Breastfeeding Mini-rotation for Family Practice Residents

Abstract

The Healthy People 2000 objectives for breast feeding are: “To increase to at least 75%, the proportion of mothers who breast feed in the early postpartum period and to increase to at least 50% the proportion who continue breast feeding until their babies are 5-6 months old.” Physicians play an important role in offering breast feeding counseling, support and problem solving. Family physicians who provide care to the pregnant woman and newborn are in a unique position to have a positive impact on the success and duration of breast feeding. Physicians need to develop knowledge and skills in order to promote successful breast feeding and to intervene appropriately if any problems surface. A breast feeding mini rotation has been developed for family practice residents. During the rotation, the resident and lactation specialist co-counsel new breast feeding mothers and out-patients who return for follow-up care. Areas covered depend upon patient needs and include, but are not limited to nipple assessment- inverted, flat, or everted, the sleepy neonate, frequency of feeding, proper latching-on and positioning, use of artificial nipples, supplemental nursing systems. The mini rotation is scheduled 2-3 afternoons per year, during the obstetrics, pediatric in-patient, and out-patient rotations. Therefore the resident is gaining knowledge and expertise in this area throughout the three years. Evaluation is measured through a pre and post test that determines knowledge, attitude change, and levels of confidence in each resident. Measurable changes can occur in breast feeding rates at discharge and at three and six months postpartum. Family physicians play a crucial role in the success of breast feeding by providing practical advice and support to the lactating woman, beginning with the prenatal period and continuing until weaning. Few physicians are skilled in assisting with problems routinely encountered by breast feeding mothers. Most residency programs offer little, if any, training about the process of breast feeding, and most residents complete their training without having seen a woman breast feed. Including a breastfeeding mini-rotation may change physicians attitudes as they develop knowledge and confidence about breastfeeding. Only when physicians are able to promote breastfeeding and offer practical information about its management will we see that the breastfeeding objectives from the Healthy People 2000 report have been met