Although most new mothers in the United States begin breastfeeding, relatively few presently manage to fulfill the AAP's infant-feeding recommendations. Despite strong lip service in favor of breastfeeding, numerous societal barriers prevent women from beginning and continuing to nurse their babies.
Health Professional Attitudes and Knowledge
Although many health providers are virtual breastfeeding champions, professional apathy and misinformation about breastfeeding are widespread. A common perception is that formula-feeding is perfectly adequate and breastfeeding is "a little bit better." However, emphasizing the extra benefits offered by breastfeeding is very different from acknowledging the potential health hazards of formula-feeding. Many well-meaning practitioners are reluctant to strongly promote the benefits of breastfeeding because they worry it will make bottle-feeding women feel guilty. Yet, they don't express similar concerns when it comes to helping their clients make other health-related decisions such as not drinking or smoking while pregnant. In my experience, parents seldom feel guilty about making an informed choice, but they often feel resentful about not being fully informed.
In addition to these obstacles, many health care providers have little knowledge of the practical management of breastfeeding and are ill-prepared to assist breastfeeding mothers in their practice. Fortunately, a growing number of physician-training programs are implementing innovative curricula to teach breastfeeding. The influx of women into medicine has improved the situation somewhat, as more women practitioners bear and nurse babies themselves. Another encouraging development is the establishment of the Academy of Breastfeeding Medicine, a physician organization devoted to the promotion, protection, and support of breastfeeding. Whenever you have a choice of health providers, I would urge you to use a prenatal interview to identify a practitioner who firmly believes that breastfeeding is both highly desirable and well worth any extra effort on your part or, for that matter, their part.
The Hospital Experience and Early Discharge. The hospital experience and early follow-up period after discharge set the stage for breastfeeding success or failure. While many hospitals have implemented family-centered maternity care practices that promote successful lactation, policies that undermine breastfeeding initiation remain widespread. Choose a hospital whose maternity routines are supportive of breastfeeding and request practices known to foster breastfeeding success.
Most new mothers now go home within a day or two of giving birth and certainly before breastfeeding is well established. An early follow-up visit within forty-eight hours is recommended by the American Academy of Pediatrics. However, such follow-up is far from universal, and many women who encounter breastfeeding difficulties after going home do not receive the extra help they require. Arrange to have your baby examined and weighed within 48 hours of discharge so any early breastfeeding problems can be identified and remedied.
A Generation of Bottle-Feeding Grandmothers
In societies where breastfeeding is traditional, the art is passed from mother to daughter. Girls frequently observe breastfeeding, beginning in childhood, and grandmothers routinely offer guidance about nursing technique and expected norms. In the United States today, the majority of grandmothers lack firsthand experience with breastfeeding since they bottle-fed their own children. This makes it difficult for them to give their daughters and daughters-in-law practical advice or direct assistance when it comes to nursing babies. At best, they can provide encouragement and support, but little practical help. At worst, unfamiliarity with breastfeeding may cause a grandmother to sabotage its success by making disparaging comments, doubting the adequacy of the mother's milk, or giving the baby unnecessary supplemental formula. The sight of her daughter or daughter-in-law nursing her grandchild may cause a bottle-feeding grandmother to feel remorse about not having breastfed her children. To help resolve such issues, I like to explain that, at the time these grandmothers were having their families, breastfeeding was not strongly encouraged and hospital practices did little to promote its success. One way to make up for not having breastfed oneself is to play a support role in helping one's daughter or daughter-in-law succeed at breastfeeding.
Early Return to Employment
The new breastfeeding policy statement of the American Academy of Pediatrics encourages women to breastfeed for at least a year. Yet, the majority of new mothers in the United States rejoin the workforce before their baby is a year old. Some return to work only six to eight weeks after giving birth. The separation of mothers and babies during the workday poses a logistical obstacle to continued breastfeeding. Although many options exist for employed mothers to maintain lactation, ranging from on-site child care to expressing breast milk at the workplace, there's no doubt that employment represents a societal barrier to successful breastfeeding. If you anticipate returning to work while still nursing your baby, the information in chapter 8 will give you practical strategies for successfully combining breastfeeding and employment.
Lack of Insurance Reimbursement for Lactation Services
As more women choose to breastfeed, more lactation concerns surface that require specialized counseling and management. Most physicians acknowledge that time constraints in a busy office and unfamiliarity with practical aspects of breastfeeding combine to limit their effectiveness in handling lactation problems. Lactation consultants are relatively new members of the health care team who provide breastfeeding education and consultation for breastfeeding problems. A lactation consultant may recommend that you rent a hospital-grade electric breast pump or purchase some breastfeeding supplies to help overcome specific problems. While the need for lactation counseling continues to grow, medical insurance companies often view specialized breastfeeding services as an elective expense that is not reimbursed. However, recent research showing that breastfeeding reduces health care costs may prompt insurance companies to start paying for lactation consultation services. Meanwhile, plan to budget money for necessary breastfeeding counseling or equipment to help you achieve success.
Successful breastfeeding is best fostered when mothers and babies are kept in close proximity and when infants are allowed to nurse in an unrestricted fashion. However, in our fast-paced, highly mobile society, many new mothers expect their nursing babies to conveniently fit into a structured routine. They may be unprepared for the normal frequency and unpredictability of nursings and the fact that breastfeeding can't be delegated to anyone else. Mother-to-mother support groups are one of the best ways for women to observe other breastfeeding mothers and learn how they accommodate a nursing baby in tow. Our society's emphasis on the breast as a sensual organ rather than a source of infant nutrition causes many nursing mothers to feel self-conscious when they need to breastfeed in public and makes others feel uncomfortable in the presence of a breastfeeding woman. Breastfeeding mothers need to know how to nurse discreetly in public and they require frequent reassurance that "breastfed babies are welcome here."