breast-feeding for the first six months, Ogburn said. Healthy People 2010 has set a goal for 50 percent of mothers to be nursing when their infants are six months old, compared with the 29 percent reported in 1998.

The benefits of breast-feeding for the child range from fewer upper respiratory infections to better bonding and lower rates of diabetes, Ogburn noted. And the American Academy of Pediatrics says that benefits to the mother include an earlier return to pre-pregnancy weight and a decreased risk of breast and ovarian cancer.

More information

Find out more about breast-feeding at the American Academy of Pediatrics.

Posted: May 2008


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