By Guest Blogger* Donna Walls, RN, BSN, ICCE, IBCLC, ANLC
The reasons women choose are as varied as the women themselves. As a clinical lactation consultant for 29 years now I have often wondered and talked with women and their families about why they chose to breastfeed and even more important why they continue to nurse when problems occur.
There have been many promotional programs over the last decades. Traditionally these have focused on lists of the benefits of receiving human milk for babies, including enhanced cognitive development, reduced risk of allergies and asthma, lower incidence of obesity and diabetes, childhood leukemia and SIDS. More recently breastfeeding advocates began also including the benefits to mothers as well, including lower risk of breast and ovarian cancer, osteoporosis and heart disease among those who choose to breastfeed.
The Department of Health and Human Services has set breastfeeding goals for the nation. In 2010 the goal was to have 75% of mothers beginning to breastfeeding and have 50% still breastfeeding at 6 months and 25% still breastfeeding at 1 year. Now the goals we are currently working toward are 81.9% beginning to breastfeed with 60.6% breastfeeding at 6 months and 34.1% at 1 year by the year 2020. We haven’t met these goals yet but we are closer than ever- yay- the message has been heard.
What have pregnant women said was the message that made sense to them? Of course the health benefits are important, but what are some of the other reasons women give when deciding to breastfeed?
Years ago I had a patient who came to my breastfeeding class, seemed interested and asked a lot of good questions. After class was over and everyone was gone she approached me and said she never planned on breastfeeding, she even thought it was a bit gross and messy but her mother had been diagnosed with breast cancer and she read that breastfeeding can reduce her risk of breast cancer. She breastfed for about 2 years and after a couple months called me to confess that she had, despite her previous opinion, fallen in love with breastfeeding.
Another mom whose husband was diabetic was breastfeeding as a preventive treatment for her baby. She was never a warm fuzzy person and often talked about feeling blue and being easily stressed, but while she was breastfeeding she noted how much better she felt, how breastfeeding was a welcomed surprise to lift her mood and spirits.
Cost has always been a motivator as well. The cost of purchasing formula can be a deciding factor for many families. According to Kelly Bonyata, BS, IBCLC, the cost of formula feeding an infant for the first 6 months of life can range from $428.96 to $1662.22, depending on type of formula and brand. Some will cite low-to-moderate income families’ ability to get formula through participation in the USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) but, WIC provides only supplemental foods along with nutrition education, it’s not designed to provide all the formula needed. WIC has also done a great job with providing incentivized food packages to breastfeeding families as a means of encouraging breastfeeding.
Other non-health related benefits can also be a big part of the reason to begin or maybe continue nursing. Convenience is often not touted as a benefit, but I believe it should be marketed more vigorously: no formula preparation, no bottle washing and so much easier for nighttime feeds. Travel can also be made easier when there is no need to figure out a way to mix, warm and store feeds in the car, airplane or in hotels.
In 2011 Avery & Magnus, released findings of their work, reporting that mothers who feel prepared, knowledgeable, and confident about breastfeeding typically have better outcomes after birth. It is so unfortunate that that we have many young women who have never seen a nursing baby, much less spend time seeing how it works. In traditional cultures, learning occurred through children watching mothers breastfeed and asking questions about how this thing really works.
With the improving breastfeeding rates in the US, more children are observing breastfeeding, and attitudes toward public breastfeeding is slowly changing and we are starting to see more moms nursing in stores, restaurants, airports and sporting events. Do we still have a long way to go- Oh yes- but your women are more likely to at least catch a glimpse of breastfeeding now that 10 years ago. It would be great to reach a point where women don’t feel the need to use covers and “hiders” when their babies need to be fed,
A recent study by Amy Brown found that women are also looking for more education of extended family so they can count on getting support from all family members. In the first weeks of breastfeeding support is key. Negative attitudes can be deadly. Many well-meaning friends and family offer “suggestions”, often based on misinformation or old wives tales. Sometimes when a new mother expresses concerns about her baby nursing frequently the immediate response is that she is “starving” her baby and she needs to give formula. When the baby wants to be held and cuddled (normal behavior for newborns) she is often told breastfeeding is spoiling that baby and she needs to let the baby “cry it out” rather than responding the infant’s cues. If the mother runs across any problems or concerns it seems more expedient to give advice to just give formula rather than helping her to fix the problem!
In my clinical practice working with new mothers I kept a journal of responses of mothers coming in for sore nipples. Most were between 1 and 3 weeks post birth. I asked them why they continued to breastfeed even though they were experiencing problems, some even pain. The responses were from “they told me it would hurt for a week (we really need to dispel that myth quickly) so I just kept going” to “it’s so much cheaper” to the number one answer, “I knew it was the best thing for my baby”. How sad that because of misperceptions and bad advice these moms had to live through the first week(s) in pain or dreading what should be a beautiful experience with her baby!
What does real support for our breastfeeding moms look like? In a perfect world breastfeeding would be the normal way to feed babies. Women wouldn’t be harassed for breastfeeding in public and all hospitals would provide the kind of care that ensured early successful nursing.
We can continue to educate professionals, extended families and expectant and new parents on the basics of lactation.
More than anything we need to do all we can to build a new mother’s confidence in her own abilities. We can avoid using negative terms such as “your nipples are not the best for breastfeeding” (nipples come in all shapes and sizes but are designed to feed human babies!), “your milk will come in in 3-4 days” (she has milk before the baby is born-colostrum is milk!) or listing all the problems that could possibly happen. Be there to listen, provide realistic anticipatory guidance, offer only evidence-based care, give positive feedback and refer her onward if indeed she has encounters problems beyond your scope.
So let’s listen to what women need and assure we have programs in place to provide the support and education needed for healthier mothers and babies!!
*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.)