Breastfeeding and the Role of Family Physicians

Family physicians care for patients of all ages, newborns through seniors, with the goal of treating the whole person and providing a patient-centered medical home. We provide comprehensive preventive health services including routine well checks, screening tests and immunizations, and ongoing care for both acute and chronic medical conditions. Family doctors perform >190 million office visits annually and provide the majority of care to America's underserved urban and rural areas. ¹ Counseling women and families about the benefits of breastfeeding is a natural fit with the tenets of family medicine and should be further integrated into our teaching curriculum and continuing medical education. Physicians and medical learners can utilize the resources of the American Academy of Family Physicians (AAFP) and the journal American Family Physician (AFP) to improve their knowledge of breastfeeding and support their patients and communities.

The AAFP represents roughly 131,400 physicians, residents, and students. ² AFP is the AAFP's editorially independent peer-reviewed evidence-based clinical journal. It is the best-read journal in primary care with a print circulation >180,000 and 26 million unique web visitors in 2017. ³ AFP is one of the largest providers of continuing medical education making it an important resource for primary care topics including breastfeeding.

The AAFP has both a policy on breastfeeding and a breastfeeding position article.^4,5 It recommends that infants be exclusively breastfed or offered expressed human milk for the first 6 months of life and then continue with additional foods to complete at least 1 year. It acknowledges the benefits to both mother and baby beyond a year and recommends that breastfeeding be continued as long as possible or desired. The position article further elaborates on the role of family physicians in breastfeeding and recommends that we be prepared to discuss and encourage breastfeeding when mothers and their infants present for follow-up care. Breastfeeding education should be provided in family medicine residencies and medical schools. The article reviews other key concepts including keeping newborns skin-to-skin with the mother after birth until successful breastfeeding; incorporating baby-friendly and breastfeeding-friendly principles in birthing centers, hospitals, and our offices; understanding rare medical contraindications to breastfeeding; removing barriers to breastfeeding and promoting it as a public health issue. A “breastfeeding toolkit” is also freely available through the AAFP to help healthcare providers easily implement the recommendations of the position article into practice. ⁶

The toolkit includes a PowerPoint presentation to educate clinicians on how to counsel patients, billing and coding resources, posters for medical offices to display on breastfeeding benefits, and resources for advocacy and community engagement.

AFP is committed to providing the best clinical content on breastfeeding for our readers and has done so for decades. It has been a focus of many review articles, editorials, and evidence-based medicine features in the journal. We make a point to highlight important content for readers in a collection called “AFP by Topic” available online and through our digital apps with a special section dedicated to breastfeeding. ⁷ An article entitled “Strategies for Breastfeeding Success” reviews the benefits of breastfeeding, clarifies scenarios in which breastfeeding is not contraindicated, and discusses the effects of medications commonly used in the postpartum period. ⁸ Examples of other practical pearls of wisdom from our content include the following: the most successful breastfeeding interventions are performed in multiple sessions and at multiple points in time; Food and Drug Administration's Pregnancy and Lactation Labeling Rule requires that manufacturers provide a summary of information about drug effects on breastfeeding infants instead of just a letter grade; breastfeeding is associated with reductions in breast cancer, diabetes, heart disease, hypertension, obesity, and ovarian cancer; face-to-face breastfeeding interventions are superior to telephone interventions.^9–12

In summary, family physicians play a big role in promoting breastfeeding since we provide primary care for a significant proportion of Americans and since patient-centered care is at the core of our training. We are collaborators by nature and will continue to work alongside our colleagues in other specialties and groups to educate physicians, medical learners, patients, and their communities on the importance of breastfeeding. The AAFP and AFP offer many important resources for constituents and readers and this will remain a priority.