Who Will Practice Breastfeeding Medicine?

This, of course, is the Academy's mission statement. Implicit in the second sentence is the recognition that all physicians must be adequately trained and prepared to support breastfeeding in the course of their daily professional lives. The Academy does not exist solely to create a corps of physician specialists dedicated to the practice of breastfeeding medicine, although such a specialty is certainly needed. It exists to bring an acquaintance with breastfeeding medicine to all physicians, regardless of their particular disciplines and fields of interest.

In recent years, our efforts have been focused on creating a certification process. Our new strategic plan (Priority 3) calls upon us to rededicate ourselves to this process. In order for the discipline of breastfeeding medicine to grow and establish itself in the world of medicine, its leadership will be drawn primarily from a community of physicians who have chosen to dedicate a substantial portion of their professional lives to teaching, practicing, and researching breastfeeding and human lactation. In the process of helping to create such a group of specialists, however, we should not forget that the physicians for whom they offer leadership must also share a basic appreciation and knowledge of the principles and practices of breastfeeding medicine.

I would certainly not suggest that the Academy has been straying from this directive. Our annual meetings have been consistently relevant not only to those who have chosen to specialize in breastfeeding medicine, but to generalists as well. And one of our most successful initiatives has been What Every Physician Needs to Know About Breastfeeding, the ABM course designed to familiarize all physicians with breastfeeding and lactation management. The highly regarded ABM protocols likewise are meant to be used by all physicians, not just those who have a special interest in breastfeeding. We must continue to expand and build upon these initiatives, even as we move toward the establishment of a certification process.

But creating a certification process will take a long time. It will be expensive. The question of who will create a certification examination is currently a matter of considerable debate. We cannot even be certain how many of our members will sit for an examination, once it becomes available. And what relevance will such a process have for our members who live outside of the United States? We continue to grapple with these troubling questions, and it will no doubt be quite a while before the certification creation process is concluded. In the meantime, we should remain mindful of the needs of those physicians who do not wish to become specialists, but who still feel that it is important to integrate breastfeeding medicine into their respective practices. In the final analysis, breastfeeding promotion and support are the quintessential primary care issues. For a pediatrician not to know the basics of breastfeeding management is tantamount to a general surgeon not knowing how to perform an appendectomy, or at least it should be.

I raise this issue because breastfeeding is growing in popularity, and it is logical to assume that in the years ahead, larger number of families will turn to their physicians for support. Not too long ago, when so few women initiated breastfeeding and even fewer continued to breastfeed for any length of time, physicians could afford the luxury of ignoring requests for help. Not any longer. Today, mothers know the importance of breastfeeding, and they expect their physicians to assist them. How will physicians respond? One option is to “outsource” all breastfeeding issues to specialists, be they expert physicians, lactation consultants, peer counselors, or Women, Infants, and Children nutritionists. While such referrals are on many occasions very appropriate, a practice of “blanket” referrals to specialists would constitute an abnegation of the responsibility the physician has to the families he or she serves. An analogous situation exists in the field of behavioral health. In the United States, 21% of children have a diagnosable mental health disorder, ¹ and fewer than one in five of these children receives the necessary treatment. ² The reason is that there simply are not enough specialists to care for all of these children. The tragedy is that such care could be rendered, at least to a considerable extent, if primary care physicians took ownership of behavioral health as an integral part of their practice. But such a commitment requires a certain degree of reorientation and additional training. Several such programs have already been implemented. And so it should be with breastfeeding medicine. There should be no need for pediatricians to refer the greater share of breastfeeding issues to outside consultants; this is their responsibility, after all. But pediatricians have to be trained to handle such issues. And they have to be appropriately equipped with strategies by which breastfeeding management can be incorporated into their daily practice routines.

Enter the Academy of Breastfeeding Medicine.

As already mentioned, the Academy has made a great start with its physician course, its protocols, and its international conferences. But there is more that we can do. We have to find ways of bringing our message to physicians in their practices, rather than simply waiting for physicians to come to us. We have to address practice management issues, in order to streamline the practice process and make it more “user-friendly” for primary care practitioners. We have to help physicians to secure adequate reimbursement for the time they spend helping their breastfeeding families, which can be quite substantial. And we have to do this in a way that is culturally and geographically appropriate.

For this to happen, we will need to rely heavily on regional ABM conferences, our newly created Regional Network Coordinator program, and the leadership offered by ABM Fellows who will increasingly come from many nations around the world, thanks to a recent liberalization of Fellowship application requirements. Those of us who live in the United States may have some ideas about how breastfeeding management might relate to healthcare reform and the emerging models of healthcare delivery, but we do not have the slightest notion how to implement similar strategies in other nations, where alternative delivery models are operative. To remain relevant outside of the United States, we will come to rely much more heavily on regional initiatives. Regardless of where such initiatives originate, one principle will remain universal: Breastfeeding promotion and support must be an integral part of all medical practices, everywhere around the world.