Time sensitive

Most days, I feel that the Affordable Care Act’s negatives outweigh its positives, but I’m not quite ready to throw out the baby with the bathwater. For example, I recently discovered that the ACA requires that all insurance companies pay for breast pumps and lactation counseling. Great idea! But, then I learned that the law neither specifies the type of breast pump nor defines who qualifies as a trained provider of lactation counseling services (Breast-Feeding Services Lag Behind the Law, Catherine Saint Louis, New York Times, Sept. 30, 2013). It turns out that with rare exceptions, finding a lactation consultant who is approved by the insurance company and then securing payment are fraught with delays that are measured in days or weeks. Of course, these delays and snafus come during a critical window for breastfeeding success.

A recent study by Wagner et al. (Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months; Pediatrics 2013;132:e865-e75) reports the obvious. Maternal concerns about their infant’s feeding difficulties, breastfeeding pain, and milk quantity were associated with early cessation of breastfeeding, with peaks at 3 and 7 days postpartum. The fact is that even mothers who had a solid intent to nurse their babies for at least 2 months worry. They become upset if they perceive that their babies are struggling to feed, or if they suspect that the babies aren’t getting enough to eat. And, they are just as vulnerable to pain as everyone else.

These concerns and worries occur in a compressed time frame of very few days and are magnified by the sleep deprivation that accompanies most deliveries. The correct advice provided by compassionate lactation consultants (and here I include pediatricians) can be critical to breastfeeding success. But, it must be provided on a time scale that matches the tempo of the lactation process. Here I am talking about hours, not days.

Interestingly and sadly, the hospital where Ms. Wagner and her colleagues collected their data doesn’t seem to understand that time-sensitive urgency. The investigators report that lactation consultants are "generally available on the maternity unit 6 days per week." Heaven help the poor mother and infant who are struggling with a poor latch on that 7th day. And, what does "generally available" mean? Folks, a new mother’s breastfeeding concerns require intensive care. The nurses and doctors in an ICU just aren’t "generally available."

The researchers also postulate that the increase in adverse outcomes later in the first week postpartum may be because "there is often a gap between hospital and community lactation services." Really? There’s the problem in a nutshell. If we want more babies to be breastfed, we have to treat the support services as critical and time sensitive. We have done a pretty good job of convincing mothers that breastfeeding is the best way to feed their newborns. Now we have to acknowledge their concerns and support them with quality advice 24/7.

Medical homes must function like homes. Your parents may have turned the lights out at 10:00 p.m., but they didn’t leave you alone and go to a motel for the night. To achieve the kind of seamless support net that new mothers need and deserve, pediatricians need to learn more about giving lactation advice themselves. They need to join with lactation consultants with whom they feel comfortable to provide 24/7 phone support and face-to-face visits on a 365/365 schedule.

The ACA appears to be offering us the opportunity to take breastfeeding support seriously. Obviously, it has some rough edges at this point. But, let’s take advantage of this chance by seeing that the support for our patients is provided in a time frame that matches the biology of breastfeeding.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He is the author of "Coping with a Picky Eater: A Guide for the Perplexed Parent" and several other books. E-mail him at [email protected].

Updated: 10/8/2013

Most days, I feel that the Affordable Care Act’s negatives outweigh its positives, but I’m not quite ready to throw out the baby with the bathwater. For example, I recently discovered that the ACA requires that all insurance companies pay for breast pumps and lactation counseling. Great idea! But, then I learned that the law neither specifies the type of breast pump nor defines who qualifies as a trained provider of lactation counseling services (Breast-Feeding Services Lag Behind the Law, Catherine Saint Louis, New York Times, Sept. 30, 2013). It turns out that with rare exceptions, finding a lactation consultant who is approved by the insurance company and then securing payment are fraught with delays that are measured in days or weeks. Of course, these delays and snafus come during a critical window for breastfeeding success.

A recent study by Wagner et al. (Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months; Pediatrics 2013;132:e865-e75) reports the obvious. Maternal concerns about their infant’s feeding difficulties, breastfeeding pain, and milk quantity were associated with early cessation of breastfeeding, with peaks at 3 and 7 days postpartum. The fact is that even mothers who had a solid intent to nurse their babies for at least 2 months worry. They become upset if they perceive that their babies are struggling to feed, or if they suspect that the babies aren’t getting enough to eat. And, they are just as vulnerable to pain as everyone else.

These concerns and worries occur in a compressed time frame of very few days and are magnified by the sleep deprivation that accompanies most deliveries. The correct advice provided by compassionate lactation consultants (and here I include pediatricians) can be critical to breastfeeding success. But, it must be provided on a time scale that matches the tempo of the lactation process. Here I am talking about hours, not days.

Interestingly and sadly, the hospital where Ms. Wagner and her colleagues collected their data doesn’t seem to understand that time-sensitive urgency. The investigators report that lactation consultants are "generally available on the maternity unit 6 days per week." Heaven help the poor mother and infant who are struggling with a poor latch on that 7th day. And, what does "generally available" mean? Folks, a new mother’s breastfeeding concerns require intensive care. The nurses and doctors in an ICU just aren’t "generally available."

The researchers also postulate that the increase in adverse outcomes later in the first week postpartum may be because "there is often a gap between hospital and community lactation services." Really? There’s the problem in a nutshell. If we want more babies to be breastfed, we have to treat the support services as critical and time sensitive. We have done a pretty good job of convincing mothers that breastfeeding is the best way to feed their newborns. Now we have to acknowledge their concerns and support them with quality advice 24/7.

Medical homes must function like homes. Your parents may have turned the lights out at 10:00 p.m., but they didn’t leave you alone and go to a motel for the night. To achieve the kind of seamless support net that new mothers need and deserve, pediatricians need to learn more about giving lactation advice themselves. They need to join with lactation consultants with whom they feel comfortable to provide 24/7 phone support and face-to-face visits on a 365/365 schedule.

The ACA appears to be offering us the opportunity to take breastfeeding support seriously. Obviously, it has some rough edges at this point. But, let’s take advantage of this chance by seeing that the support for our patients is provided in a time frame that matches the biology of breastfeeding.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He is the author of "Coping with a Picky Eater: A Guide for the Perplexed Parent" and several other books. E-mail him at [email protected].

Updated: 10/8/2013

Most days, I feel that the Affordable Care Act’s negatives outweigh its positives, but I’m not quite ready to throw out the baby with the bathwater. For example, I recently discovered that the ACA requires that all insurance companies pay for breast pumps and lactation counseling. Great idea! But, then I learned that the law neither specifies the type of breast pump nor defines who qualifies as a trained provider of lactation counseling services (Breast-Feeding Services Lag Behind the Law, Catherine Saint Louis, New York Times, Sept. 30, 2013). It turns out that with rare exceptions, finding a lactation consultant who is approved by the insurance company and then securing payment are fraught with delays that are measured in days or weeks. Of course, these delays and snafus come during a critical window for breastfeeding success.

A recent study by Wagner et al. (Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months; Pediatrics 2013;132:e865-e75) reports the obvious. Maternal concerns about their infant’s feeding difficulties, breastfeeding pain, and milk quantity were associated with early cessation of breastfeeding, with peaks at 3 and 7 days postpartum. The fact is that even mothers who had a solid intent to nurse their babies for at least 2 months worry. They become upset if they perceive that their babies are struggling to feed, or if they suspect that the babies aren’t getting enough to eat. And, they are just as vulnerable to pain as everyone else.

These concerns and worries occur in a compressed time frame of very few days and are magnified by the sleep deprivation that accompanies most deliveries. The correct advice provided by compassionate lactation consultants (and here I include pediatricians) can be critical to breastfeeding success. But, it must be provided on a time scale that matches the tempo of the lactation process. Here I am talking about hours, not days.

Interestingly and sadly, the hospital where Ms. Wagner and her colleagues collected their data doesn’t seem to understand that time-sensitive urgency. The investigators report that lactation consultants are "generally available on the maternity unit 6 days per week." Heaven help the poor mother and infant who are struggling with a poor latch on that 7th day. And, what does "generally available" mean? Folks, a new mother’s breastfeeding concerns require intensive care. The nurses and doctors in an ICU just aren’t "generally available."

The researchers also postulate that the increase in adverse outcomes later in the first week postpartum may be because "there is often a gap between hospital and community lactation services." Really? There’s the problem in a nutshell. If we want more babies to be breastfed, we have to treat the support services as critical and time sensitive. We have done a pretty good job of convincing mothers that breastfeeding is the best way to feed their newborns. Now we have to acknowledge their concerns and support them with quality advice 24/7.

Medical homes must function like homes. Your parents may have turned the lights out at 10:00 p.m., but they didn’t leave you alone and go to a motel for the night. To achieve the kind of seamless support net that new mothers need and deserve, pediatricians need to learn more about giving lactation advice themselves. They need to join with lactation consultants with whom they feel comfortable to provide 24/7 phone support and face-to-face visits on a 365/365 schedule.

The ACA appears to be offering us the opportunity to take breastfeeding support seriously. Obviously, it has some rough edges at this point. But, let’s take advantage of this chance by seeing that the support for our patients is provided in a time frame that matches the biology of breastfeeding.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He is the author of "Coping with a Picky Eater: A Guide for the Perplexed Parent" and several other books. E-mail him at [email protected].

Updated: 10/8/2013