The Role of the American Academy of Family Physicians in Supporting Breastfeeding

The American Academy of Family Physicians (AAFP) comprises 115,900 family physicians, and these include medical students and residents, worldwide. We also care for everybody. We truly are cradle to grave. Family physicians see one in every four visits made to a physician in this country. Twenty-five percent of ambulatory visits are to family physicians. Almost 30% of all medical students—that's osteopathic and allopathic in this country—are members of the AAFP. They don't all go in to family medicine, nor do they really stay in primary care, as the majority eventually subspecialize. We have students for an important period of time, and what we do with that time is critical. It is important that we talk to all the members of our organizations, as we go through this effort to promote breastfeeding.

As you look at what we do as family physicians, we're the cornerstone of relationships, in the entire family, of every aspect of what goes on with the relationship among the mother, her child, the family, and the community. I want to touch base on some of those aspects. We do have 214 million visits annually, and we do comprehensive care. This is really important, because while the process of preconception, then getting pregnant, and then going through the birthing process is incredibly special and powerful, I have relationships with women long before they are even in the preconception phase. I have a chance to be talking about pregnancy and child-rearing from the moment the family first comes in. Because even if I only see one member of that family, I'm still treating the family. Even if it's just one person, even if it's just the child that I'm seeing, mom or dad brings them in, and I get a chance to talk about more than just the child's issues that day. I know what's going on, I'm able to be a part of that relationship early on. And we can be talking about fears and concerns in different ways. A lot of times with my teenagers, or preteens unfortunately now, you're doing the “sex, drugs, rock and roll talk” because it's those issues that are in the forefront. And I get a chance to see my patients as they continue on in life to becoming a mother.

This is important because we need to “mother the mother.” That's what we can do as family physicians because we don't discriminate by organ systems, disease processes, location in the hospital, age, or gender. As family physicians, we're able to create that safe place for mothers-to-be, for mothers, for the families after. Much of what I'm seeing in care is still siloed.

How do we break down silos? That must be a main focus of our conversations. Because we're all doing the same work, and we need to know who we are and how we can help each other in this regard. We know that reducing fragmentation in our healthcare system is a good thing. As we treat the family, we are in a unique position to impact what happens when new mothers leave the hospital—that 75% are breastfeeding when they leave, but the percentage then plummets by the time they are in the office for a return visit. Family physicians have an opportunity to address this issue whether or not we actually did the delivery. Sometimes families will see an obstetrician for maternity care, because not all family physicians do obstetrics. Families may also take their child to see a pediatrician. But, they may also be seeing us for adult care. The bottom line is that care is being provided by someone, and we all need to work together and communicate better. If I'm taking care of a family and I know that one physician is seeing my patient for her pregnancy and another provider is going to see her newborn, then it's up to me to be a part of that entire process—to say, how can I help? That's what we need to do. Because we all believe the same things about what we have to do to make a difference for our children and for our families. What else can we do? Should we do?

Please be reassured, the AAFP stands with promoting that breastfeeding is a good thing! I will reinforce that we do recommend breastfeeding, as do all of you, for at least 6 months, and preferably a year and even longer. We all know the benefits of the First Food. We can try to make sure our members—our students, our residents, and our family physicians—understand this. We have such an opportunity; since almost 30% of all medical students are members of the AAFP, we can reach them, even if they ultimately go into another specialty. So, we need to continue to make inroads within the curricula of medical schools and within residencies. Our residents rotate through many clinical areas so we have more potential for outreach—if you look around, you'll probably find a family physician somewhere! And we need to be part of this process. We know that patient care, especially mother and newborn care, is about relationships, connections, education. As you likely know, “docere”—the root word for doctor—means “to teach.” And that's what a lot of this is—it's overcoming fear, overcoming the negative public relations, overcoming advertising and misperceptions, and learning how to reach people for better education. And we're good at that.

Discussions about the patient-centered medical home are important—how we create teams; how we coordinate the resources available; how we recognize that a lot of care is now asynchronous, it's not face to face—even home visits don't have to be home visits in the same way—they can be a call, an e-mail, whatever the technology is or the preference of the patient and the mother and the family. Team care is critical now, especially in primary care, as we don't have enough primary care physicians or providers right now. We must promote the identification of those team members and find a way to make sure we are all working together. We have to remember that each role is unique, and one team member cannot be simply interchanged with another but instead can augment what others do. Many primary care services don't require a physician but can be done by other members of the team.

The transformation we need is really about learning how to integrate processes, resources, teammates, people—all to better care for the family. Even if we're all doing different parts of that care, how do we come together so that we create that patient-centered medical home? It's not about everyone being in the same building or even in the same practice. In many ways, it's community-based care. It is a way of taking care of things throughout a bigger network. We all have the capacity to make an impact, and we all do more then we think we can do. We can make that difference.

The AAFP has an extensive and thorough position paper on breastfeeding. It's being revised right now by our Commission on Health of the Public and Science; it should come out later in the fall, and we're going to have a big push in terms of educating our students, residents, and family physicians. A lot of this is a culture shift, and we have to recognize that we're all players in this sea change. This is a critical public health issue. This is something we all know that we have to continue to address for many, many reasons. We have to work to be a cornerstone to everything about healthy people. We have lost important foundation over the years, lost nuclear families, and lost the village feel of caring for each other. At the time of birth, we have lost that precious skin-to-skin connection that used to be natural. There is a real need and interest in reclaiming that. We just have to make it okay. Whenever you have a culture change, it's scary. So our job is to work on alleviating the fears.