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Posted by Dr. Claire McCarthy June 4, 2012 11:09 AM
A study just came out in the journal Pediatrics saying that only a third of the mothers who plan on exclusively breastfeeding for three months or more actually do it.
It's too bad, because breast milk really is the best nutrition for an infant--it's what they were meant to have. Not that formula can't be fine, but breast milk and breastfeeding can have tremendous health and emotional benefits for babies and their mothers. Some of those benefits, like lowering the risk of obesity, can last long beyond when breastfeeding stops.
The study was specifically looking at how birthing hospitals do or don't support breastfeeding, and they found that mothers are more likely to continue breastfeeding if the hospitals don't give the babies formula. Well, that's a shocker. You'd think it would be a no-brainer that hospitals shouldn't give formula to newborns if their moms are planning on breastfeeding, but it turns out that 78 percent of US hospitals routinely give formula to healthy breastfeeding infants.
But that's not the whole story. Even when the hospitals do everything right, less than half of moms reach their breastfeeding goals.
As a pediatrician, I've been supporting--or trying to support--moms in breastfeeding for more than twenty years. While there are lots of different reasons why women stop breastfeeding--each situation is unique--there are four that I hear most often. What makes me most sad is that there are solutions to each one--but moms need our help with those solutions.
Reason #1: a rough start. All those beatific pictures notwithstanding, breastfeeding can be hard work,especially at the beginning. It can take a little time for both mom and baby to get the hang of it--and throw in sore nipples and the exhaustion of just giving birth and it's easy to understand why some moms reach for the bottle (of formula).
Solution: support! If lactation support could be made available to every mom, it would make a huge difference. A certified lactation consultant is ideal, but a relative or friend with breastfeeding experience can be great too. Breastfeeding was meant to happen in a supportive community; we need to do a better job of making that happen.
Reason #2: worry that the baby isn't getting enough. We are a bottle culture. When we can't see how much our baby drinks, we get anxious. Add to that the simple fact that breastfed babies eat more frequently than formula-fed ones (breast milk is more easily digested, so moves through faster) and babies like to stay at the breast because it's the Most Wonderful Place in the World to them, and you can see why moms start thinking they aren't giving the baby enough--and start supplementing with formula.
Solution: support (see a theme here?). And education. If babies are eating at least every 3 hours or so, wetting at least 6 diapers in 24 hours, pooping regularly, and if moms can hear and see swallowing and their breasts feel full, chances are all is fine. Weighing the baby regularly can show that the baby is getting enough. Visits from a nurse, support from a doctor, check-ins from a lactation consultant--all of these can help families as they gain experience and confidence.
Reason #3: discomfort with nursing in public. Again, we are a bottle culture--and a culture that sexualizes breasts. Even though breastfeeding is just feeding a baby, many women often feel or are made to feel unwelcome or uncomfortable when they do so in a public place.
Solution: if we are truly going to raise breastfeeding rates in this country, we are going to have to get over some of these feelings and make it truly okay for women to breastfeed wherever they need to (gosh, I wish that were as simple as it sounds).
Reason #4: they need to go back to work. This is the deal-breaker for lots of moms. Working and breastfeeding can be done; I've done it. But finding the time and place to pump (and affording the pump in the first place), as well as transporting and storing breast milk, can be stressful. Add that to the general stress of going back to work, throw in a less-than-supportive workplace, and there goes the exclusive breastfeeding plan.
Solution: um..support. Insurance should pay for breast pumps. Education about using them should be easily available from all pediatrician's offices, and lactation consultations should be easily and widely available as well. More employers should be willing to create spaces for women to pump, and be flexible about schedules so that they can.
It's not going to work to blame hospitals or blame mothers for our low breastfeeding rates. This is something we all need to own--and, if we want to change it, something we all need to work on together.
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About MD MamaClaire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »
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