Beruflich Dokumente
Kultur Dokumente
COMMITTEE OPINION
Number 658 • February 2016 (Replaces Committee Opinion Number 361, February 2007)
(Reaffirmed 2017)
including Healthy People 2020 targets for increasing care (12). Obstetric care providers should be aware that
worksite lactation programs, reducing formula supple- personal experiences with infant feeding may affect their
mentation of breastfed infants in the first 2 days of life, counseling. In addition, pervasive direct-to-consumer
and increasing the proportion of births that occur in marketing of infant formula adversely affects patient and
facilities that provide recommended care for lactating health care provider perception of the risks and benefits
women and their infants (Table 1). of breastfeeding.
Because lactation is an integral part of reproduc- Beginning conversations about lactation early in
tive physiology, all obstetrician–gynecologists and other prenatal care by asking the patient and her family, “What
obstetric care providers should develop and maintain have you heard about breastfeeding?” sets the stage for
skills in anticipatory guidance, support for normal breast- a patient-centered discussion. When taking an obstetric
feeding physiology, and management of common com- history, obstetrician–gynecologists and other obstetric
plications of lactation. Obstetrician–gynecologists and care providers should specifically ask about any breast
other obstetric care providers should be in the forefront surgeries, prior breastfeeding duration, and any previ-
of policy efforts to enable women to breastfeed, whether ous breastfeeding difficulties. Prior problems leading to
through individual patient education, change in hospital earlier-than-desired weaning should be discussed, antici-
practices, community efforts, or supportive legislation. patory guidance should be provided, and appropriate lac-
tation support resources should be identified. The breast
Prenatal Care examination can identify surgical scars indicating prior
The advice and encouragement of the obstetrician– surgery, as well as widely spaced, tubular breasts that
gynecologist and other obstetric care providers are criti- may indicate insufficient glandular tissue (4). A breast
cal in assisting women to make an informed infant feed- assessment and breastfeeding history should be obtained
ing decision. As when discussing any health behavior, the as part of prenatal care, and identified concerns and risk
obstetrician–gynecologist is obligated to ensure patient factors for breastfeeding difficulties should be discussed
comprehension of the relevant information and to be with the woman, and communicated to the infant’s
certain that the conversation is free from coercion, pres- health care provider, either directly or as part of shared
sure, or undue influence (11). Families should receive records. Obstetrician–gynecologist and other obstet-
noncommercial, accurate, and unbiased information so ric care providers should engage the patient’s partner
that they can make informed decisions about their health and other family members in discussions about infant