What these studies did not address is perhaps most important to the practicing clinician in our struggle to promote and sustain breastfeeding—how and when should we intervene? Can we, as suggested in the study by Willis and colleagues, make a difference in improving the dismal rates of initiation and sustained breastfeeding? What is the optimal timing of discussions about the use of pacifiers? What can we do to promote change?
Designing the necessary intervention studies will likely take the combined efforts of physicians, nurses, and behaviorists within our discipline joined by our many colleagues in obstetrics, pediatrics, public health, and epidemiology. As more of our investigators receive training and experience in the design and conduct of clinical trials, the use of survival analyses, logistic regression models including effect modification to explore large national databases, and qualitative analysis, our literature base will expand exponentially in complexity and richness. In addition, we will also improve our ability to successfully compete for funding to support our work. The opportunities for family physicians to receive training in research methodology continue to expand and include fellowships, part-time master’s degree programs, and faculty development programs such as the Grant Generating Project. We encourage our investigators to pursue training and collaboration to enhance the types of research that will provide the next level of information that can be translated into practice.
As practicing family physicians, we can provide the laboratory for testing strategies to alter the timing of prenatal and postpartum visits, to tailor the messages delivered, or to involve office staff in effecting change. But ultimately it is our relationships with our patients that are deserving of study and will lead us to eventual solutions to the problems that we all face. We have seen how continuity of care can improve neonatal outcomes, but we need to understand more about how this works.12 Our long-term relationships provide opportunities and perhaps the legitimacy to intervene at many critical junctures in the lives of our patients. Through these relationships we should be able to more effectively uncover important concerns and preferences and to participate with women as they make informed health care choices that are in keeping with their values and may lead to optimal health for themselves and their families.