Note: This article has been updated to ACOG’s Committee Opinion #756 published in 2018.

News articles reporting on the American College of Obstetricians & Gynecologists breastfeeding Committee Opinion “Optimizing Support for Breastfeeding as Part of Obstetric Practice” have featured its position that obstetricians should support a woman’s informed decision to formula feed. No disagreement with the sentiment, but this misses the document’s real importance as a detailed blueprint for promoting successful breastfeeding. Here are some of the goodies that lie within.

Obstetrician gynecologists and other obstetric care providers should discuss the medical and nonmedical benefits of breastfeeding with women and families. . . . Contraindications to breastfeeding are few . . . . Most medications are safe in breastfeeding with rare exceptions (p. 189).

The World Health Organization’s “Ten Steps to Successful Breastfeeding” [steps listed in a box] should be integrated into maternity care (p. 188). . . . [They are] an evidence-based set of health care practices that support breastfeeding physiology, including early skin-to-skin care, rooming-in, and feeding on demand (p.191). . . . [W]omen who undergo cesarean delivery may need extra support. . . . Skin-to-skin contact is feasible in the operating room (p. 191).”

Families should receive noncommercial, accurate, and unbiased information. . . . [D]irect-to-consumer marketing of infant formula adversely affects patient and health care provider perception of the risks and benefits of breastfeeding (p. 190). . . . Distribution of formula marketing packs . . . implies that formula is a recommended feeding method. Moreover, provision of samples implies the health care provider’s endorsement of a specific brand. . . . Such marketing should not occur in inpatient or outpatient settings (p. 191-192).

Prior problems . . . should be discussed, anticipatory guidance should be provided, and appropriate lactation resources should be identified. . . . Obstetrician-gynecologist and other obstetric care providers should engage the patient’s partner and other family members in discussions about infant feeding and address any questions and concerns. This patient-centered approach allows the health care provider, the patient, and her family to anticipate challenges, develop strategies to address them, and collaborate to develop a feeding plan that is compatible with the woman’s and family’s goals (p. 190).

Obstetric care providers should collaborate with certified lactation professionals and the infant’s care provider to evaluate and manage breastfeeding problems (p. 193).

Most medications are safe for use during breastfeeding. Obstetrician-gynecologists and other health care providers should consult lactation pharmacology resources . . . because inappropriate advice often can lead women to discontinue breastfeeding unnecessarily (p. 188).

My favorite is:

The obstetrician-gynecologist is obligated to ensure patient comprehension of the relevant information and to be certain that the conversation is free from coercion, pressure, or undue influence (p. 188).

If only all obstetricians abided by this, whatever the option under discussion, what a wonderful world it would be!