New guidelines challenge mothers: Wake up to benefits of breast-feeding!
New guidelines challenge mothers: Wake up to benefits of breast-feeding!
Providers, activists: Revamp social and workplace norms
American mothers don’t breast-feed long enough to ensure the best health for their babies, according to the Elk Grove Village, IL-based American Academy of Pediatrics. A recent report from the academy states that even the present 59% breast-feeding rate for newborns in the hospital is below par. Then it drops to 21% at six months — far below the ideal, the academy says. The target, according to the report, is a 75% breast-feeding rate for neonates.1Ideally, babies should ingest nothing but mother’s milk for their first six months, the guidelines state. Further, "it is recommended that breast-feeding continue for at least 12 months, and thereafter for as long as mutually desired." The policy’s authors suggest the introduction of solid food complements between six and 12 months. (For a thumbnail sketch of current breast-feeding practices, see table, "Updated Breast-feeding Trend through 1996," p. 18. For the complete guidelines from the academy, see "Recommended Breast-feeding Practices," p. 19.)
At first blush, the recommendations might appear as laughable dictums from isolated theorists who forget that most American mothers go back to the time clocks before their babies are 6 months old.
But a woman shouldn’t have to choose between working and nursing, assert women’s advocates. One of them is M. Jane Heinig, PhD, IBCLC, editor-in-chief of the Journal of Human Lactation and faculty member at the department of nutrition of the University of California, Davis. Heinig says too many new mothers meekly accept the status quo when they go back to work, even if it means nursing their babies or pumping their breasts in the corner of a public restroom.
Heinig regards the new recommendations as fortification with which women’s health care providers can prepare working/nursing mothers to ask for private space where they can pump their breasts. "Women don’t have to apologize for being whiners when they ask for these facilities," she says. Armed with the academy’s recommendations, they can tell their bosses, "Here’s the reason for all this."
Workplace obstacles are just part of the issue, insists Leslee Wencley, RN, BSN, IBCLC, lactation specialist at the Women’s Center of Crittenton Hospital in Rochester, MI. Consider Australia, she says. "There’s a 90 to 95% breast-feeding rate, even with women who work outside their homes," Wencley says.
A more pervasive obstacle is the common perception of motherhood in U.S. culture — images of nursing women have not etched their way into that picture.
We’re a bottle-feeding culture’
The shift away from breast-feeding started 35 to 40 years ago, says Mary Lofton, spokeswoman for LaLeche League International in Schaumburg, IL. In the 1960s, when infant formulas appeared in force, "people began to think formula was better for babies, and the norm changed away from breast-feeding," she says.When she breast-fed her children during the 1970s, she was the exception among her friends. "The first thing they would ask me," she recalls, "was, When are you going to wean your baby?’"
The shift has continued ever since. In women’s magazines, pictures of mothers bottle-feeding replaced scenes of babes at breast. In airports, the international symbol for a mothers’ room is not a picture of a baby, Lofton points out, but a picture of a bottle. Now women’s health care providers have to re-educate women to see breast-feeding as the norm, she says.
Contrary to conventional wisdom, breast- feeding is not instinctual for mothers or infants. "Babies do have a sucking instinct, but their brains have to be imprinted with the experience of sucking their mothers’ nipples within an hour of birth," says Theresa Chambliss, RN, CLE, lactation nurse specialist and owner of Breast-feeding Resources of Westminster, CO.
In recent years, few new American mothers have seen their grandmothers, mothers, or aunts breast-feeding babies.
Most babies need a bit of coaxing and coaching to get them started, Chambliss adds. She argues that brief maternity stays and bare-bones obstetrical staffing are huge obstacles to completing such a fundamental postpartum service. Women’s care providers hurry to help as much as they can before bidding a hasty "goodbye and good luck." Chambliss insists, "That’s why lactation nurses, both in hospitals and outside of hospitals, are important."
Guiding moms through foreign territory
Women’s health services are conducting a diligent grassroots crusade to effect a return to breast-feeding as the cultural norm. At Integris Baptist Medical Center in Oklahoma City, for example, "Working without Weaning" classes prepare new moms and dads for changes on the homefront. Integris lactation consultant Angie Tomlinson, RN, IBCLC, says the one-time postpartum class encourages fathers to pitch in with housecleaning or meal preparation, which frees their mates to spend time breast-feeding.Lofton says a mother "has to walk through her day seeing herself as a breast-feeding woman." Lacking family role models, a woman can find others among her peers in a lactation support group. There, she’ll learn how all sorts of women, including stay-at-home mothers and corporate executives, manage to nurse their babies. (LaLeche League, which sponsors a nationwide lactation group network, is listed in the resource box, p. 20. Also, see insert, "Go Back to Work and Continue to Breast-feed? Yes, You Can!" for a sample of a useful breast-feeding information handout.)
Back to nature along new pathways
The outlook for employer support of nursing mothers is cautiously optimistic, say some of the specialists who spoke with Women’s Health Center Management. In keeping with family-friendly policies, some companies even provide breast-feeding education programs for pregnant employees as well as lactation rooms where nursing women can pump their breasts. We can expect this trend to continue as women occupy more management positions, forecasts Jill Leary, RN, CLE, lactation consultant for the Women’s and Family Services department at Lutheran Hospital in Wheat Ridge, CO.Economics is another factor in the trend toward workplace lactation facilities. Since breast-fed babies catch fewer infections than bottle-fed babes in day care settings,1 Chambliss explains, nursing mothers have lower absenteeism rates. The prospect of luring productive, highly trained women back to work also motivates employers to support on-site lactation programs.
Helping non-nursing moms fend off guilt
Twenty years ago, breast-feeding mothers such as Lofton experienced social pressure by going against the tide. The new recommendations could unwittingly cause similar stress for today’s mothers who choose formula-feeding. Let’s face it: Given all the encouragement and support in the world, some simply will not find ways to incorporate breast-feeding into their lives."I deal with this every single day," Leary says. "But I tell them to focus on the positive things they do for their child and don’t look back. The bottom line is enjoying the baby because that’s what comes across to the baby."
Her stance resonates with Elizabeth Toledo, vice president of the Washington DC-based National Organization for Women. "Some women find it very difficult to breast-feed because of financial, logistical, health, or other reasons. Some are able to overcome those obstacles; some aren’t. We shouldn’t use these findings to judge some mothers as good’ and others bad’ because of their decision on this one issue of their baby’s health care."
Judgments aside, Heinig would still like to see providers treat a not-to-nurse decision as a red flag. "Providers should see breast-feeding as the norm," she advises. "If a woman says she is not going to breast-feed, I would hope the provider would be probing to find out why. Maybe there are abuse issues or the woman is feeling out of control of her life. Maybe those deeper issues are areas where the provider can help. Otherwise, they might affect her parenting if they’re not resolved."
Reference
1. Work Group on Breast-feeding. Breast-feeding and the use of human milk. Pediatrics 1997; 100:1,035-1,039.
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