MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

“The Breast Whisperer”

The New York Times recently published “The Breast Whisperer,” profiling an in-demand Brooklyn lactation consultant and the women she serves. Despite a lackluster title, the piece does a nice job highlighting the frequently overlooked and woefully unanticipated demand women have for education and support when learning “the art” of breastfeeding. This is especially true of first-time mothers, particularly in the early days following a baby’s birth.

I’m always pleased to see a well-read publication devote space to birth, breastfeeding and issues related to integrating pregnancy and infant care into women’s personal and professional lives. In 2009, The Atlantic Monthly published the misguided but much buzzed about “The Case Against Breastfeeding” and The New Yorker published “Baby Food: If breast is best, why are women bottling their milk?

Here are a few thoughts in response to “The Baby Whisper”….

Ms. Brill’s pediatrician wrote out a phone number as if it were a prescription. “Call this woman,” he said. “She’s seen every new mom in Brooklyn.”

Kudoos to Ms. Brill’s pediatrician. Why? Rather than ply her with bad information, he referred her to someone who has the necessary knowledge and experience to help. While the AAP supports exclusive breastfeeding for the first six months, pediatricians do not study lactation. A good pediatrician supports women to breastfeed and hooks them into appropriate, evidence-based care for assistance when needed.

Once you go home from the hospital, you’re on your own….

Most U.S. women birth babies in hospitals from whence they depart before colostrum gives way to breastmilk. Going home before the milk comes in leaves many to anxiously face an important transition alone. If women received in-home visits by a paraprofessional capable of assessing breastfeeding or a lactation consultation, many (most?) incorrect latches and early missteps could be addressed, clearing the way for breastfeeding to take hold.

Because women generally go home after birth with no plans for follow-up lactation support, birth is, essentially, treated as the final event in maternity care. Women accessing midwifery care, whether through homebirth or birth center-based care, tend to move seamlessly from birth preparation and support right into breastfeeding care. They don’t have to ask – it is part of the package. Because midwifery understands the critical import the first days following birth have on breastfeeding, support is built into maternity care. Where breastfeeding rates are high at 3- and 6- months, I bet you’ll find a midwife.

About 74 percent of American mothers tried breast-feeding their newborns in 2006, according to the latest figures from the Centers for Disease Control and Prevention. That was up from 58 percent in 1985 and 27 percent in 1970. But many struggle to make it work and give up — by three months, a third of infants were exclusively breast-fed in 2006; by six months, 14 percent.

At 90.4%, Oregon has one of the nation’s highest rates of breastfeeding initiation. Nine in 10 women leave the hospital indicating plans to breastfeed. At six months, exclusive breastfeeding plummets to 22.3%. Clearly, women get the message that breastfeeding is important and they leave the hospital planning to act on this information. So, what fuels such a dramatic drop off?

Many factors contribute to the plummet. Hospital practices, because the play an enormous role in a woman’s success, are a good place to explore. I wager reimbursement practices are critical to reversing the drop from 90.4% to 22.3%. Pegging public (Medicaid/OHP) and private insurance reimbursement for maternity care services to breastfeeding rates at three- and six-months is an intriguing idea. Accordingly, the rational response for hospitals would be to create breastfeeding-friendly models of care starting with ensuring mothers and babies get off to a good start – milk is in and the latch is correct.

A century ago virtually all American mothers nursed their babies, but by the 1950s, formula was the norm.

Most women probably decide to breastfeed without realizing that in doing so they are unearthing/resurrecting a once nearly universal practice eviscerated by post-World War II cultural norms for “modern” living. It is no wonder the path from making the decision to breastfeed to doing it is rife with challenges. Not having been breastfed themselves or regularly witnessing breastfeeding, new mothers are on their own. They lack female relatives and friends equipped to assuage normal, anxious moments before they can way to confidently breastfeeding.

If more women understood this, how differently might they feel about their plans to breastfeed and the challenges they might face in bringing breastfeeding back from the brink of extinction? Would this perspective spare any of them the unwarranted, undeserved sense of failure many carry? Might they instead see themselves as deserving of support and demanding it?

Closing thoughts and one wish….

What about women who cannot access, let alone afford, a lactation consultant? Everyday we learn more about the power of breastfeeding to improve the long-term quality of life for women (lowered rates of breast cancer, diabetes, ovarian cancer), children (improved health, reduced rates of obesity) and the community as a whole.

Breastfeeding represents a powerful form of preventive care with exponential multiplier effects. How can health care systems, employers and public policy better support women to realize its benefits?

If I could have one and only one modest wish granted, it would be for every person with whom a mother and infant come into contact to be able to recognize a proper breastfeeding latch and know how to connect the pair with a lactation expert. By everyone, I mean nurses aides, nurses, midwives, OB/GYNs and pediatricians. Everyone.


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