Breastfeeding handbook for physicians

338 Pages·2014·11.56 MB·English

by  LeTourneau, Anthony Alex

B A P
Breastfeeding Handbook for Physicians re omf ePricaonli cy of t
B2yn dth Eed Aitmioenrican Academy of Pediatrics and The American College of ast ediatrAiccsadehmey
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Obstetricians and Gynecologists e
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Editor in Chief d
Richard J. Schanler, MD, FAAP, FABM
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Coeditors
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Nancy F. Krebs, MD, MS, FAAP
Sharon B. Mass, MD, FACOG, FABM H
Jointly developed by the American Academy of Pediatrics (AAP) and The American a Breastfeeding Handbook
College of Obstetricians and Gynecologists (ACOG), the new Breastfeeding Handbook n
for Physicians, 2nd Edition, is an essential one-stop guide to the latest and best in d
for Physicians
breastfeeding management, support, education, and advocacy.
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Topics addressed include o
• Anatomy and lactation physiology • Medication issues o
• Breastfeeding benefits • Contraception issues
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• Management and support how-tos • Nursing refusal

• Breastfeeding techniques • Insufficient milk syndrome f
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• Lactation support technology • Weaning
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• Risk factors and contraindications • Counseling recommendations

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• Feeding patterns • Breastfeeding resources
• Relactation h
…and much more!
• Complementary feeding y
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New in the 2nd Edition c
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} All-new chapters: the unique benefits of human milk for preterm infants; breastfeeding a
issues during disasters n
} Expanded how-tos for a breastfeeding-friendly office environment
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} The latest AAP and ACOG policies

} Revised preventive health care checklists

} Coverage of recent national initiatives: 2011 Surgeon General’s Call to Action to

Support Breastfeeding; updated Healthy People 2020 targets for breastfeeding;

provisions of the 2010 Patient Protection and Affordable Care Act that promote 2
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and support breastfeeding
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For other pediatric resources,
visit the AAP Bookstore at
www.aap.org/bookstore.
AAP
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Breastfeeding Handbook
for Physicians
2nd Edition
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American Academy of Pediatrics Department of Marketing and Publications
Maureen DeRosa, MPA, Director, Department of Marketing and Publications
Mark Grimes, Director, Division of Product Development
Alain Park, Senior Product Development Editor
Sandi King, MS, Director, Division of Publishing and Production Services
Theresa Wiener, Manager, Publications Production and Manufacturing
Jason Crase, Manager, Editorial Services
Linda Diamond, Manager, Art Direction and Production
Julia Lee, Director, Division of Marketing and Sales
Linda Smessaert, MSIMC, Brand Manager, Clinical and Professional Publications
Library of Congress Control Number: 2013949402
ISBN 978-1-58110-804-0
eISBN 978-1-58110-805-7
MA0670
American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019
The American College of Obstetricians and Gynecologists
409 12th St SW
PO Box 96920
Washington, DC 20090-6920
Illustrations by Anthony Alex LeTourneau
The recommendations in this publication do not indicate an exclusive course of treatment or serve
as a standard of care. Variations, taking into account individual circumstances, may be appropriate.
This book has been developed by the American Academy of Pediatrics and The American College of
Obstetricians and Gynecologists. The authors, editors, and contributors are expert authorities in the
field of pediatrics. No commercial involvement of any kind has been solicited or accepted in the
development of the content of this publication.
Products are mentioned for informational puporses only. Inclusion in the publication does not imply
endorsement by the American Academy of Pediatrics and The American College of Obstetricians and
Gynecologists.
The publishers have made every effort to trace the copyright holders for borrowed material. If they
have inadvertently overlooked any, they will be pleased to make the necessary arrangements at first
opportunity.
Copyright © 2014 American Academy of Pediatrics and The American College of Obstetricians and
Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording,
or otherwise, without prior permission from the publisher. Printed in the United States of America.
4-97/0913
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Editorial Committee
Editor in Chief
Richard J. Schanler, MD, FAAP, FABM
Coeditors
Nancy F. Krebs, MD, MS, FAAP
Sharon B. Mass, MD, FACOG, FABM
Staff
American Academy of Pediatrics
Maureen DeRosa, MPA
Mark Grimes
Sunnah Kim, MS, RN, CPNP
Ngozi Onyema-Melton, MPH, CHES
Alain Park
The American College of Obstetricians and Gynecologists
Gerald Joseph, MD, FACOG
Debra Hawks, MPH
Mindy Saraco, MHA
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AAp Section on Breastfeeding
Executive Committee
2012–2013
Richard J. Schanler, MD, FAAP (Chair)
Margreete Johnston, MD, FAAP
Susan Landers, MD, FAAP
Lawrence Noble, MD, FAAP
Kinga Szucs, MD, FAAP
Laura Viehmann, MD, FAAP
Subcommittee Chairpersons
Lori Feldman-Winter, MD, FAAP
Ruth A. Lawrence, MD, FAAP
Joan Younger Meek, MD, FAAP
Sandra Sullivan, MD, FAAP
Jennifer Thomas, MD, FAAP
2013–2014
Richard J. Schanler, MD, FAAP (Chair)
Margreete Johnston, MD, FAAP
Susan Landers, MD, FAAP
Mary O’Connor, MD, FAAP
Joan Meek, MD, FAAP
Kinga Szucs, MD, FAAP
Subcommittee Chairpersons
Lori Feldman-Winter, MD, FAAP
Ruth A. Lawrence, MD, FAAP
Natasha Sriraman, MD, FAAP
Sandra Sullivan, MD, FAAP
Jennifer Thomas, MD, FAAP
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ACOG Committee on
Obstetric practice
Members, 2012–2013
George A. Macones, MD, FACOG Howard L. Minkoff, MD, FACOG
(Chair) Karla W. Nacion, PhD, CNM
Jeffrey L. Ecker, MD, FACOG Michelle Y. Owens, MD, FACOG
(Vice Chair) Christian Michael Pettker, MD,
Richard H. Beigi, MD, FACOG FACOG
Aaron B. Caughey, MD, FACOG Eva K. Pressman, MD, FACOG
Lorraine Dugoff, MD, FACOG Raymond L. Cox, Jr, MD, MBA,
James D. Goldberg, MD, FACOG FACOG (Ex Officio)
Rebecca Jackson, MD, FACOG Neil S. Silverman, MD, FACOG
Denise J. Jamieson, MD, MPH, (Ex Officio)
FACOG Cathy Whittlesey, (Ex Officio)
Liaison Representatives
Vincenzo Berghella, MD, FACOG Joshua M. Copel, MD, FACOG
Debra Bingham, PhD Craig M. Palmer, MD
William M. Callaghan, MD, FACOG Lu-Ann Papile, MD, FAAP
Julia Carey-Corrado, MD, FACOG Phillip Price, MD, FACOG
Beth Choby, MD, FAAFP Uma M. Reddy, MD, MPH, FACOG
Members, 2013–2014
Jeffrey L. Ecker, MD, FACOG (Chair) Karla W. Nacion, PhD, CNM
James D. Goldberg, MD, FACOG Christian Michael Pettker, MD, FACOG
(Vice-Chair) Alison M. Stuebe, MD, FACOG
Richard H. Beigi, MD, FACOG Methodius G. Tuuli, MD, FACOG
Aaron B. Caughey, MD, FACOG Joseph R. Wax, MD, FACOG
Lorraine Dugoff, MD, FACOG Tina Clark-Samazan Foster, MD
Yasser Yehia El-Sayed, MD, FACOG FACOG (Ex Officio)
Rebecca Jackson, MD, FACOG William A. Grobman, MD, FACOG
Denise J. Jamieson, MD, MPH, (Ex Officio)
FACOG Cathy Whittlesey (Ex Officio)
Howard L. Minkoff, MD, FACOG
Liaison Representatives
Vincenzo Berghella, MD, FACOG Rhonda Hearns-Stokes, MD, FACOG
Debra Bingham, PhD Craig M. Palmer, MD
William M. Callaghan, MD, FACOG Uma M. Reddy, MD, MPH, FACOG
Julia Carey-Corrado, MD, FACOG Kristi L. Watterberg, MD, FAAP
Beth Choby, MD, FAAFP
Joshua Copel, MD, FACOG
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Contributors
The following individuals have provided valuable advice and skill in
preparation of this revision of the Breastfeeding Handbook for Physicians.
Philip O. Anderson, PharmD, FASHP
University of California San Diego, La Jolla, CA
Michelle G. Brenner, MD, IBCLC, FAAP
Eastern Virginia Medical School/Children’s Hospital of
The King’s Daughters, Norfolk, VA
Lori Feldman-Winter, MD, MPH, FAAP
Cooper Medical School of Rowan University, Division of Adolescent
Medicine, Children’s Regional Hospital at Cooper, Camden, NJ
Margreete Johnston, MD, MPH, FAAP
Meharry Medical College and Vanderbilt University, Department
of Pediatrics, Children’s Clinic East, Nashville, TN
Nancy Krebs, MD, MS, FAAP
University of Colorado School of Medicine, Aurora, CO
Susan Landers, MD, FAAP, FABM
Pediatrix Medical Group, Seton Healthcare Family, Austin, TX
Ruth A. Lawrence, MD, FAAP, FABM
University of Rochester School of Medicine, Rochester, NY
Sharon Mass, MD, FACOG
Morristown Memorial Hospital, Morristown, NJ
Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC
The Florida State University College of Medicine, Orlando, FL
Lawrence Noble, MD, FAAP
Mount Sinai School of Medicine, New York, NY
Richard J. Schanler, MD, FAAP, FABM
Cohen Children’s Medical Center of New York and
Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
Kinga A. Szucs, MD, FAAP
Indiana University School of Medicine, Indianapolis, IN
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viii
Contributors
Jennifer Thomas, MD, MPH, IBCLC, FAAP, FABM
Lakeshore Medical Clinic, Franklin, WI, and
Medical College of Wisconsin, Milwaukee, WI
Laura Viehmann, MD, FAAP
Warren Alpert Medical School of Brown University, Providence, RI
Todd Wolynn, MD, MMM, IBCLC, FAAP
Kids Plus Pediatrics, Pittsburgh, PA
The editors would also like to acknowledge the work done by the
contributors of the previous edition.
Pamela D. Berens, MD, FACOG, FABM
Lori Berkowitz, MD, FACOG
Cheston M. Berlin Jr, MD, FAAP
Linda S. Black, MD, FAAP
Keith R. Brill, MD, FACOG, FACS
Margarett K. Davis, MD, MPH
Sharon L. Dooley, MD, MPH, FACOG
Arthur I. Eidelman, MD, FAAP
Lori Feldman-Winter, MD, MPH, FAAP
Lawrence M. Gartner, MD, FAAP
Madeline H. Gartner, MD, FACS
M. Jane Heinig, PhD
Nancy Krebs, MD, MS, FAAP
Susan Landers, MD, FAAP, FABM
Ruth A. Lawrence, MD, FAAP, FABM
Sharon Mass, MD, FACOG
Joan Y. Meek, MD, MS, RD, FAAP, FABM, IBCLC
Margaret C. (Peggy) Neville, PhD
Edward R. Newton, MD, FACOG, FABM
Victoria Nichols-Johnson, MD, FACOG
Barbara L. Philipp, MD, FAAP, FABM
Larry Pickering, MD, FAAP
Nancy G. Powers, MD, FAAP, FABM
Richard J. Schanler, MD, FAAP, FABM
Wendelin Slusser, MD, MS, FAAP
Carol L. Wagner, MD, FAAP, FABM, FASCN
Nancy E. Wight, MD, FAAP, FABM
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Contents
Preface .....................................................................................................................xiii
1 The Scope of Breastfeeding ................................................................1
Categories of Breastfeeding ......................................................................2
Breastfeeding in the United States ...........................................................3
Breastfeeding Education .........................................................................10
Ethics ..........................................................................................................19
Custody Rights .........................................................................................21
Recommended Practices.........................................................................21
2 Rationale for Breastfeeding: Benefits to Infants,
Mothers, and Society ...........................................................................27
Benefits of Breastfeeding for the Infant ................................................27
Benefits of Breastfeeding for the Mother .............................................34
Economic Impact of Breastfeeding .......................................................36
3 Composition of Human Milk .............................................................41
Nutritional Components ........................................................................41
Non-nutritional Components in Human Milk ...................................47
4 Anatomy and Physiology of Lactation ..........................................53
Anatomy of the Breast .............................................................................53
Physiology of Lactation ...........................................................................58
5 Breastfeeding: Management Before and
After Conception ...................................................................................63
Initial Visit .................................................................................................63
History .......................................................................................................64
Physical Examination ..............................................................................66
Education ..................................................................................................68
6 Peripartum Care: The Transition to Lactation .............................73
Labor and Delivery Care .........................................................................73
Breastfeeding Technique .........................................................................76
Problem Solving .......................................................................................80
Hospitals Can Affect Breastfeeding Success ........................................83
7 Breastfeeding in the Hospital: The Postpartum Period ...........89
Breastfeeding Risk Factor History .........................................................89
Feeding Patterns .......................................................................................91
Assessment of the Infant .........................................................................95
Assessment of the Mother ......................................................................99
Discharge Planning ................................................................................102
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