A large majority of Canadian mothers choose to breastfeed. According to a 1994 National Population Health Survey, nearly 73% of moms nursed their babies - a vast improvement from the 38% who did so in the 80s. Over the years, clinical evidence of the benefits of breastfeeding has been steadily mounting. "It's healthier for both mother and baby," says Dr Beverly Chalmers, PhD, a perinatal consultant in Kingston who's involved with the WHO and UNICEF's Baby-Friendly Hospital Initiative. Breastfeeding cuts down on a mother's risk of developing breast, uterine and ovarian cancer and also helps mum get back to her pre-pregnancy weight. As for the newborn, mother's milk protects against gastrointestinal infections, allergies, asthma and other medical problems.

Even though the management of maternity patients doesn't usually fall under primary care, it's important that you encourage mothers-to-be to breastfeed. Here are some pointers on how to field your patients' questions and make sure they're well-informed about breastfeeding.

THE BREAST ADVANTAGE
Boost confidence "A huge amount of help comes from giving new mums confidence," says Dr Chalmers. She adds that it's important to encourage mothers-to-be to learn about breastfeeding before the baby is born. Suggest that they meet with new mothers who are breastfeeding so they can actually see how it works. Groups like La Leche League and the Breastfeeding Committee of Canada are great resources for pregnant women.

Going through the motions Breastfeeding is an acquired skill that requires a hands-on approach. New mums can best learn the correct way to hold the baby (see illustrations below) and the proper latch-on technique once the baby is born, explains Dr Chalmers. In most cases it's the postpartum nurse, a lactation consultant or a midwife who introduces mum to the wonderful world of breastfeeding. Among the techniques taught by the experts, the C-hold is one of the most essential that a woman must master to achieve proper latch-on.

Had enough? "Is my baby getting enough milk?" is one burning question that appears to consume all new mums. Dr Chalmers explains that baby's behaviour such as crying or waking too often is a good indicator that it isn't getting its fill. "The most significant sign that a baby's not feeding enough," explains Dr Chalmers, "is if there aren't many wet diapers." An infant should produce stool at least two to three times daily and wet their diaper at least six to eight times every day.

Epidural effects Some mothers worry about the effects of medications used during labour on breastfeeding. "It can have an effect on breast milk and breastfeeding," confirms Dr Chalmers. "Babies may be more dopey for the first few days," she adds. Her advice is that mums might want to use alternative pain management methods. But having an epidural should not discourage mums from breastfeeding.

Knowing when to stop The Canadian Paediatric Society (CPS) recently extended the recommended period of exclusive breastfeeding — meaning no other foods or liquids, including water — from four to six months. Dr Margaret Boland, chair of the CPS nutrition committee, explains that the change was made in concordance with the WHO's recommendations. There's some evidence that extending exclusive breastfeeding to six months can further protect infants from gastrointestinal infections. Tell patients that extending exclusive nursing to six months can benefit them as well. "It prolongs the delay of getting back to regular periods," explains Dr Boland, "and it also helps mum continue to lose weight."