Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, April 12, 1994 TAG: 9404120108
SECTION: EXTRA PAGE: 6 EDITION: METRO
SOURCE: Jane Brody
DATELINE: LENGTH: Long
According to periodic surveys, women who are young and unemployed, who live on low incomes and who lack college educations are the least likely to attempt to breastfeed, and if they do try, are the most likely to abandon it before their babies are 6 months old.
Babies of such mothers face the highest risk of health problems that could best be countered by starting life on breast milk.
These facts are especially discouraging to researchers who continue to uncover health-saving and possibly life-saving benefits of mother's milk to the newborn child.
But a 10-year slide in breastfeeding may be reversing, according to national surveys of tens of thousands of new mothers by Ross Laboratories, a baby formula company.
In 1992, the last year for which data have been released, 53.9 percent of babies were breastfed in the hospital and 20.1 percent were still being nursed at 6 months of age.
The comparable figures in 1990 were 51.5 percent in the hospital and 19 percent at 6 months, significantly lower than in 1982, when breastfeeding in the hospital peaked at 61.9 percent. A preview of the 1993 data indicates that breastfeeding is continuing to regain popularity.
Yet, the practice still lags among less affluent and less educated women, whose babies, for many reasons, including low vaccination rates and greater exposure to environmental contaminants like cigarette smoke, especially need the nutrients and disease protection that mother's milk bestows.
And many affluent and well-educated mothers continue to choose bottle-feeding for reasons of convenience or, for lack of support, give up nursing as soon as any difficulty arises.
The United States is still far from the goal established in 1990 by the Department of Health and Human Services that by 2000, 75 percent of mothers nurse their babies at least in early infancy and 50 percent continue to nurse until their babies are 5 or 6 months old.
In Patient Care, a magazine for physicians, Dr. Carole Stashwick, a pediatrician at Dartmouth Medical School, recently listed these reasons for the waning of breastfeeding:
Less emphasis on its benefits in lay publications; inadequate attention to nursing by professionals involved in newborn care; direct marketing of infant formulas to mothers; the common practice of hospitals' sending new mothers home with a sample of formula; and a general failure of modern society to pass on breastfeeding skills to new mothers, most of whose own mothers and grandmothers had chosen the bottle over the breast.
Most people assume, incorrectly, that breastfeeding comes naturally. Actually, it is a learned skill for both the mother and her infant. Although babies are born with a ``rooting'' tendency to nuzzle the breast and with an instinct to suck, neither baby nor mother knows instinctively how to breastfeed, Stashwick wrote.
First-time mothers often need help in getting started with breastfeeding, but nowadays most leave the hospital within two days of delivery, before the mother's milk even comes in. Once home, there is no one to help when breastfeeding fails to go smoothly.
The first weeks of nursing can be a challenge. Some mothers become anxious when their babies cry a lot or seem to reject the breast or lose too much weight. Some mothers' nipples become cracked or sore, and others lack support for breastfeeding from their babies' fathers or grandparents.
As one 33-year-old first-time mother put it: ``Nursing seemed to be going well in the hospital, but as soon as we got home, the baby refused the breast. She began crying incessantly and wouldn't even sleep. She was obviously hungry but still refused to nurse. So I gave up, and as soon as I gave her a bottle, she was happy.''
The mother said that at the hospital, ``three different people gave me conflicting advice: hold the baby this way, hold her that way, feed on demand, feed on a schedule, never give her a bottle, supplement with formula if she still seems hungry.''
Then, too, there are important socioeconomic obstacles. Many new mothers must return to work - sometimes within weeks and often within three months of the birth - and decide, again mistakenly, that there is no point in nursing for so short a time.
And in the case of mothers receiving federal aid under the Special Supplemental Food Program for Women, Infants and Children (WIC), infant formula is provided for those who bottle-feed, but no special supplements are offered to those who nurse.
In Quebec, to encourage breastfeeding, the comparable program now pays a cash allowance of $37.50 a month to mothers who breastfeed.
Breastfeeding specialists are founts of helpful advice. For example, it helps to change the baby's position from one feeding to another to assure that milk is drained from all areas of the breast.
Besides the traditional cradling position, try a football hold, with the baby tucked under one arm so she approaches the breast from the side, or try nursing lying down face to face with the baby.
Be sure that the baby latches on to the nipple properly. The entire nipple and most of the areola (the surrounding dark area) should be in the baby's mouth and the baby's lips should spread out around it.
Women with flat or inverted nipples can wear plastic breast shields called Swedish milk cups for several hours a day at the end of pregnancy and at the start of nursing to help pull out the nipple.
As the baby begins to suck, the milk is ``let down'' from the breast ducts into the nipple. (Often some milk drips from the opposite breast at this time.)
The baby's gulping noises are an indication that milk is being swallowed. During the first days of nursing, the mother often feels brief uterine contractions when the baby begins sucking.
In a society accustomed to precise measurements, many mothers who breastfeed worry about whether their babies are getting enough to eat. A baby will mostly empty a breast in about 10 minutes of nearly continuous sucking.
Those who fall asleep after a few minutes of nursing need to be awakened and kept stimulated (for example, by tapping the feet) until they have eaten enough. To maintain a good milk supply and to assure that the baby is getting enough, newborns should be nursed every two to three hours.
Success at nursing can be measured by whether the baby seems content afterward, produces at least six wet diapers and several fairly liquid, mustard-colored stools each day and wakes up at least every four hours around the clock to be fed.
A baby who is gaining weight normally is well-fed, but experts advise against home baby scales, which are often inaccurate and can be anxiety-provoking instead of reassuring.
Breastfeeding is most likely to succeed when both mother and father are well informed. Many hospitals now have lactation specialists on staff; be sure to leave the hospital with a phone number to call if nursing difficulties begin at home.
The hospital specialist may also be able to refer you to a local breastfeeding support group. Other useful resources include the following:
La Leche League International, 9616 Minneapolis Ave., Franklin Park, Ill. 60131; phone 800-LA LECHE (525-3243) or (708) 455-7730.
International Childbirth Education Association, Box 20048, Minneapolis, Minn. 55420; (612) 854-8660.
Lact-Aid International Inc., Box 1066, Athens, Tenn. 37371; (615) 744-9090.
- The New York Times
by CNB