Got Milk?
Armed with research on the benefits of breastfeeding, nurses encourage new mothers to feed their babies the natural way
By Donna Hemmila
August 24, 2004
When new mothers who are working tell pediatric nurse Mary Hagedorn that they have a difficult time breastfeeding, she can relate.
As a new mother who worked 12-hour shifts on a busy pediatric intensive care unit, she sometimes had trouble finding the time and privacy to pump breast milk. As a nurse, she knew the benefits of breastfeeding outweighed the difficulties, and she was determined to keep breastfeeding her baby.
“I think it took a lot of perseverance, and I was a health practitioner,” said Hagedorn, RN, PhD, CNS, CPN.
Many new mothers start off breastfeeding, but pressures from work and family can derail efforts to meet what the World Alliance for Breastfeeding Action calls The Gold Standard — exclusive breastfeeding from birth to 6 months. That is the recommendation of the American Academy of Pediatrics and was the theme of World Breastfeeding Week (Aug. 1-7). The campaign aims to encourage more women to breastfeed their babies.
According to the U.S. Department of Health and Human Services, about 70% of U.S. mothers initiate breastfeeding when their babies are born, but only 33% are still at it six months later. The numbers are up only slightly since 1998, when the Centers for Disease Control and Prevention estimated 69% of new moms breastfed and 29% continued after six months. The agency has set a goal of raising those percentages by 2010 to 75% at birth, 50% at 6 months, and 25% at 12 months.
Numerous studies have shown a connection between breastfeeding and baby health: fewer bouts of respiratory ailments, diarrhea, and ear infections and a lower risk of SIDS. But recent research is finding that breastfeeding is a factor in long-term health benefits in later life.
A 1998 study of Pima Indians attributed lower risk of diabetes in adults who were breastfed two months or longer. In a study published in May, researchers from the Institute of Child Health in London found a 14% lower ratio of LDL to HDL cholesterol in teenagers who had been breastfed.
A 2002 study from the National Institute of Child Health and Human Development and the Norwegian University of Science and Technology discovered that children who had been breastfed exclusively scored 11 points higher on IQ tests. Yet despite the scientific research, breastfeeding rates seem to have reached a plateau in the last decade.
Parental concerns
At the Pediatric Academic Societies’ annual meeting in May, researchers presented new studies that focus on two serious parental concerns: infant mortality and obesity. Breastfeeding advocates see this latest research as a way to persuade more families to view breastfeeding as the preferred method of nourishing their babies.
According to researchers from the National Institute of Environmental Health Sciences, breastfed babies in the United States have a 20% lower risk of dying in the first year than children who are not breastfed.
Researchers examined CDC records of 1,204 children who died between 28 days and 1 year, excluding those with cancer or congenital anomalies since those conditions may have prevented breastfeeding. They compared those babies with 7,740 children who were still alive at 1 year.
Most studies examining the relationship between breastfeeding and infant mortality focus on developing nations and infectious disease. This study, published in the May issue of Pediatrics, is the first using U.S. statistics that shows a lower risk of mortality among babies.
Epidemiologist Walter Rogan, MD, one of the researchers, estimates that breastfeeding could potentially save the lives of 720 babies a year in the United States.
“Breastfeeding isn’t thought of as a public health issue,” Rogan said. “I think it is.”
Obesity certainly is gaining prominence as a health issue with the latest statistics proclaiming 67% of Americans as obese. Even more alarming is the rising rate of childhood obesity: The CDC ranks 15.3% of children age 6 to 11 years old as obese. Researchers from Cincinnati Children’s Hospital Medical Center have discovered a link between breastfeeding and a lower risk for later-life obesity and associated conditions such as Type 2 diabetes and coronary artery disease.
The study’s principal author, Lisa Martin, PhD, of the Cincinnati Children’s Research Foundation Center for Epidemiology and Biostatistics, had been involved in identifying genes associated with obesity. Her research is the first to discover the presence in human milk of adiponectin, a protein that affects how the body processes sugar and lipids. The study also confirmed the presence of leptin, which affects the feeling of fullness after eating.
The researchers tested samples from 30 women who had donated to the hospital’s research milk bank. The samples ranged from the first day of lactation to the 400th day. The highest levels of adiponectin were found in colostrum, Martin said, with the levels decreasing with the length of lactation.
Many people blame the rise in obesity on the proliferation of fast-food consumption in the 1950s. That’s also the time when U.S. breastfeeding rates start to plummet, Martin said, reaching around 20% in 1956, according to La Leche League International.
Economic demands
Economic demands are making it tougher for new moms today to keep breastfeeding, Hagedorn said.
“Women are working harder, longer, and faster,” she said. “We’re doing what the job of two or three people used to be in our parents’ generation.”
Workplace perks such as on-site day care centers and lactation rooms that were used to lure moms back into the workforce have gone by the wayside with the economic downturn. Women find it difficult to have the time and privacy to pump breast milk and to store it, particularly if they work in low-wage jobs with rigid time constraints.
At the Colorado Springs Health Partners practice where Hagedorn works, patients receive a follow-up visit three days after birth. That’s when Hagedorn starts strategizing with new moms about managing breastfeeding and career. She advises working moms to forego running errands during their lunch break and instead use the time to relax and pump milk. She offers practical tips like how to store the milk so coworkers won’t use it in their coffee and how to master a breast pump in a public restroom stall if that’s the only place available.
Linda Ennis, director of the nurse-midwifery program offered by the University of California, San Francisco and San Francisco General Hospital, thinks the standard medical model of giving birth doesn’t provide enough support to breastfeeding mothers.
“It’s a little bit of a flaw in our U.S. health care system,” said Ennis, MS, CNM. Breastfeeding education and support is a cornerstone of midwifery education, she said, and midwives approach the practice as a family affair.
Caregivers need to tailor the education to meet the individual mother’s needs, she said, and to support the woman’s decision of whether to breastfeed. Women in low-wage jobs have less flexibility and privacy to pump breast milk during the workday, she said, and some women fear they may not have enough milk to sustain their infant.
While going back to work is a common reason why women give up on breastfeeding, another deterrent remains the lack of family and community support. The first weeks of living with a new baby are stressful, and breastfeeding can be painful. If the baby’s father or other family members discourage the mother, she may turn to bottlefeeding.
“When they start to run into resistance, the tendency is to fold because they don’t have that support,” said Cheryl Thorne, RN, CPN, who works in the General Clinical Research Center at Texas Children’s Hospital in Houston.
Thorne breastfed both her now-adult children and believes her daughter’s generation will adopt breastfeeding more readily than their parents because of the greater exposure to breastfeeding role models and support programs.
Support system
The need for a continuing support system has led Sutter Health’s Alta Bates Summit Medical Center in Berkeley, Calif., to expand its breastfeeding program. In late 2005, the hospital, which has about 10,000 births a year, will open an outpatient lactation center.
Alta Bates now has an inpatient program with seven certified lactation consultants. About 85% of all new moms at Alta Bates breastfeed, said Joan Gress, RN, IBCLC, manager of the hospital’s breastfeeding support program.
“I think we’re turning the tables a bit,” she said.
American culture has become one of bottlefeeding, she said, and new mothers may never have been exposed to other women who breastfed. They need instruction, reassurance, and follow-up support. At Alta Bates, the lactation consultants visit with every mom who delivered early and those who are referred by their care provider.
Most women have made up their minds about choosing to breastfeed by the time they arrive for delivery, Gress said. The lactation consultants meet with the few who are still ambivalent and request more information. The program offers a weekly support group for breastfeeding families, but the new center also will offer a place where a mother can nurse her baby while the consultant observes to give instruction and encouragement.
At the Kaiser Permanente Hayward (Calif.) Medical Center, Miriam Levitt, RN, IBCLC, said the lactation consultants see every new mother at discharge, and more than 90% leave the hospital breastfeeding. The medical center is the only one in the area certified under the Baby-Friendly Hospital Initiative. Created in 1991 by the United Nations Children’s Fund and The World Health Organization, the initiative’s goal is to promote breastfeeding globally.
More than 16,000 hospitals and birth centers have been awarded the baby-friendly designation, including 42 in the United States. To be certified, a facility has to meet 10 criteria including offering prenatal breastfeeding education and support programs after discharge, not administering any liquids or supplements to newborns unless prescribed for medical reasons, and training all caregivers about the benefits of human milk. The hospital does not accept free formula from the manufacturers, Levitt said.
“Even though most mothers will make an attempt to breastfeed, the bottle is seen as a normal thing and it becomes easy to give up [breastfeeding],” Levitt said.
Health practitioners need to turn that perception around, she said, so women begin to view breastfeeding as the norm and bottlefeeding as just an alternative to the preferred feeding method.
Mixed message
A public service ad campaign that highlights the risk of not breastfeeding launched in early June after a six-month delay because of the content.
The controversial TV and print ads are the product of the HHS Office on Women’s Health and the Advertising Council, a nonprofit association of advertising professionals known for creating public service campaigns like Smokey Bear and McGruff, the crime-fighting dog.
The breastfeeding campaign was set to begin in December, but pressure from the formula manufacturers about the message delayed it. Instead of just stressing the benefits of breastfeeding, the ads emphasize the risks of not breastfeeding.
According to statements from the United States Breastfeeding Committee, concerns were raised that the scientific research on certain claims were new or inconsistent, that the ads were too negative, and that they made formula-feeding mothers feel guilty. More than 1,000 letters supporting the ads were sent to the Department of Health and Human Services, which ordered changes to the commercials that critics say watered down the message.
Not all breastfeeding supporters were pleased with the tone of the ads. American Academy of Pediatrics President Carden Johnston, MD, in a letter to HHS Secretary Tommy Thompson, questioned the negative message and cautioned the department to “avoid making any claims that cannot be scientifically validated and thus undermine the credibility of the campaign.”
One commercial shows a pregnant woman getting thrown from a mechanical bull and says, “You wouldn’t take risks while you’re pregnant. Why start after?”
The ad says breastfeeding can lessen ear infections, diarrhea, and respiratory illnesses and ends with the tagline “Babies are born to be breastfed.”
Previous versions of the ads that were broadcast on ABC TV’s 20/20 but not distributed to media outlets included statistics that compared risks of leukemia and diabetes for formula-fed vs. breastfed babies. The statistics and references to leukemia and diabetes were eliminated. The ads can be viewed at www.adcouncil.org/campaigns/breastfeeding .