What Do Race and Ethnicity Have to do with Breastfeeding?

We’ve long known that breastfeeding rates vary considerably across racial and ethnic groups. And the data have long shown that non-Hispanic black mothers are least likely to nurse. But this is in the US. A recent British study reasserts the importance of considering social and cultural factors. The study looked at rates of breastfeeding initiation and continuation among a diverse sample of new moms in the UK and compared them with those in the US. After accounting for differences attributed to demographics, economics, and psychosocial factors, researchers found the exact opposite. Asian (Indian, Pakistani and Bangladeshi) and Black mothers (Caribbean and African) had higher rates than white mothers did. The researchers hope that this information will result in more effective public health outreach efforts. Pediatrics. 2006 Nov;118(5):e1428-35.

Give New Moms Some Space

Want quiet time to bond with your newborn? Your best bet may to get out of the hospital as fast as possible. Confirming what may strike you as common sense, a recent study out of Case Western Reserve University’s nursing school recorded all the interruptions new moms and babies experienced in a 12 hour period on the baby’s first day post-partum. Researchers looked at how many interruptions occurred and how long they lasted in conjunction with how much “alone time” moms and babies had together, how often and how long moms and babies nursed, and mothers’ perceptions of the day. Their study revealed an average of 54 interruptions, each lasting an average of 17 minutes. And – not surprisingly – moms perceived that these interruptions had a negative impact on breastfeeding. J Obstet Gynecol Neonatal Nurs. 2006 Nov-Dec;35(6):709-16.

Planning on Breastfeeding? Think Twice about that Epidural!

Childbirth Connections’ Listening to Mothers II survey recently reported that 76% of women were given an epidural or received spinal analgesia during their birth. Yet a recent study out of Australia found that women who received epidurals with fentanyl in it were more likely to have breastfeeding problems in the first week and were more likely to wean sooner than women who hadn’t had them. Rare, however, is the woman who learns about this risk of epidurals ahead of time. Yet shouldn’t this be part of the informed consent to which all women are entitled? International Breastfeeding Journal 2006, 1:24 (11 December 2006)

The Dollars and Sense of Breastfeeding

One of the statistics battered about in breastfeeding circles is that the US spends 3.6 billion dollars a year to treat conditions and diseases that breastfeeding could prevent. That’s no small change. But what is this figure based on? It reflects the amount of money we would save if the nation were to reach the targets set forth in Healthy People 2010, compared to the 1998 levels of 64 percent of women nursing at the get-go and 29 percent at six months.

Based on a review of epidemiological studies, a large chunk of this savings comes from the cost of preventing premature deaths due to inflammation and infection of the intestines, called necrotizing enterocolitis. When we set that aside, the amount saved is about $0.5 billion. This is a conservative estimate, though, because it only considers a subset of the conditions breastfeeding helps prevent.

Another study (1995) showed that women who use formula miss more paid work because their children are sick compared to women who breastfeed, while a 1999 study found that for every 1000 babies, formula-fed babies had 60 more episodes of lower respiratory tract illness, 580 more episodes of ear infections, and 1,053 more episodes of gastrointestinal illness. The extra cost per baby to treat these three conditions in the first year? Between $331 and $475, for a total of $331,051.

However you look at it, formula-feeding results in excess illness, increasing the cost of health care. The point is not to chastise women who give their babies formula! Instead, statistics like these drive home the importance of removing the obstacles that make it next to impossible for so many women to breastfeed.

Click here for references, all of which were listed on the website of the Pan American Health Organization.

It’s amazing how strongly people feel about pacifiers! Some moms can’t imagine parenting without one. Others almost seem to find them the root of all evil. Pacifiers have been in the news a lot lately, but with confusing and contradictory messages. Here is some information to help you sort it all out.

Click here to read about pacifiers and breastfeeding, pacifier use for preemies, and pacifiers and SIDS prevention.

For those of you who missed the New York Times article that originally appeared on October 8, 2006, let me fill you in. Let me preface it by saying that I have one complaint: I wish I’d written it!

Called “The great New York breast-feeding test” the reporter, nursing mother Tracy Connor, nursed her 3 month old all around New York City. Her goal? To find out just how accommodating the public domain is for nursing moms. This is especially interesting given that New York State has the most progressive breastfeeding legislation in the country. Not only was New York the first state to enact any form of breastfeeding legislation, but as of 1994 the law guarantees breastfeeding in public as a woman’s civil right – regardless of whether she is on public or private property. Moreover, it clearly states that laws governing public exposure do not apply to breastfeeding! The upshot is, wherever a nursing mother otherwise has the right to be, she has the right to nurse.

So, off went Tracy to test the waters - from a public bus to the upscale Le Cirque restaurant, from Babies R Us to a computer store, to the Metropolitan Museum of Art.

Ok, this wasn’t a scientific study. The sample size of nursing locations wouldn’t measure up in any way to standards of validity and reliability. But in Tracy’s experience, it didn’t matter how ordinary or elegant the locale; at the core, how a nursing mom is initially treated is usually a function of who she happens to be around. The bottom line was that individual employers may still give women a hard time, but their employers usually end up defending the mom.

The message to moms is, be confident, not apologetic. And if necessary, but perhaps only if necessary, be assertive. When Tracy was challenged, she simply reminded the employer of the law and that was it.

Note: The photo accompanying this article was taken somewhere in Denmark, I believe. (A friend forwarded it to me.) Can you imagine the ruckus if this beautiful pro-breastfeeding image appeared on a city building somewhere in the U.S.?!

Childbirth

Child birth Connection. (formerly - since 1918 - The Maternity Center Association). Childbirth Connection has an information-packed site, half geared toward women and families and the other half for health care professionals. A great place to find evidence-based information to help you make the best decisions for you and your family, or the families you work with.

Breastfeeding

This site from internationally renowned lactation Diane Weissinger, Common Sense Breastfeeding, is not the most elegant, but well worth a visit anyway. You’ll find an array of well-written “common sense” articles on all aspects of the breastfeeding experience ranging from the early days, to how breastfeeding works, to the breastfeeding life, and much more. Great stuff for both parents and providers!

Of special interest is their national landmark survey of women’s childbearing experiences - Listening to Mothers II. Read about how a representative sample of 1600 mothers across the U.S. experienced pregnancy, labor, birth, and the post-partum period. Fascinating, albeit discouraging statistics. Click here to go directly to the report.

Mothering/Parenting

The Mothers Movement Online - On the web for almost four years, Judith Stadtman Tucker’s site is a rich and fabulous resource for anyone interested in how social, cultural, economic and political issues affect mothers. Loaded with essays, opinions, discussions, resources, research, news, and information to spur you to action, her site is a must visit for anyone interested in social justice and progressive social change, particularly on issues involving work and families.

Nikki's Story

One of the reasons stories are powerful is that we see ourselves reflected in each others experiences. This happened to me recently, even though my “nurslings” are now 12 and 8. I was at a conference in Atlanta when I met Nikki, a 30 year old, soft-spoken mother lovingly wearing her 3 ½ week old baby in a sling. When I saw her take out her hand-held breast pump and begin to express her milk into a bottle, I knew there was a story behind her efforts to provide her son with breast milk. Nikki graciously – and tearfully - shared her story with me and has given me permission to share it with you. It is a story in progress and is a shining example of the strength required of new moms, particularly in the face of health care professionals who may disagree with a woman’s right to choose where and with whom she gives birth.

The Birth

Like me, Nikki pushed for a long time during her birth. Her son experienced a lot of head compression and was immediately suctioned because of meconium. Nikki then began to discover what the research shows: both head compression and suctioning can negatively affect a baby’s ability to nurse.

Keagan had been born at home with a midwife but Nikki decided to go to the hospital to have them repair a tear caused by her son rotating in the vaginal canal. Upon arrival she encountered a staff who was furious that she had birthed her baby at home and not at their hospital, where she had received her prenatal care. They separated mother and baby, gave him some formula, and threatened Nikki and her husband with child protective services. “I had made a decision beyond their control and they wanted to control that,” Nikki recalls. “They wanted me to have repercussions for not complying.”

The hospital also refused to give Nikki a breast pump, wrongly claiming that there was no point in pumping colustrum because she wouldn’t be able to express enough to make it worthwhile.

Click here to read the rest of Nikki's story.

A Lasting Impression - Anne's Story

I had just turned seven myself when my childhood friend Wendy sent me an invitation to her seventh birthday party in the early spring. My mother helped me to buy a birthday gift that I brought to the party that day. Among the gifts Wendy had received for her birthday was a new baby sister Cindy, who had arrived just a few days before the planned party. Her parents knew the party was important to Wendy so they held the event but just a few of us attended. We were allowed to see the baby for a few minutes. Wendy was very proud of her, I remember.

Mother and baby were lying on her parent’s bed. I had seen tiny babies before because I was the oldest of five children, old enough to recall my two youngest brothers and to have a faint recollection of another brother when they were all newborns. Wendy’s mom was lying with the baby in the crook of her arm and she was feeding the baby in a way I had never seen before. My mother had bottle-fed us all and I was very familiar with the multitude of glass bottles and rubber nipples in a sterilizer in our kitchen. But this was different and it seemed truly amazing to me that day. Wendy’s mother was feeding Cindy from her breast. It was so quiet in there, just the gentle sucking of the newborn infant and her mom gazing at her with adoration.

We stayed only a few minutes, just long enough to see the new baby sister. But it was a moment etched in time for me, and it was the single greatest factor that influenced me to breastfeed my own children many years later. Was it really possible to provide your child with milk from your own breast, to offer all the nutrition that a baby needs and to be as happy and contented as Wendy’s mother and her baby seemed to be?

When I was pregnant with my son more than twenty years later, I knew that I would breastfeed him and believed with all my heart that I could do it. The early days were not easy because it required us both to learn the process, but my desire to succeed was strong and we were successful. Three years later, I also breastfed my little girl. The feeling I experienced while breastfeeding was like no other I had ever felt in my life. And the bond I have with my children is deeper than I could have ever imagined or I can really comprehend.

When I grew up and I moved away I lost touch with Wendy and her family. Only once I ran into her when I was visiting my parents in our old hometown. She had become a nurse as I had also. But the image of her mother with her baby sister Cindy has remained with me and it has been a driving force in the work I do around breastfeeding advocacy and counseling. Impressions in childhood, I have realized, can become the experiences of a lifetime.

Note: Above photo (demonstrating the importance of a good latch!) is from breastfeeding.com.

Have you or anyone you know lost pay because you took time to nurse your baby or express your milk at work? Have you ever used a pump that didn’t work well because it was poorly designed? Have you wished you could write off breastfeeding equipment as a medical expense? Breastfeeding advocates will be happy to know that congresswoman Carolyn Maloney is reintroducing the Breastfeeding Promotion Act to help working families and nursing moms.

The act would do four things: 1) amend the Civil Rights Act of 1964 so that breastfeeding moms can’t be fired or discriminated against in the workplace for expressing milk of nursing during lunch or breaks; 2) provide tax incentives for businesses that establish private lactation areas in the workplace and take other pro-breastfeeding steps; 3) require that the FDA develop minimum quality standards for breast pumps so that they are safe and effective; and 4) allow breastfeeding equipment and services to be medically tax deductible.

I know, I know, we’re all super busy. But I encourage you to take a minute to write to Congresswoman Nancy Pelosi, Speaker of the House of Representatives, encouraging her to lend her support to this bill. No mother should have to choose between her work and the well-being of her baby.

Send your letters and cards to:

Representative Nancy Pelosi; 2371 Rayburn HOB; Washington, DC 20515

ICAN (International Cesarean Awareness Network) Silver Anniversary Conference. April 20-22, 2007 Syracuse, NY. Speakers include Marsden Wagner, Sharon Storton, Diane Weissinger, Esther Booth Zorn, and more. Click here for info.

La Leche League’s 50th Anniversary International Conference. July 20-23, 2007. Chicago, IL. Speakers include Barbara Behrmann, Ina Mae Gaskin, Ruth Lawrence, Peggy O’Mara, Gayle Pryor, and many others. Click here for info.

ILCA (International Lactation Consultant Association) Annual International Conference and Meeting. August 15-19. San Diego, CA. Click here for info.

BOLD 2007. Birth on Labor Day. September 2007. Over 25 states and several other countries will offer performances of Karen Brody’s play Birth: A Testimonies Play about Childbirth in America. “Red Tent” events will take place, as well, where local women will gather to tell their birth stories. Fascinating and powerful! Click here to learn more.

An excellent gift for pregnant women, nursing mothers, and anyone who works with them.

Official breastfeeding support has never been greater, yet only 14 percent of women exclusively breastfeed at six months, a far cry from the national goal of 50 percent. Why such a discrepancy? And why does breastfeeding remain so controversial? Everything from the brouhaha surrounding breastfeeding and co-sleeping, to the pros and cons of attachment parenting, to the scandalous way publicly nursing mothers are treated, to the question of when is a child too old to nurse, myths and misinformation abound. Yet mothers struggle with these issues every day.

The Breastfeeding Café: Mothers Share the Joys, Challenges, & Secrets of Breastfeeding is a collection of candid stories and anecdotes, in which women from all over the U.S. discuss the joys and rewards, frustrations and challenges, sorrow and anger, pride and satisfaction, and humor and poignancy that characterize the nursing experience in our contemporary, bottle-feeding culture.