by Dr Louise Santhanam, General Practitioner
I went to my GP about 8 weeks after I had my section. He couldn’t believe I was still feeding and pumping and said I shouldn’t bother, the twins would have everything they needed from my milk by this point. He said most twin mums bottle feed. I wanted to ask for help with my back pain and vasospasm but after that I didn’t bother.
My health visitor asked me to see my GP as she suspected my baby had oral thrush. The GP took the time to ask how breastfeeding was going and he congratulated me on breastfeeding. He could have just given me a prescription and said no more but those few minutes of his time gave me a real boost.
The GP’s Role in Supporting Healthy Infant Feeding
The RCGP core competencies of a GP include developing ‘the knowledge and skill required to provide high quality care to groups of patients who may have needs that require you to adapt your clinical approach’. This includes care of infants, young children, pregnant women and new mothers. Competent clinical management includes ‘offering appropriate evidence-based management options’, ‘making safe and appropriate prescribing decisions’ and referring ‘appropriately to other professionals and services’. The curriculum learning objective ‘Practicing Holistically and Promoting Health’ includes the role of breastfeeding, and infant feeding issues fall under the ‘Caring for the Whole Person’ area of capability.
A GP’s involvement in promoting and supporting healthy infant feeding can therefore complement the vital role of colleagues working in Midwifery, Health Visiting and Lactation Support. This page summarises how collaboration in this field can benefit both patients and Primary Care.
The role of the GP with regards to infant feeding can include the following:
- Support for practices which enable a mother to initiate and continue breastfeeding for as long as desired by herself and her baby
- Competence to manage common infant feeding problems and timely referral to specialist colleagues when necessary
- Competence in prescribing for breastfeeding mothers without inappropriate recommendations to interrupt or cease breastfeeding
- Appreciation of the clinical issues relating to infant formula and the evidence base
- Sensitive, evidence based support for maternal mental health when it is impacted by infant feeding
- An understanding of the International Code of Marketing of Breastfeeding Substitutes and the responsibilities of health workers to protect breastfeeding and formula fed infants
- Support for breastfeeding colleagues and patients in the GP Practice: developing a breastfeeding friendly Practice environment and policies
- Facilitating infant feeding clinical education for peers and junior colleagues
Appropriate Promotion and Support for Breastfeeding
A recent large study of new mothers attitudes towards breastfeeding education and promotion and support showed that mothers valued breastfeeding information but want breastfeeding promotion to move away from the perception that ‘breastfeeding is best’, and instead consider it as normal. Women want information beyond the health benefits of breastfeeding and feel the promotional message should be that every breastfeed given is of value1.
Women are less likely to breastfeed if they perceive that their doctor does not support breastfeeding (either due to no expression of opinion on feeding choice or due to direct encouragement of artificial feeding). GPs can promote breastfeeding and support women in their decision to breastfeed through provision of accurate and consistent information2.
The Benefit to Patients and to Primary Care
There is an increased incidence of illness attributable to the current low breastfeeding rates in the UK. A report from 2012 suggested that a moderate increase in breastfeeding rates could lead to savings of about £40 million per year3. In Harrow rates of hospital admissions for gastroenteritis in children under 1 were reduced to 16% lower than the UK average following implementation of multidisciplinary healthcare professional training and the development of a network of trained breastfeeding peer supporters.
Economic modelling suggests that over 50,000 fewer GP appointments per year would be used in assessing children with gastroenteritis, respiratory illness and ear infections alone if breastfeeding rates could be increased to 45% at 4 months, with 75% of neonatal infants breastfed upon discharge. Additionally there could be an estimated 865 fewer cases of breast cancer annually and 361 fewer cases of NEC3.
Other studies have corroborated a significant reduction in URTI, LRTI and GI infections in infants who have been exclusively breastfed4 and lower consultation rates for babies breastfeeding at discharge from hospital after birth5. A UK study suggests that in a large cohort of singleton, term infants an estimated 53% of diarrhoea hospitalizations could have be prevented each month by exclusive breastfeeding and 31% by partial breastfeeding. Similarly, 27% of lower respiratory tract infection hospitalizations could have been prevented each month by exclusive breastfeeding and 25% by partial breastfeeding6.
When the prescribing of specialised infant formula is considered, total community spends are increasing, in particular spending on specialised milk for allergy (e.g. 212% increase to £9.14 million in London between 2006/7 and 2012/13)7. In London the reasons for the increase in spend have been investigated and include: increasing cost of specialised milks, geographic inequity in dietetic provision and advice, greater focus on allergy and increasing diagnosis of Cows’ Milk Protein Allergy (CMPA), poor communication between secondary and primary care and wastage from over-prescribing. A good understanding for the circumstances in which specialised formula is necessary, careful diagnosis and appropriate prescribing could therefore contribute to cost-effectiveness in primary care.
Working Towards Best Practice in Primary Care
This section of the website contains information which can support GPs to improve their personal practice and the Practice environment.
Consultation Resources A series of links to guidelines, support organisations and resources which the GP may find useful in practice
Kit & Contacts Useful equipment and the colleagues whose contact details will help
Supportive Language This page is in development
The Law The basics on the legal protections for breastfeeding in the UK
The GP Practice Suggestions for developing a Practice environment that is welcoming to breastfeeding
The GP Infant Feeding Champion Developing a special interest role for the GP
- Brown A. What Do Women Really Want? Lessons for Breastfeeding Promotion and Education. Breastfeeding Medicine. 2016;11(3):102-110.
- Odom E, Li R, Scanlon K, Perrine C, Grummer-Strawn L. Association of Family and Health Care Provider Opinion on Infant Feeding with Mother’s Breastfeeding Decision. Journal of the Academy of Nutrition and Dietetics. 2014;114(8):1203-1207.
- Unicef UK: Preventing Disease and Saving Resources- the potential contribution of increasing breastfeeding rates in the UK October 2012
- Duijts L, Jaddoe V, Hofman A, Moll H. Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy. Pediatrics. 2010;126(1):e18-e25.
- McConnachie A, Wilson P, Thomson H, Ross S, Watson R, Muirhead P et al. Modelling consultation rates in infancy: influence of maternal and infant characteristics, feeding type and consultation history. British Journal of General Practice. 2004;54:598-603.
- Quigley M, Kelly Y, Sacker A. Breastfeeding and Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort Study. Pediatrics. 2007;119(4):e837-e842.
- First Steps Nutrition Trust: Specialised Infant Milks in the UK 0-6 months- Information for Health Professionals Updated March 2017