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.

Planning to head off childhood obesity

September is Be Kind to Writers and Editors Month, and as both writer and editor here at Birth Story, I intend to take advantage of this important event. I've been writing some long posts, but I'm hoping to keep them a bit shorter this month.Red typewriter

September is also Baby Safety Month, as well as National Preparedness Month, two interrelated observances, you could say, as planning ahead could help keep that baby safe.

Jane E. Brody's Personal Health column in the New York Times Science section today, for example, suggests that moms should adopt a healthy regimen, and maintain a lean frame, even before they get pregnant, if they want to help their children avoid becoming overweight themselves.

Brody's piece is a survey of the present understandings of how a mother's weight while pregnant affects the health of her fetus.

Her chief reference is a recent Lancet article that sought to tease apart the influence of genetics from the effects of more-than-adequate weight gain during pregnancy.

A separate study in Circulation "found that a woman’s weight before pregnancy was even more important than excessive weight gain during pregnancy in predicting a number of risks for the baby" that included childhood obesity," Brody writes.

"The new findings suggest that Americans are now caught in a vicious cycle of increasing fatness, with prospective mothers starting out fatter, gaining more weight during pregnancy and giving birth to babies who are destined to become overweight adults," Brody writes.

The latest recommendations from the Institute of Medicine, a subsidiary of the National Academy of Sciences, call for these weight gains during pregnancy:

¶28 to 40 pounds for thin women, with a B.M.I. of 18.5 or lower.

¶25 to 35 pounds for normal-weight women, with a body mass index of 18.6 to 24.9.

¶15 to 25 pounds for overweight women, with a body mass index of 25 to 29.9.

¶11 to 20 pounds for obese women, with a body mass index of 30 or higher.

Image courtesy of Wikimedia Commons

Too many first-time moms get C-sections

The most telling finding of a new study on cesarean sections in hospitals in the United States is that 31.2 percent of first-time mothers had C-sections.

"Reducing primary cesarean delivery is the key" to bringing down the overall C-section rate, the researchers concluded. In 2007, the last year studied, America's C-section rate stood at 32 percent, a new high.

The study, an analysis of nearly 229,000 births at 19 hospitals between 2002 and 2008 published on-line ahead of a print article in the American Journal of Obstetrics and Gynecology, was conducted under the aegis of the National Institute of Child Health and Human Development.

The study found that 44 percent of women attempting a vaginal delivery were induced. Half of the women who had C-sections for dystocia — slow or difficult labor — were cervically dilated to less than 6 cm, far short of the 10 cm dilation that signals that birth is imminent, when the decision was made to operate.

Of the 29 percent of women in the study who had previous C-sections, and were allowed a trial of labor, 57 percent delivered vaginally.

The overall cesarean rate was 30.5 percent.

The abstract of the study concludes, "To decrease cesarean delivery rate in the United States, reducing primary cesarean delivery is the key. Increasing vaginal birth after previous cesarean rate (sic) is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparous women and in induced labor."

Many of the births included in the study took place at teaching hospitals, where more complicated birth often land, the study's authors noted.

Breast-feeding story: Nora

At a baby shower before my older daughter, Nora, was born, I held up each newly unwrapped garment and device for the shower guests to admire  with a big, stiff smile, because I had no idea what to do with any of it. I was the youngest of four children, and while I babysat as a teen-ager, I was never the girl people were clamoring to have watch their infants. In any case, baby technology had moved along quite a bit since then.

The theme for my first few months as a mother was discovery  — oh, yes, indeed, many, many discoveries, made usually in a panic, in the middle of the night. Breast-feeding, like everything else, was uncharted terrain for me. My mom had tried to breast-feed a couple of my older sisters but told us she was too "nervous" to succeed. As a baby, I was premature and colicky, and wound up thriving on soy formula.

I don't think either of my sisters who had children breast-fed. (They are both deceased, or I would ask them. Mamas, don't let your babies grow up to be smokers.)

By the late 1980s, though, breast-feeding was common but still spottily supported. Interviewing pediatricians a few months before my due date, I remember my delight when I found a male (!) doctor I liked a lot who supported my plan to breast-feed exclusively for several months. (His wife had breast-fed their four children, which can dispose a male doctor to be more supportive of breast-feeding than he might be otherwise.) He left the practice about a week before Nora was born. So much for planning.

At the time, my employer offered an unpaid 12-month maternity leave. Even though my husband was then serving an apprenticeship as a reporter at the old City News Bureau of Chicago, pulling down $11,000 a year, we had saved prodigiously and agreed I should take the full 12 months. So I was free to breast-feed without the constraints of a job.

It went well — not perfectly, but well. I vividly remember the early days, holding the newborn Nora on my forearm, her head against the crook of my elbow, her tush cradled in my hand.

At one point, though, I had a bout of mastitis, which was terrifying while in progress, as my breast hardened, heated up and turned red. I managed to find a lactation specialist who advised me over the phone — they seemed to be scarce and far-flung at the time. My best source was a calm old book, Nursing Your Baby by Karen Pryor, which a friend had recommended. It never failed me.

I breast-fed Nora almost exclusively for about five months. (She did get the odd bottle, including one her first night of life, in the hospital — not my idea.) I thought breast-feeding was beyond easy — always available, always satisfying, and so blissful for both of us. However, I did feel like a combination of Cinderella, always scampering home from the ball in time for that next feeding, and Bossy the Cow.

Nora had eight teeth by the time she was eight months old, when she hit on a delightful (for her) new game. She bit me, hard, at the end of every feeding. She never broke the skin, but she hurt me. She would laugh heartily while I jumped and howled, and then she would hop down and crawl off. Every feeding.

I spent two weeks soliciting advice, reading books, trying all kinds of things to get her to stop. Nothing worked. It seemed to me that giving me that good painful chomp was the best part of breast-feeding for Nora now, while I dreaded every session. She was eating all kinds of food and drinking from a cup. Most women I knew breast-fed for several months — seldom more than a year — and the recommendations hadn't yet come down that advise staying the course for at least a year.

So I weaned Nora. It took two weeks. She was nine months old when we finished. She was a bright and busy girl, and she barely noticed. At first, I wept, then I was sad for a long time.

But I had a life again. I was still Nora's mom, I still wasn't back at work, but I could move freely out in the world. My mind began to re-focus on activities and issues that went beyond parenting. At the time, I felt relief weighing against the regret. I still think it was not a bad thing for that child, at that time, or for me.

$1.5 billion from the Gates Foundation

The Bill & Melinda Gates Foundation this month committed $1.5 billion over the next five years to support programs that will work to improve maternal and child health, family planning and nutrition in developing countries.

Bill and Melinda Gates

Melinda Gates announced the  plan on Monday at Women Deliver 2010, a gathering of world experts, advocates and policy makers in Washington D.C.

“In poor countries, pregnancy and childbirth often end in tragedy. Our goal must be to build a world where every birth brings joy and hope for the future,” Gates said.

Gates said that the money will be used to support local efforts toward a comprehensive approach to health that will include family planning, prenatal care, nutrition and improving the conditions under which women give birth.

“Every year, millions of newborns die within a matter of days or weeks, and hundreds of thousands of women die in childbirth,” said Gates. “The death toll is so huge, and has persisted for so long, it’s easy to think we’re powerless to do much about it. The truth is, we can prevent most of these deaths – and at a stunningly low cost – if we take action now.”

Gates said, “Most maternal and newborn deaths can be prevented with existing, low-cost solutions – such as basic prenatal care, or educating mothers about the importance of keeping babies warm,” said Gates. “Countries that have made women’s and children’s health a priority – and have invested in proven solutions – are achieving amazing results.”

Researchers at the Institute for Health Metrics and Evaluation at the University of Washington say that maternal mortality has fallen more than 35 percent since 1980, from more than 500,000 maternal deaths to about 343,000 in 2008, according to a press release from the Gates foundation.

Deaths among children younger than 5 are also down dramatically. About 7.7 million children are expected to die this year, down from 11.9 million in 1990, and 16 million in 1970, the release stated.

The Bill & Melinda Gates Foundation, one of the world's largest philanthropic entities, is a "family foundation driven by the interests and passions of the Gates family," according to its stated principles. The foundation seeks to impact a number of major global issues, including health and education.

Bill Gates, founder of the Microsoft computer software giant, co-chairs the foundation with Melinda Gates and his father, William H. Gates Sr.

Photo by Kjetil Ree / www.commons.wikimedia.org