Letters to the Editor Enabling Women to Achieve Their Breastfeeding Goals To the Editor: I commend Dr. Stuebe for her review of the actions obstetrician–gynecologists (ob-gyns) can take to enable women to achieve their breastfeeding goals.1 There are certainly many benefits of breastfeeding for both the mother and infant. The Baby-Friendly Hospital Initiative likely will aid many women in beginning the process of breastfeeding before they leave the hospital postpartum. However, what is possibly more important is the maintenance of breastfeeding once our patients go home from the hospital. Our society lacks the infrastructure to support mothers who desire to breastfeed exclusively, and this expectation is often unrealistic for many of our patients’ chaotic lives. I can only quote from a recent article examining whether breastfeeding is actually causally linked to its many purported benefits: “Total commitment to 6 months of exclusive breastfeeding is a very high expectation of mothers, especially in an era when a majority of women work outside the home, often in jobs with little flexibility and limited maternity leave, and in a country that offers few family poli-
Letters to the Editor Guidelines. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. A word count should be provided. The maximum number of authors permitted is four, and a corresponding author should be designated (and contact information listed). Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. A signed author agreement form is required from all authors before publication. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com).
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cies to support newborns or their mothers.”2 I feel that Dr. Stuebe failed to acknowledge this important obstacle to breastfeeding. Many of our patients feel guilty or perceive that they are bad mothers when they cannot breastfeed exclusively. As an ob-gyn, I feel it is my duty to support women who desire to breastfeed, but also to validate my patients’ experiences and feelings that breastfeeding is often a challenge and sometimes not possible. Financial Disclosure: The author did not report any potential conflicts of interest.
Rebecca H. Allen, MD, MPH Department of Obstetrics and Gynecology Warren Alpert Medical School of Brown University Women and Infants Hospital Providence, Rhode Island
REFERENCES 1. Stuebe AM. Enabling women to achieve their breastfeeding goals. Obstet Gynecol 2014;123:643–52. 2. Colen CG, Ramey DM. Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Soc Sci Med 2014;109C:55–65.
In Reply: As you note, multiple factors affect whether a woman is able to achieve her breastfeeding goals. I focused my review on how we, as providers of clinical care, can enable women to succeed.1 However, to create a culture where breastfeeding is accessible for all women, we need to do more than implore mothers to breastfeed—we need to make sure they are able to do so.2 I agree wholeheartedly that we need to validate our patients’ experiences. As I wrote, “. our role is to meet our patients where they are. We can address misconceptions, and we can provide accurate information to help make a plan that works for the mother, her partner, and her family.” (Kiley KC and Stuebe A. Ask the experts. Enabling women to
achieve their breastfeeding goals. Obstet Gynecol 2014. Available at: http://journals.lww.com/greenjournal/ Documents/Mar2014_AtE_Stuebe.pdf. Retrieved April 14, 2014.). Lack of such patient-centered counseling may contribute to breastfeeding disparities. In a recent qualitative study, African American mothers in North Carolina reported insufficient practical advice, support, and encouragement for breastfeeding from their health care providers.3 When our patients encounter obstacles, we need to advocate for them, and we need to fight for policies that enable all women to choose how to care for and feed their children, unconstrained by their life circumstances. As I recently blogged, “A culture that protects the right of families to care for their children—with evidencebased maternity care, comprehensive support for new families, universal health care, paid maternity leave, high-quality childcare and a living wage—is also a culture that protects the right to breastfeed.”4 Financial Disclosure: The author did not report any potential conflicts of interest.
Alison M. Stuebe, MD, MSc Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina
REFERENCES 1. Stuebe AM. Enabling women to achieve their breastfeeding goals. Obstet Gynecol 2014;123:643–52. 2. Stuebe A. Breastfeeding medicine: building a breastfeeding culture. Available at: http://bfmed.wordpress.com/2012/11/16/ building-a-breastfeeding-culture/. Retrieved April 14, 2014. 3. Ringel-Kulka T, Jensen E, McLaurin S, Woods E, Kotch JB, Labbok M, et al. Community-based participatory research of breastfeeding disparities in African American women. ICAN: Infant, Child Adolesc Nutr 2011;3:233–9. 4. Stuebe A. Shame, guilt and the search for common ground: breastfeeding medicine. Available at: http://bfmed.wordpress. com/2014/03/04/shame-guilt-and-thesearch-for-common-ground/. Retrieved April 14, 2014.
OBSTETRICS & GYNECOLOGY
Letters to the Editor Guidelines. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. A word count should be provided. The maximum number of authors permitted is four, and a corresponding author should be designated (and contact information listed). Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. A signed author agreement form is required from all authors before publication. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com).
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cies to support newborns or their mothers.”2 I feel that Dr. Stuebe failed to acknowledge this important obstacle to breastfeeding. Many of our patients feel guilty or perceive that they are bad mothers when they cannot breastfeed exclusively. As an ob-gyn, I feel it is my duty to support women who desire to breastfeed, but also to validate my patients’ experiences and feelings that breastfeeding is often a challenge and sometimes not possible. Financial Disclosure: The author did not report any potential conflicts of interest.
Rebecca H. Allen, MD, MPH Department of Obstetrics and Gynecology Warren Alpert Medical School of Brown University Women and Infants Hospital Providence, Rhode Island
REFERENCES 1. Stuebe AM. Enabling women to achieve their breastfeeding goals. Obstet Gynecol 2014;123:643–52. 2. Colen CG, Ramey DM. Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Soc Sci Med 2014;109C:55–65.
In Reply: As you note, multiple factors affect whether a woman is able to achieve her breastfeeding goals. I focused my review on how we, as providers of clinical care, can enable women to succeed.1 However, to create a culture where breastfeeding is accessible for all women, we need to do more than implore mothers to breastfeed—we need to make sure they are able to do so.2 I agree wholeheartedly that we need to validate our patients’ experiences. As I wrote, “. our role is to meet our patients where they are. We can address misconceptions, and we can provide accurate information to help make a plan that works for the mother, her partner, and her family.” (Kiley KC and Stuebe A. Ask the experts. Enabling women to
achieve their breastfeeding goals. Obstet Gynecol 2014. Available at: http://journals.lww.com/greenjournal/ Documents/Mar2014_AtE_Stuebe.pdf. Retrieved April 14, 2014.). Lack of such patient-centered counseling may contribute to breastfeeding disparities. In a recent qualitative study, African American mothers in North Carolina reported insufficient practical advice, support, and encouragement for breastfeeding from their health care providers.3 When our patients encounter obstacles, we need to advocate for them, and we need to fight for policies that enable all women to choose how to care for and feed their children, unconstrained by their life circumstances. As I recently blogged, “A culture that protects the right of families to care for their children—with evidencebased maternity care, comprehensive support for new families, universal health care, paid maternity leave, high-quality childcare and a living wage—is also a culture that protects the right to breastfeed.”4 Financial Disclosure: The author did not report any potential conflicts of interest.
Alison M. Stuebe, MD, MSc Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina
REFERENCES 1. Stuebe AM. Enabling women to achieve their breastfeeding goals. Obstet Gynecol 2014;123:643–52. 2. Stuebe A. Breastfeeding medicine: building a breastfeeding culture. Available at: http://bfmed.wordpress.com/2012/11/16/ building-a-breastfeeding-culture/. Retrieved April 14, 2014. 3. Ringel-Kulka T, Jensen E, McLaurin S, Woods E, Kotch JB, Labbok M, et al. Community-based participatory research of breastfeeding disparities in African American women. ICAN: Infant, Child Adolesc Nutr 2011;3:233–9. 4. Stuebe A. Shame, guilt and the search for common ground: breastfeeding medicine. Available at: http://bfmed.wordpress. com/2014/03/04/shame-guilt-and-thesearch-for-common-ground/. Retrieved April 14, 2014.
OBSTETRICS & GYNECOLOGY
