Breastfeeding: Innovative Approaches to Healthy Beginnings Stacey Levin, RN, IBCLC HealthONE Alliance Lactation Program Denver, Colorado

Breast milk is the most complete form of nutrition for infants and an important contributor to infant health

AAP Policy Statement “Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth….Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet. It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.”

Benefits to Infants: Less severe diarrheal illness Reduced incidence of upper respiratory infection and ear infection Recent studies have shown reduced risk of Type I & II Diabetes Less allergic disease, asthma Less overweight and obesity

Benefits to Mother: Reduced postpartum blood loss Reduced risk of osteoporosis Reduced risk of pre-menopausal breast cancer Reduced risk of ovarian cancer Possible reduced risk of post-menopausal breast cancer if breast feeds for >2 years or if breast feeds during early 20’s

Social and Economic Benefits Family – hundreds of dollars in savings in formula costs Employer – less work missed by mothers in companies that support and provide lactation programs within the company Health care system – fewer sick visits, fewer prescriptions, fewer hospitalizations, total medical care expenses decreased by 20% if infants breastfed exclusively

Good News: Breastfeeding rates have increased over the past 10 years. For 2002, initiation rates hit an all-time high of 70.1% with 33.2% duration at six months for all mother/infant pairs Strong gains among black and Hispanic mothers, mothers < 24 years of age, those receiving WIC, those with a grade-school education, those in the South Atlantic region and mothers with low birth weight infants

Disappointing News: Healthy People 2000 goals of 75% initiation and 50% still breastfeeding at six months were not met and have therefore remained unchanged for Healthy People 2010 Slight declines for in-hospital breastfeeding rates were noted for 35 year olds (2002 vs rates) Asian and Hispanic rates were down overall, but rates at six months were down slightly for black mothers in the past year and remained unchanged for Asian and Hispanic mothers

Mountain and Pacific regions have decreased slightly over the past year Results vary by demographic groups Mothers with college education rates 50% higher than mothers without college education Non-WIC mothers exclusively breastfed at rate 70% greater than WIC mothers White mothers breastfed at double the rate of black mothers 2:1 gap for these same groups at six months of age Substantial gap still exists between non-WIC and WIC recipients

An important Public Health goal should be to increase breastfeeding rates among all populations, but especially among low-income, less-educated and certain racial and ethnic groups

Most emergent issues in breastfeeding today: Duration Disparities among certain racial/ethnic groups Accessing care Support for women living in crisis Education of clinicians Supporting women in the workplace

A woman’s ability to breastfeed depends on the support she receives to make breastfeeding as easy as possible and to remove the barriers that discourage her from continuing Support is most critical during the first few weeks postpartum Most breastfeeding is discontinued during this time because of sore nipples and perceived low/insufficient milk supply

Mothers need access to lactation management services provided by physicians, nurses, lactation specialists, peer counselors and other trained health care providers Physicians and nurses should be knowledgeable about lactation basics especially during the prenatal and postnatal period A recent study showed that obstetricians were least confident resolving problems associated with low milk supply and pediatricians were least confident dealing with breast pain associated with sore cracked nipples Culturally appropriate training should be integrated into health profession schools Lack of support from health care provider for African- American women has been cited as a major barrier to breastfeeding

Lactation consultants available to or staffed in Pediatric and Family Care offices in order to ease time crunch for providers to address issues and give advice on importance of breastfeeding Outpatient lactation support clinics Breastfeeding education for women and their partners, and other significant family members during prenatal and postpartum visits

Support for Women in the Workplace Over half of the women in the US with children under the age of one are working outside of their homes Many return to work within 3 months with the majority returning within 6 months African-American women are more likely to return to work within 8 weeks and return to jobs that do not allow them to be successful at breastfeeding

Provide prenatal lactation education specifically tailored to working women Provide education to co-workers as to why breastfeeding mothers need support Provide adequate breaks, flexible work schedules, job-sharing and part-time work without penalty to mother Provide appropriate facilities for pumping and storage of milk

Provide access to hospital-grade electric breast pumps in the workplace or purchase or subsidize purchase of individually owned portable breast pumps for mothers Provide access to a lactation professional on site or by phone for education and support during pregnancy, after delivery and upon return to work

Provide on-site or near-site child care programs to allow infants to be breastfed during the day or make accommodations for child to be fed expressed breast milk at the facility Educate employers to benefits of supporting breastfeeding Reduced employee turnover Reduced absenteeism Improved morale

Designation as “Mother-Friendly” employer Assist health care providers in presenting accurate information and support for combining employment and breastfeeding Support legislation to provide tax credits to employers who provide breastfeeding support services Bridge the gap between employers’ and employees’ perception of need for work-site breastfeeding support

Public Support Peer support especially for populations with low breastfeeding rates Hispanics, African-Americans, Asians and teen mothers Health education in schools to stress importance of breastfeeding for health of mother and child Education directed toward fathers and other family members who influence the woman’s decision to breastfeed

Media campaign to present images of breastfeeding as the standard feeding method of infants in all places mothers and their infants go Support legislation to protect the rights of the breastfeeding mother Help to ensure that the marketing of formula does not interfere with the establishment of breastfeeding