The U.S. Preventive Services Task Force is keeping its 2016 recommendations in support of breast-feeding nearly identical to those issued in 2008, with the exception of deleting one word: “promote.”
The independent panel of experts, who are funded and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, recommended eight years ago that physicians “promote and support” breast-feeding among their patients. Only “support” survived this year.
The new guidelines still wholeheartedly recommend breast-feeding as the best choice for mothers and children but, as one of the authors explained, the change is meant to relieve pressure on women who cannot breast-feed, or make an informed choice not to do so.
“We felt that ‘supporting’ really emphasized that it’s about making sure that women have what they need when they make that choice,” Dr. Maureen Phipps said.
Phipps is chairwoman and Chace-Joukowsky professor of obstetrics and gynecology at Brown University and Women and Infants Hospital in Rhode Island.
The panel recommendation makes it clear that breast-feeding has proven health benefits, from preventing infection and allergies to lowering risk of diabetes and heart disease. But the decision to drop the word "promote" raises intriguing questions about the lines between patient autonomy, physician empathy and evidence-based recommendations.
Dr. Karen Duncan, a New York obstetrician-gynecologist, explained that some women have a lot of trouble breast-feeding, or cannot breast-feed because they are taking certain medications. So, in her view, the rewording was a “positive step” to help alleviate some of the stigma those women might feel.
“We don’t want to shame or pressure women into doing something they are unable to do,” she said. “We do think breast-feeding is the best […] but we need to be understanding that there are many circumstances that go into a woman’s decision about how to feed her baby.”
She added that social media – like Pinterest boards where moms display elaborate baked goods and impeccably decorated birthday parties – have increased the pressure women feel surrounding motherhood.
Some breast-feeding advocates, however, take issue with the wording change.
“Women need to understand all of the risks of formula, and benefits of human milk,” said spokeswoman Diana West of La Leche League International, an organization dedicated to helping mothers worldwide to breast-feed through "mother-to-mother support, encouragement, information, and education," according to its website.
West noted a distinction between the “guilt” women may feel if they don’t breast-feed, and “regret” that they weren’t fully informed about the benefits.
“What we really come to understand is that far too often, women feel tremendous regret because they were not given adequate information and support [about breast-feeding] when they needed,” she said.
She worries the new guidelines will do women a “disservice,” and lead to fewer women getting comprehensive information about the benefits of breast-feeding.
While she understands the motivation behind the change, New York City obstetrician-gynecologist Dr. Abigail Winkel finds the new wording “a little disappointing,” she said.
“It is an extremely important thing for doctors to be empathetic to their patients,” Winkel said. “But our patients need to be educated about something that has such a positive health benefit.”
It is crucial, she said, that doctors not avoid those tough conversations.
If breast-feeding is really not possible, Winkel advises patients to “let it go and move on,” she said. Being stressed about failure to breast-feed will only interfere with bonding, and there are “loads of other healthy behaviors” that mothers can engage in, like skin-to-skin contact, she added.
The guidelines call for further research into ways to decrease guilt and anxiety in women who cannot breast-feed. But regardless of linguistic nuances, the Preventive Services Task Force makes one thing crystal clear: when at all possible, breast is best.