On mandatory breastfeeding

Many people mocked supermodel Gisele Bundchen as a "boob" and a "twit" a couple of years ago when she said the law should require mothers to breastfeed for at least six months. It turns out Bundchen may just have been a little ahead of her time.

As of this summer, hospitals in New York City will no longer make formula available to new mothers and babies unless it is medically indicated, or promote its use in any way. "Latch On NYC" is an initiative of the city's mayor, Michael Bloomberg.

"Motherhood" by Mary Cassatt

Studies have been piling up in recent years that show that breast-fed babies  do better in a number of ways than bottle-fed babies. Still, fewer than one-third of babies are consuming only breast milk at 3 months, and nearly four-fifths of babies have stopped breastfeeding altogether before the recommended minimum of one year. 

And as Linda Lowen wrote recently on About.com,

Part of the problem is that we like our swag -- our goodie bags packed with toys and samples and coupons. Hospitals give these out as a matter of course, and as new moms we're eager for it.

The swag started with the formula companies. And they knew exactly what they were doing. They were hooking women at an emotional and vulnerable time, and from there they reeled us in.

Taking the free samples of formula away from new moms in hospitals protects them from the manufacturers who make it so easy to start a baby off on formula, rather than on the breast, Lowen wrote.

But even some breastfeeding proponents are protesting the new methods for giving breast-feeding a leg up in the nursery. Some women say mothers are already feeling the effects of Latch On NYC, which will go into effect Sept. 3.

New NYC mom Jacoba Urist wrote in a Wall Street Journal blog about her experience trying to have her baby fed with formula at the New York University Medical Center, where she had given birth, so she herself could sleep through the night. Nurses twice said they couldn't find any formula, and brought Urist her baby in the middle of the night to breastfeed, she wrote.

After Sept. 3, lack of cooperation, if such it was among those nurses, will turn to rules in NYC. "With each formula bottle a mother requests, she’ll get a lactation lecture about why she should use breast milk instead," Urist writes of Latch On NYC. She supports breastfeeding in general and does it herself, but thinks the new rules themselves will "prey on women in the days (sometimes hours) after they deliver a baby."

Kara Spak, a new mother and my former colleague at the Chicago Sun-Times, made an especially compelling case for leaving formula-feeding moms in peace, in a recent commentary about Latch On NYC in the Sun-Times.

Spak, who is perhaps best known nationally for winning more than $85,000 as a contestant on Jeopardy in 2010, wrote that she intended to breastfeed, but her baby wasn't thriving on breast milk. Ultimately, she had to choose between her baby's health and the breast-feeding ideal. She began feeding her new daughter formula, and continues to do so.

After that traumatic beginning, when Spak talked with her friends with babies, all of whom were committed breast-feeders, it turned out that all of them had had problems nursing, she said.

And that's the travesty here, or one of them, anyway. As Alissa Quart reported in her recent New York Times op-ed piece, "The Milk Wars,"

For most women, there is little institutional support for breast-feeding. According to the Bureau of Labor Statistics, only 11 percent of private-sector workers get paid family leave through their employers. Once mothers go back to work, there are few places where they can pump milk for later use.

Jane Brody's NYT column in response to Quart's piece, "The Ideal and the Real of Breastfeeding," gave readers a look at this longtime health writer's own rocky experience with nursing many years ago, plus a survey of studies and anecdotal evidence that makes it clear that, while breast might be best, it isn't for everyone.

On a more positive note, this year's "Big Latch-On," completed just this weekend, attracted 8,862 nursing babies (and their moms) in 23 countries, a new record.

And check out Birth Story's previous posts on breastfeeding.

Image: Motherhood by Mary Cassatt

How hospitals can promote breast-feeding

The Baby Friendly Hospital Initiative, an international program, has created a list of things birth facilities in the United States can do to optimize the chances that mothers will choose to breast-feed their babies.

Here are "The Ten Steps To Successful Breast-feeding," from BFHI USA:

    1. Have a written breast-feeding policy that is routinely communicated to all health-care staff.
    2. Train all health-care staff in skills necessary to implement this policy.
    3. Inform all pregnant women about the benefits and management of breast-feeding.
    4. Help mothers initiate breast-feeding within one hour of birth.
    5. Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infants.
    6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
    7. Practice “rooming in” — allow mothers and infants to remain together 24 hours a day.
    8. Encourage breast-feeding on demand.
    9. Give no pacifiers or artificial nipples to breast-feeding infants.
    10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

The BFHI is underwritten by the World Health Organization and the United Nations Children's Fund (UNICEF).

Clearing the first hurdle in breast-feeding

Fewer than 4 percent of births in the United States occur at facilities that are considered "baby friendly," according to the latest Breast-feeding Report Card, issued this week by the Centers for Disease Control and Prevention.Happy baby

That's interesting, in light of the fact that birth is the one point at which the nation's breast-feeding practices actually meet the goals set by Healthy People 2010.

And, it raises some questions: Are American women determined to breast-feed even in the teeth of an unsupportive environment? Or does strong support from the hospital not matter much in their decision? Do problems caused by settings where breast-feeding is not actively promoted only show up later?

Or are environments that come after the birth facility, including families, other medical advisers, child-care centers and workplaces, even less sympathetic to breast-feeding?

Only two hospitals in Illinois, my home state, are among the 99 "baby friendly" facilities recognized by the Baby-Friendly Hospital Initiative as providing "an optimal level of care for infant feeding." These are Pekin Hospital in Pekin and St. John's Hospital in Springfield.

Thirty of the hospitals on the list are in California.

"Although the hospital is not and should not be the only place a mother receives support for breastfeeding, hospitals provide a unique and critical link between the breastfeeding support provided prior to and after delivery," the BFHI's website states.

The BFHI is a joint global effort of the World Health Organization and the United Nations Children's Fund (UNICEF).

Mixed report on breast-feeding

Three-fourths of American babies start life on the breast, but moms are giving up on breast-feeding sooner than officials would like to see.

Healthy People 2010, a national statement of health goals, sets the bar for breast-feeding at birth at 74 percent. Fully 75 percent of American moms are breast-feeding at birth, so the country is (barely) meeting that objective.

However, the goals would have half of mothers breast-feeding at six months of life and a quarter continuing on at a year. In practice, 43 percent are breast-feeding at six months and 22 percent at one year.

"We need to direct even more effort toward making sure mothers have the support they need in hospitals, workplaces and communities to continue breastfeeding beyond the first few days of life, so they can make it to those six- and 12-month marks," said William Dietz, M.D., Ph.D., director of Nutrition, Physical Activity, and Obesity for the Centers for Disease Control and Prevention in Atlanta, Ga.

The CDC issues an annual report card of how "key community settings" like hospitals and child-care centers are supporting breast-feeding, which research has demonstrated can improve an individual's lifetime health outlook.

While the overall news is good for moms' getting a start on breast-feeding at birth, the swing among the various states ranges from 90 percent in Utah to to 53 percent in Mississipi.

We dream for our children

My children are 10 years apart in age, and one thing that has struck me since Maeve's birth almost 13 years ago is how much more complicated the world grows as they get older.

When children are small, you can see clearly how their perfect lives will roll out. You can see them graduating from Harvard — or perhaps Yale; you devote serious time to considering which would be better — going into law or medicine, gliding along until they finish up as President of the United States. Along the way, of course, there will be sports trophies, prom dresses, all the trimmings.

Reality sets in gradually. It turns out the kids have learning disabilities, or strange hair, or no interest in sports — whatever, and likely in multiples. Ten years or so after spinning all those perfect dreams, you might find yourself praying they'll finish high school. Or even, please, God, let them stay alive through high school.

When Maeve was in preschool, I remember sitting in a group listening to moms in the Harvard vs. Yale stage, while my mind was on the then-exotic sensation some teen-aged boys in Nora's vast social network had created by sending nude pictures of girls they had probably known since kindergarten out across the Internet. I remember thinking that perhaps I had seen some of those boys, and those girls, on swings in the park or at a library reading hour when they too were small.

What I mean to say is that many of the things that seem critical when children are little get put firmly in perspective as they grow.

Poking around Lisa Belkin's Motherlode blog on the New York Times website this week, I landed on a post called "A Breast-Feeding Guru Who Uses Formula," which attracted me because I have been writing about breast-feeding. Through Belkin, I discovered Katie Allison Granju and her mamapundit blog. (I know, where have I been?)

Granju is a writer and digital-media expert who has become an authority on breast-feeding. Nevertheless, she found with her fifth child, Georgia, now seven weeks old, that she was unable to breast-feed. "I did have colostrum for the first week or two, but I never got the full enchilada," she writes in a post on Babble.com.

She tried "pumping, herbs, supplemental nursing system, plenty of skin to skin with baby, nursing on demand, nipple shields," all to no avail.

She is "resigned" now to the fact that Georgia is a bottle-fed baby, and she does what she can to inject warmth and meaning into an experience she never expected a child of hers to have.

But Granju believes that a horrific recent event in her life has contributed to her inability to breast-feed.

"I suspect that the biggest factor in my inability to produce milk at the moment is that my oldest child died in my arms only a few weeks before G was born. God only knows what the shock of that experience did to my body and its normal functioning," she wrote.

The death of Granju's son Henry from a drug overdose is about as terrible as this world gets. We dream for our children but they live the lives we give them. My heart goes out to the Granjus.