Mamas on Bedrest: How The US Can Overcome Barriers to Breastfeeding

April 11th, 2012

Human breastmilk is the best food for human babies.

Everyone from the American Academy of Pediatrics to Surgeon General Regina Benjamin, MD., have extolled its virtues and clearly stated, in no uncertain terms, that “Breastmilk is Best.” We know that infants who are breastfed are at decreased risk of lower respiratory tract infections in the first year, lower incidence of diarrhea and vomiting, have fewer ear infections, are less likely to develop asthma, childhood obesity and type 2 diabetes, Sudden Infant Death, eczema, acute lymphocytic and acute myelogenous leukemia. In preterm infants, lack of breastfeeding is linked to a 138% increase in necrotizing enterocolitis, a potentially life-threatening problem. Breastfeeding also benefits mamas. The risks for breast cancer and for ovarian cancer are increased in women who have never breastfed.

So it is a huge disappointment to see that in the United States according to the Centers for Disease Control and Prevention (CDC) only 74% of mothers start breastfeeding exclusively at birth. By six months, that number dips to approximately 43% exclusively breastfeeding and by one year that number is a sparse 23% who are still breastfeeding. What is even more disappointing is that amongst African American mothers, only 60% initiate breastfeeding and only 28% are still breastfeeding at six months.

These numbers are far from the targets set for Healthy People 2020.

Breastfeeding Goal                       Current Rate

Ever-breastfed infants                                         82%                                                74%
Exclusive breastfeeding at 3 mos                   44%                                                 33%
Breastfeeding at 6 mos                                        61%                                                 43%
Exclusive breastfeeding at 6 mos                   24%                                                 14%
Breastfeeding at 12 mos                                     34%                                                 23%

New Mothers Need Breastfeeding Support to Continue Breastfeeding long term

What the CDC and the data from the Infant Feeding Practices Study II (IFPS II) showed is that while many mothers started with the intention of breastfeeding, there is a large lack of support provided to new mothers in order to be successful. The surgeon general’s call to action cited the following five obstacles to breastfeeding,

  1. Lack of experience  and/or lack of understanding amongst family members,  consequently lack of support for the nursing family
  2. Limited support from other nursing mothers
  3. No support of provisions available for breastmilk pumping for moms at work.
  4. Lack of up-to-date instruction and information from health care professionals
  5. Hospital practices that impede successful breastfeeding and hinder getting professional help from a knowledgeable nurse or lactation consultant

Support from Qualified, Educated Hospital Personnel is Critical to Breastfeeding Success

These barriers are directly addressed and removed when hospitals are educated and willing to support new mothers who wish to breastfeed.  The US Breastfeeding committee also recommends placing a newborn immediately on mama’s chest at birth, even before cutting the umbilical cord, because evidence shows that

“a baby who is placed skin-to-skin will likely find the breast and initiate breastfeeding within the first 60 minutes of life”

To better ensure that hospital staff are able to support and educate new mothers about the benefits of breastfeeding and to assist with any potential problems, The CDC developed Baby Friendly Hospital Practices as part of the IFPS II. These practices have also been promoted by the World Health Organization and the United Nations Children’s Fund (UNICEF) in the Baby-Friendly Hospital Initiative, which includes a breastfeeding-promotion component. The Baby-Friendly Hospital Initiative has identified “10 Steps to Successful Breastfeeding”

  • Have a written breastfeeding policy that is routinely communicated to all health care staff
  • Train all healthcare staff in skills necessary to implement this policy
  • Inform all pregnant women about the benefits and management of breastfeeding
  • Help mothers initiate breastfeeding within 1 hour of birth
  • Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants
  • Give newborn infants no food or drink other than breast milk unless medically indicated
  • Practice rooming-in by allowing mothers and infants to remain together 24 h/d
  • Encourage breastfeeding on demand
  • Give no artificial teats, pacifiers, dummies, or soothers to breastfeeding infants
  • Foster the establishment of breastfeeding support groups and refer mothers to them upon discharge from the hospital or clinic.

Sometimes a mama and her baby must be separated following delivery. In these cases, mamas should be taught to use breast pumps and to express breast milk that can be stored and given to their infants for feedings. When the infants are stable enough to breastfeed, mama and baby should be coached on best breastfeeding techniques by a trained lactation consultant to ensure the best chance of success.

Ensuring Success after Discharge Home

Prior to discharge, a trained lactation consultant should meet with mama again to ensure that principles of latching on, milk letdown, normal infant stooling patterns and weight gain are understood. Mama should be evaluated to ensure that she is not experiencing nipple pain, has adequate experience expressing milk and knows how to pump if needed, has all of her questions answered, has resources and numbers to call if she has subsequent questions and/or needs support.

For Resources on Breastfeeding Support, check out our resources page here.

For useful books on Breastfeeding, Check out our Amazon.com store and look in the breastfeeding section.

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