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Years ago, when breast-feeding was practically the law of the land, mothers could teach their daughters how to nurse a new baby almost as easily as they passed on family recipes.
But the advent of easy-to-use commercial formula changed all that, essentially weaning a generation or two of babies away from mother's milk. In the process, the age-old techniques for putting a baby to breast were lost to most women.
The loss is particularly problematic now that a growing body of scientific evidence suggests that breast-feeding is better than formula for babies and their mothers.
"Breast-feeding women have to be able to ask someone, 'Am I doing it right?' " says Dr. Jeanne-Marie Guise, an obstetrician-gynecologist and researcher at Oregon Health & Science University in Portland.
"Mothers tend to have problems when the milk first comes in, when the baby has a growth spurt and they worry about the supply of milk, and when they're returning to work and wondering how they're going to do their jobs and still breast-feed," she says.
Guise recently published a review of programs that attempt to teach women the fine art of breast-feeding. She and her colleagues sorted through hundreds of studies, looking for methods that not only encourage mothers to try breast-feeding but also keep the women nursing for at least three months after they leave the hospital with their babies.
"We found that breast-feeding education is quite doable, and something that a lot of places are doing well," she says.
What worked best for most women was a structured educational session that lasted 30 to 90 minutes. It offered the women information about the benefits of nursing, about a woman's physiology and how breast-feeding works, and included enough time to discuss the problems new mothers were experiencing. The setting could be a classroom with a group of mothers or a one-on-one session with a mother and a trained educator.
"The important thing is that a mother forms a real partnership with someone who knows about lactation," Guise says. "It can start during the pregnancy and continue through delivery and postpartum, lasting until some remote time."
The results of her study, published recently in the Annals of Family Medicine, form the basis for new federal recommendations on breast-feeding programs that target new mothers. The guidelines are for doctors, including obstetricians, family practitioners and pediatricians.
"Doctors should make sure that women are connected with an effective program, either at a hospital or on the community level," says Dr. Alfred O. Berg, chairman of the U.S. Preventive Services Task Force, which issued the breast-feeding education recommendations. "We found that the usual thing of having a doctor tell women they ought to try breast-feeding didn't have much of an effect at all."
The U.S. Department of Health and Human Services, in its 2010 objectives, wants to have 75 percent of all new mothers breast-feeding at the time of hospital discharge, 50 percent when the babies are 6 months old and 25 percent at a baby's first birthday. In Texas, for example, about 69 percent were nursing at discharge in 2001 and about 30 percent were still nursing six months later. The state doesn't survey after that point.
"It looks like we've got a long way to go in achieving the goals," says Dr. Berg, chairman of the Department of Family Medicine at the University of Washington in Seattle. "But the numbers have been impressive in recent years, given the fact that babies in this country were almost exclusively bottle-fed not too long ago."
Guise's review found that educational programs increased the proportion of mothers initiating breast-feeding by 23 percent and those continuing to breast-feed for one to three months by 39 percent. The differences implied that enrolling 10 women in such programs would result in two additional women initiating breast-feeding and four additional women breast-feeding for as long as three months.
Such findings do not surprise many breast-feeding educators, who are helping more and more new mothers to breast-feed their babies. Hospitals and doctors increasingly are encouraging mothers to nurse almost immediately after their babies are born.
"Physically, mothers and babies are trying to meet each other after birth, and we should allow it within the first hour," says Jeannette Crenshaw, a registered nurse and family education coordinator at Presbyterian Hospital of Dallas. "Babies are looking for the breast, and for the mothers, it brings out an instinctive sense of falling in love with their babies."
Getting mothers and babies over the hurdles of initial breast-feeding becomes the task of lactation consultants who run educational programs in many hospitals. Hospitals typically offer breast-feeding classes, which are optional to new mothers, followed by individual consultations.
However, most women leave the hospital two days after they give birth, before their full milk supply comes in. For the first few days, mothers secrete colostrum, a nutritional substance thought to jump-start the baby's digestive system.
"About 88 percent of our mothers go home intending to breast-feed, but they can run into problems," says Candace Priest, a lactation consultant at Presbyterian Hospital of Plano, Texas. She also manages A Mother's Gift, the hospital's breast-feeding resource center, which offers outpatient services for new mothers including baby weighing and nursing advice.
About 25 percent of breast-feeding mothers will return for help.
"A lot of new moms come back with sore, bleeding, cracked nipples," Priest says. "An improper latch by the baby is the No. 1 problem in breast-feeding. Adding to the fact that the moms are so sleep-deprived, it can be the reason they stop nursing."
Lactation experts often solve the problem by assessing how a baby's palate and tongue are gripping a mother's breasts. "A small adjustment can make a big difference in the mother's comfort," she says.
Most problems, including inadequate milk supply, are resolved within the first six weeks, Priest notes. "We've even worked closely with women who've had breast surgery, including breast reductions, and they've successfully breast-fed their babies. It just takes persistence."
Some hospitals are going beyond educational programs and follow-up support care. They are changing the maternity ward environment to make it much more breast-feeding friendly readily allowing babies to room with their mothers, withholding all liquids from babies except human milk and prohibiting use of artificial nipples and pacifiers until breast-feeding is established.
POSSIBLE BENEFITS OF BREAST-FEEDING
For the baby:
-A more complete source of nutrition
-Provides immunity from respiratory tract infection, diarrhea, ear infection, pneumonia and urinary infection, and other conditions
-Possibly encourages earlier development of the infant's immune system
-Provides lower protein than cow's milk, a factor that aids digestion and reduces stress on immature infant kidneys
-Offers lipids and enzymes that promote efficient digestion and use of nutrients
-Promotes less weight gain and leaner development at age 1 than formula
-Reduces the likelihood of childhood obesity
-Lowers the risks for diseases, including diabetes types 1 and 2, inflammatory bowel diseases, childhood cancer, asthma and allergies
-Allows better bonding with mother
For the mother:
-Increases levels of oxytocin, a hormone that stimulates uterine contractions, helping to expel the placenta
-Minimizes postpartum blood loss
-Promotes earlier return to post-pregnancy weight
-Delays the resumption of normal menstrual cycles, delaying fertility in most women
-Provides psychological benefits, such as increased self-confidence and bonding with the baby
-Possibly reduces the risk of premenopausal and postmenopausal breast cancer for women in their early 20s who nurse up to two years
-May lower the risk of ovarian cancer
-Saves hundreds of dollars, maybe more, in the cost of feeding a newborn, even after subtracting the cost of a breast pump and additional food for the nursing mother.
-Reduces total medical expenses by 20 percent compared with expenses for a bottle-fed baby
-Keeps employers happier because parents miss less work, since breast-fed babies are healthier
SOURCES: HHS Blueprint for Action on Breastfeeding, U.S. Department of Health and Human Services, Office on Women's Health
(c) 2003, The Dallas Morning News. Distributed by Knight Ridder/Tribune News Service.