Resident physician advances breastfeeding support

It isn’t any secret that medical schools across the U.S. do a poor job educating students about infant feeding. Lactation and breastfeeding education in med school typically covers the anatomy of the breast and reaffirms the AAP’s stance on infant feeding: “Breastfeeding is a natural and beneficial source of nutrition and provides the healthiest start for an infant.” [http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx#sthash.9lE40iXl.dpuf]

It seems to be a trend then that physicians are left to seek out their own breastfeeding training in order to better help their patients.

Often, physicians become motivated to help women after they struggle personally with breastfeeding.

Jacobitz-Kizzer_Sarah(1)This is the story of Sarah Jacobitz-Kizzier, MD, MS, a Family Medicine Resident Physician at the University of Iowa Hospitals and Clinics and mother of three.

“It wasn’t until I had my first child that I recognized there was this need for women who were starting families…based on my own personal struggles in the immediate postpartum period, even before hospital discharge,” Jacobitz-Kizzier explains. “I initially hadn’t thought of breastfeeding as part of women’s and children’s health until I really experienced some of the difficult situations that a breastfeeding woman has to deal with.”

For Jacobitz-Kizzier, those difficult situations included lack of access to lactation professionals in and out of the hospital, engorgement, nipple pain, production concerns, and the list goes on.

Even so, she reports managing to “push through” with phone support, but admits this was not ideal.

“I felt like I did OK with phone support with my first baby, but it’s only because I was very driven,” she says. “I was trained as a scientist and really wanted what was best for my baby without recognizing how hard it was going to be at the time.”

Despite the hard work that breastfeeding often requires, Jacobitz-Kizzier remembers the joy of breastfeeding her babies.

“Over the course of having my third child and breastfeeding him…it has reminded me of just how fulfilling it can be to exclusively breastfeed an infant,” she says. “It is just such a joy and that’s hard to convey to people in the clinic setting. I wish I could really impress that on my patients.”

Jacobitz-Kizzier’s lactation education in medical school included a one hour lecture about the anatomy of the breast and a brief discussion in physiology about lactogenesis.

“There was no training about [breastfeeding] technique, no discussion about common problems before discharge, no training about clinical problems as far as in the first few months postpartum…when to introduce complementary food,” she continues.

Acknowledging this deficit, Jacobitz-Kizzier completed The Lactation Counselor Training Course to learn how to care for breastfeeding women in a clinical setting. Family medicine offers an ideal combination of infant and maternal health where mom and baby can be cared for as a dyad, she says.

Before taking the CLC training, Jacobitz-Kizzier says that she “didn’t understand some of the deepest fundamentals like supply and demand– the nature of milk production.”

“Just that deficit alone was critical in how I now counsel my breastfeeding moms,” she says. “It is of paramount importance to protect exclusive breastfeeding.”

After completing the course, she says she’s also more aware of “how vitally important it is to protect the mother baby dyad.”

She names protecting her patients from “the undue influence of formula companies”, supplying them with resources for work and childcare, and helping them understand what medications are compatible with breastfeeding.

“Medical school is still coming from a paradigm of studying pathology and disease, and so rather than being focused on wellness and nutrition and normalcy, we are trained on only the diagnosable and fixable,” Jacobitz-Kizzer says.

Until this paradigm changes, physicians will struggle to offer proper infant feeding counseling.

Jacobitz-Kizzier offers this suggestion: “When folks are getting trained about infant nutrition during their pediatric and family medicine rotations, there needs to be an emphasis on the role of the physician in the patient’s life, and if women are going to attempt to breastfeed, the physician needs to be comfortable…helping [the mother] problem solve.”

Last January, Jacobitz-Kizzier started conducting research on breastfeeding rates and resident preparedness at the Family Care Center at the University of Iowa Hospitals and Clinics.

Her work, entitled Breast is Best: Breastfeeding Rates and Resident [Physician] Preparedness at the Family Care Center, involved calculating what percentage of family medicine patients breastfeed their infants and then studying the breastfeeding knowledge, attitudes and beliefs among resident doctors.

Below are some of her findings:

  • 90 percent of resident doctors practice breastfeeding counseling but only 11 percent feel their training was adequate

  • 77 percent of the residents explicitly state that breastfeeding is the superior nutrition

  • When asked, “Do you know what is and is not effective to increase milk production,” only 28 percent said ‘yes’.

  • Less than 30 percent of resident doctors report feeling confident offering breastfeeding counseling.

  • 100 percent of the participating resident doctors replied that they think breastfeeding in public is socially acceptable.

Jacobitz-Kizzier recently offered a breastfeeding inservice lecture to address specific concerns from the survey. She covered information and hands on training about breast pumps, optimal latch, other breastfeeding techniques and suggested the use of ILCA’s Clinician’s Triage Tool.

Jacobitz-Kizzier will resurvey the Resident Physicians to assess if their knowledge and confidence has increased. She hopes present her work at the Society of Teachers of Family Medicine Conference in April 2015.

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