Abstract
The Internet has clearly invaded the practice of medicine as Thomas and Shaikh 1 report from their study of electronic communications by physicians regarding breastfeeding issues. They describe the impact of “unsolicited e-mails” on the office practice and the issues of counseling individuals they do not know and will never see. The prototype for this kind of medical assistance began in the 1950s with the establishment of poison information centers, a network of which expanded across the country and around the world and remains today utilizing telephone technology. It has been shown to save lives. This move to electronic communication is the new mode, and the authors show it provides service. Personally, when approached by e-mail I usually pick up the phone to respond, which still permits a fuller discussion and an opportunity to get all the facts. If it moves to texting, there are some risks. Texting is fraught with misinterpretations just as abbreviations in medicine have been for decades. Whether you Laugh Out Loud, or send Lots Of Love, LOL could be JK. (Just kidding.)
The role of body mass index (BMI) and gestational weight gain (GWG) on the outcome of maternal breastfeeding performance was actually studied by Bartok et al. 2 They conclude that BMI and GWG are not independent risk factors for breastfeeding cessation or for the early introduction of formula. Contrary to the report of other investigators, Bartok et al. 2 suggest that the potentially modifiable factors are the mother's plans for duration and the importance that mothers assign to breastfeeding. Obesity and weight gain, however, remain risk factors that require prenatal, ultrapartum, and postpartum intervention and support.
From the clinical standpoint, nipple pain remains a challenge to the primary care provider. No randomized controlled trials of therapy have identified the best treatment. Dermatology dogma has always maintained that multipurpose preparations present more risks than benefits as in other medical treatment protocols. Dennis et al. 3 report a carefully designed and executed comparison of all-purpose nipple ointment (APNO) (intervention group) versus plain lanolin ointment (control group). APNO contains an antibacterial (2% mupirocin ointment), an antifungal substance (miconazole powder), and hydrocortisone (0.1% betamethasone) by prescription. Nipple pain was measured at baseline and 1 week and 12 weeks postpartum using validated pain scales. Breastfeeding exclusivity was measured at 1 and 12 weeks; as well, mastitis, yeast infection, and satisfaction with feeding were tallied at 12 weeks. At 12 weeks, breastfeeding exclusivity and duration rates were better in the lanolin (control) group than in the APNO group, although the differences did not reach statistical significance. Nipple healing rates were similar in the two groups. The authors conclude that APNO is not more effective than lanolin. Dermatologists, it should be noted, would agree that the exposure to unnecessary antibiotics, antifungals, or corticosteroids is not worth the risk.
We also direct your attention to the review of breastfeeding definitions by Labbok and Starling. 4 Consistent terminology is imperative if the science of breastfeeding and lactation is going to thrive. We applaud the authors for their thorough review and support the suggestion that a group be assembled for rigorous scientific debate. We further suggest that the Academy of Breastfeeding Medicine (ABM) and the International Society for Research in Human Milk and Lactation (ISRHML) become key players.
The Academy of Breastfeeding Medicine has a revised protocol 5 that has been certified by the Protocol Committee and approved by the Board of the ABM. “Analgesia and Anesthesia for the Breastfeeding Mother” is a revision of the original Protocol #15. 6 This is a thorough, up-to-date review of all medications available during delivery and postpartum to provide analgesia and anesthesia by all routes.
A special opportunity for Breastfeeding Medicine is the publication of the 30 top abstracts submitted to the International Society for Research in Human Milk and Lactation, 7 whose biannual meeting was held in Trieste, Italy, September 27–October 1, 2012. These items are an opportunity to review the science being carried in the laboratories around the world. You will recognize many names of the world investigators as contributors to the great evidence accumulating about the constituents of human milk. Much of this work is taking our thinking down new pathways or helping to explain or challenge old pathways. Collectively, they provide even more evidence that human milk is for human babies. It may not be long before it becomes a moral obligation for physicians to make provisions for all babies, even our most fragile prematures, to receive human milk.