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Nurse practitioner Susan Crump assists a patient at the Mississippi Breastfeeding Medicine Clinic.

Ill-informed caution on the part of physicians is costing Mississippi children a crucial step towards a healthy start, says one of the state's leading medical experts on breastfeeding.

"I've heard so many stories where women say their doctor gave them a prescription and told them they had to stop breastfeeding," said Dr. Becky Saenz, founder of the Mississippi Breastfeeding Medicine Clinic in Madison. "A lot of people don't realize it, but if the physician had had the time or the knowledge about which reference book to look that up in, it may not have been true."

The default disclaimer on virtually all prescription and over-the-counter drugs must be weighed, Saenz said, against postmarketing studies in which mothers have volunteered samples of their milk for researchers to measure the drug's effect.
"When I give a talk, the list of drugs that's absolutely contraband for breastfeeding moms still fits on one slide," she said.

Saenz, a former assistant professor in the University of Mississippi Medical Center's Department of Family Medicine, is the only doctor in Mississippi to have earned the degree of fellow of the Academy of Breastfeeding Medicine. She is also a diplomate of the American Board of Family Practice and an International Board Certified Lactation Consultant (IBCLC).

Saenz founded her specialty clinic in July 2003 to meet the needs of breastfeeding mothers and their children, and also consults with their primary care physicians. She now employs a nurse practitioner to help with the patient load.

The clinic has seen more than 2,000 mothers and their babies since its opening. Its patients are referred from OB/GYNs, pediatricians, hospital lactation consultants, WIC program lactation specialists and leaders with the La Leche League.

Saenz began to specialize in breastfeeding medicine after her first child was born in 1996 and she realized how little her medical training had prepared her to breastfeed her daughter.

"There's a big knowledge gap — particularly in Mississippi," she said. "Most of us came through medical school and residency at a time when there weren't so many breastfeeding mothers. We had some lectures, but because we didn't have the patient population to learn on, the lectures didn't mean as much."

In recent years, though, breastfeeding rates have risen, along with a growing awareness of its health merits for both children and mothers, and better public support for breastfeeding moms.

A decade ago in Mississippi, fewer than 20 percent of mothers started off breastfeeding their babies while 10 percent made it to the six-month mark, Saenz said. More recent studies by the Centers for Disease Control and Prevention show that nearly half of Mississippi moms now give breastfeeding a try, with about 20 percent continuing through the first six months.

"It's a huge step in just 10 years," Saenz said. "This is a huge number of women who need their doctors to be knowledgeable."

For caregivers looking to bring their breastfeeding knowledge up to speed, one resource is the workshops offered at conferences for professional organizations like the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and others.

Additionally, UMC partners with the La Leche League and the Mississippi Department of Health WIC program for the annual April conference "Breastfeeding: The Gold Standard." This year's conference covered such topics as breastfeeding issues among groups such as adolescent and working mothers. Also on the program was a dentist's presentation on breastfeeding's relationship to proper development of a child's oral cavity, airway and facial form — and how that development can reduce risk for snoring and obstructive sleep apnea later in life.

Although the three-day conference offers CME credit for physicians, few doctors other than pediatricians typically attend, Saenz said.

For physicians in need of a quick reference to ensure they're not unnecessarily stopping moms from breastfeeding because of a prescription, Saenz recommends "Medications and Mothers' Milk: A Manual of Lactational Pharmacology." Edited by Thomas W. Hale, RPh, PhD, professor of pediatrics at Texas Tech University School of Medicine, it is updated regularly to reflect new drugs and research.
Among pediatricians, obstetricians and family practice physicians, the recommendations provided by their respective professional academies can also be a source of support.

"There are things obstetricians can even do in the delivery room to help moms get started," Saenz said.

Meanwhile, emerging research exploring the links between breastfeeding and lowered risk for obesity and type 2 diabetes is of particular import in Mississippi.

"A mom's decision to breastfeed and our helping her to continue benefits the child's health lifelong," Saenz said.

"Breastfeeding is too important to sacrifice on altar of ignorance," she said. "Ask the question, whether than just automatically assume."



May 2007

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