Breast-feeding Blues

I’ve done it in the back seats of cars, and darkened movie theaters, and with my dress hiked up to my chin in a country club ladies room while other wedding guests waited outside crossing their legs. I’ve done it in the back pews at church, and department store dressing rooms, and behind the horse barn at the State Fair. Since I’m able to just disrobe with one hand, passersby are usually unaware of what I’m doing. But one time I wound up exposing myself in a Galleria bookstore.

“It’s wonderful what you’re doing,” said a lovely woman who threw herself in front of me while I hurried to cover up. “I did it with all of my kids, too.”

Breast-feeding is the missing verb here – though, as many nursing mothers find out, a more explicit physical activity might raise fewer eyebrows. Though mothers have been breast-feeding their children since the dawn of time, but the act of stopping everything, sitting down, and lifting your shirt to nurse a hungry baby doesn’t always mesh so well with the pace and protocols of modern life.

Nevertheless, a recent report from the U.S. Centers for Disease Control finds that three out of four new American moms are breast-feeding their infants– the highest rate in decades, and for good reason. This simple act, most experts agree, can strengthen and sweeten the bond between mother and child, boost and buffer of baby’s immune system, lower of baby’s risk of obesity, diabetes, allergies, asthma, and even raise his or her IQ a couple of points. Breast-feeding helps a new mom burn off the extra baby weight and lowers he risk of breast and ovarian cancer. The money saved on infant formula could even be used to start college savings account.

“There’s really no debate anymore – breast-feeding is better for moms and babies in every way,” says Laura Duckett, an associate professor at the University of Minnesota School of Nursing. That’s why, she says, the American Academy of Pediatrics strengthened its recommendations three years ago, advising new moms to breast feed their babies exclusively for the first six months of life and to continue breast-feeding for the first year and beyond – “as long as mutually desired by mother and child.” The longer you can do it, the better.

Unfortunately, few new moms make it to that goal. According to the same CDC study, while 77 percent of new moms try to breast-feed, only one in three breast-feed exclusively for six months and only one in five carries on through  the first year. Of course, there are many reasons a woman might choose to stop breast-feeding. What troubles breast-feeding advocates is the possibility that many women are giving up not because they want to, but because they don’t know how to continue.

“We often hear from women who are new to this country that they don’t believe mothers breast-feed in America because they never see it – it’s not out in the open,” says Colly Huberty, a lactation consultant for the Women, Infants and Children program of the St. Paul – Ramsey County Department of Health. Advocates say nursing women need to come out of the shadows to get the support they need and to serve as role models for the next wave of new mothers.”It’s the best thing I ever did – not just for my babies but for myself,” says Duckett, who has studied and promoted breast-feeding for 35 years. “The more we learn about the benefits, the more important it is that we talk to women and get the word out.”

Fortunately, breast-feeding happens to be a popular topic of conversation among new moms. When St. Paul author Andy Steiner set out to write a book on the subject, she was surprised by how many women sought her out to tell their stories. What did they want her to know? “That breast-feeding was nothing like they thought,” says Steiner. “It was harder than they’ve been told it would be, more challenging – but also more rewarding.”

Among the difficulties Steiner recounts in Spilled Milk: Breast-feeding Adventures and Advice from Less-than-Perfect Moms are leaky nipples, painful letdowns, grandparents who wonder whether their breast-feeding daughters are hippie freaks, and partners who were looking forward to the instant breast augmentation that accompanies lactation but were appalled by what a naturally engorged breast really looks like. “The word bovine came up a lot,” Steiner notes.

Another reoccurring topic is the stress that new mom’s experience while breast-feeding – wondering whether they’re doing the right thing, the right way, for the right duration and for the right reasons. “Women feel guilty and ashamed if they didn’t do it for very long, and they filled guilty and ashamed if they think they did it too long,” says Steiner.

“We really set women up for failure in this country,” says Joanne Slavin, a professor in the Food Science and Nutrition department at the U of M, who believes our “drive-by style of birth and delivery–the way we expect a new mom to go home and paint her house during maternity leave,” is antithetical to a healthy breast-feeding start. Many new moms are discharged from the maternity ward before their milk “comes in,” a complex hormonal process that takes place two to five days after delivery. What’s more, a generation or two ago a new mother often returned home to a circle of female family members and friends, who would help guide the breast-feeding process. But nowadays, Slavin says, “Grandmas aren’t around.”

Even if they were– those grandmas may not have much experience to share. That’s because breast-feeding rates fell during the 1960s and early 1970s, plummeting to a historic low in 1972, just as our current generation of moms were born. Experts say the support and encouragement of a woman’s inner circle is important for breast-feeding success and duration. “If you don’t know many people who breast-feed, it’s less likely you’ll try it or get the support you need,” says Huberty.

Complicating matters is the aggressive marketing of infant formula. According to the CDC, the number of people who mistakenly believe that “formula is just as good as breastmilk” nearly doubled between 1999 and 2003, roughly thesame time the U.S. formula industry increased its ad spending from $29 million more than $46 million. The practice of sending new moms home from the hospital with a complimentary diaper bag packed with also sends a mixed message about the importance of breast-feeding. A recent study published in the American Journal of Public Health revealed that women who went home with complimentary formula were 39 percent more likely to stop exclusive breast-feeding at 10 weeks than women who didn’t receive the freebies.

“One of the problems in the U.S. model of healthcare is that there’s no money to be made from breast-feeding,” says Slavin, adding that many hospitals no long have lactation consultants on staff because their services aren’t reimbursed. At the same time, according to the U.S. Department of Agriculture, private and government insurers spend at least $3.6 billion every year to treat diseases and conditions that breast-feeding could help prevent.

“It’s a terrible shame,” Slavin says, “because it takes just a little investment of time and attention for the mother and baby to work it out, and there are these critical moments when just a little help can make a world of difference.”

For Kelly Maynard, a St. Paul copyeditor, the critical moment came a few days after she returned home from the hospital with her son, Noel. She worried she wasn’t making enough milk (a common fear among the new moms – and often the reason they turn to formula), but Marusia Kachkowski, a St. Paul – Ramsey County public health nurse, weighed the baby and reassured his mother that he was doing fine (breast-fed babies tend to be leaner then bottle-fed babies). She also showed Maynard how to make sure the latch between the breast and baby’s mouth was right and advised her to relax and take are cues from the baby. “She was like a sea of calm” says Maynard, who has breast fed her son successfully for a year. “Who knows what would have happened if she hadn’t been there?”

Small interventions – whether they’re from a La Leche League volunteer, a board-certified lactation consultant such as catch Kachkowski, or a friend down the street – help many new mothers over the first hurdle of breast-feeding. “You usually find that these women after darkest day – their milk is coming in, they can’t remember the directions they got at the hospital, and they’re overwhelmed,” says Kachkowski, who just completed a master’s thesis entitled “Barriers to Breast-feeding in the 21st Century.” “It’s amazing what a little help can do to get a new family on the right path.”

Another hurdle is the transition back to work–particularly for moms in Minnesota who return to paying jobs in greater numbers than women almost anywhere in the nation. Though state law requires employers to allow a nursing woman the time and a reasonable place to pump, the rules can mean different things in different places. When I worked in a newsroom, I could excuse myself to visit a designated nursing mom’s room, but a friend of mine who worked at an art gallery had to repair to the least used bathroom and hope no one walked in on her. “It can be a hassle, but I try to tell women it’s really a very short period of time that you’re inconvenienced,” says Huberty.

Often the final obstacle to completing a full year of breast-feeding is getting comfortable doing it anywhere that your baby is hungry. A 2003 Porter Novelli survey found that 37 percent of Americans believe women “should breast-feed in private places only.” But that view seems to be changing. When The View’s Barbara Walters complained about being seated next to a nursing mother on an airplane, more than 200 “lactivist” moms held a “nurse-in” outside ABC Studios. (Any one of the women might have pointed out that nursing relieves the air pressure in a newborn’s in years during an airplane’s takeoff and landing.)

Protests like that – and the celebrations were likely to see you during international breast-feeding week in August – remind us that breast-feeding moms are a new majority among new moms in this country. “But to me,” says Kachkowski, “just to seeing a mother at Rainbow nurse her baby is more important than any big kumbaya event you might see on television.” Sometimes, she says, she can’t resist giving that nursing mom an encouraging nudge. “I am so proud when I see uneventful, every day nursing that I’ll sometimes say, ‘That’s really great what you’re doing–keep it up.”

Mpls/St.Paul, August 2008



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