The Virginian-Pilot
                             THE VIRGINIAN-PILOT 
              Copyright (c) 1995, Landmark Communications, Inc.

DATE: Tuesday, September 19, 1995            TAG: 9509180223
                                             LENGTH: Long  :  239 lines

CORRECTION/CLARIFICATION: ***************************************************************** CORRECTIONS Virginia Beach General Hospital participates in UNICEF's Baby-Friendly Hospital Initiative, a program encouraging hospitals to support breast-feeding. It was omitted from a UNICEF list provided for Tuesday's Daily Break story on breast-feeding. Correction published , Wednesday, September 20, 1995. p. A2 < ***************************************************************** REDISCOVERING BREAST-FEEDING MANY NEW MOTHERS WHO WANT TO NURSE THEIR BABIES ARE THWARTED BECAUSE THEY LACK KNOWLEDGE AND NEEDED ADVICE

BY NOW, THE research is well known: Breast-feeding increases children's intelligence. Reduces childhood illnesses. Promotes bonding between mothers and children. Maybe even cures cancer.

Yet, only five in 10 American women leave the hospital breast-feeding their new babies. Within six months, only two of those new mothers are still breast-feeding. By the time the baby is a year old, fewer than one mother in 10 is still breast-feeding.

In the rest of the world, nine out of 10 women nurse immediately after birth, and the average age at which they wean is 2.8 years.

A decade ago, the U.S. surgeon general established the goal of increasing the nation's breast-feeding rate to 75 percent by 1990. Obviously, there's still a long way to go.

So why don't more American women breast-feed?

That's a difficult question. It's also one that is dividing American women today much like the work-outside-or-inside-the-home debate.

There are the breast-feeding moms looking down their nipples at their bottle-feeding counterparts. They sniff out their disapproval for the latex-tipped, formula-filled substitutes, making those women who don't breast-feed feel guilty, inadequate and ashamed.

Then there are the non-breast-feeding moms who become almost shrill defending their right not to nurse. They sneer at La Leche League, a group that promotes natural nursing, as ``breast-feeding Nazis.''

But probe deeper with this second group, ask them individually why they didn't breast-feed, or stopped breast-feeding after a short time, and frequently the answers become less defensive and more regretful. Nearly every reason, it turns out, can be traced to a lack of information, education and support, rather than a lack of desire.

``It was just extremely painful,'' remembers Jeannette Brudowsky of Virginia Beach, who struggled for a month to breast-feed her daughter five years ago. Her nipples eventually cracked and bled, and her daughter vomited clots of blood.

When she called her pediatrician, she says, he told her, ``You know, you don't have to breast-feed.''

That was all she needed to hear. From then on, her daughter was bottle-fed.

But giving up nursing is something she has always regretted. Today, Brudowsky, a registered nurse who works at Children's Hospital of The King's Daughters, belongs to a breast-feeding support group at the hospital. The information she's gaining will not only help her counsel the new mothers she sees in her job in the neonatal intensive care unit but also, she hopes, will provide a more successful breast-feeding experience when she has another child.

She knows now, as she didn't five years ago, that breast-feeding shouldn't be a painful experience.

Not if women hold their babies in the right position.

But many women don't know what the right position is. They have no one to show them.

In years past, women learned about breast-feeding from their mothers. Who learned about it from their mothers. Who learned about it from their mothers, and so on and so on. But in the mid-20th century, something happened to that line of progression. Formula.

Once formula - actually doctored cow's milk or milk made from soybeans - was available, it was touted as the modern way to feed babies. The idea of using sterile bottles instead of the supposedly germ-ridden breast was an obvious progression of the movement that had taken birth from the home into the hospital, and made what used to be a natural process in this country into a medical one.

But the move to bottles left generations of women without any knowledge of breast-feeding. And so when nursing again became popular in the 1980s, women floundered.

Because, contrary to popular knowledge, breast-feeding is not an automatic action for either baby or mom.

``Breast-feeding shows that very little of what we do is instinctual,'' says Dr. Ardythe Morrow, associate professor of pediatrics at Eastern Virginia Medical School. ``There's always a certain knowledge base required.''

A mom needs to learn how to hold her baby. How to get babies to latch on to her breast. How often to feed. How to make sure babies get enough to eat. How to handle problems that can arise - like breast infections, engorgement or a baby who simply goes on a nursing strike and refuses to eat.

But these days, most American women leave the hospital within 24 hours after giving birth. They go home tired, sore and confused - days before their milk comes in. Even while in the hospital, the maternity unit's nurses may not have the time - or knowledge - to show new moms how to breast-feed.

To compensate, most area hosptials have hired full- or part-time lactation consultants - specially trained professionals who can counsel women about breast-feeding. They try to visit moms who have decided to breast-feed while they're still hospitalized, but may not have time to see all of them.

Still, they encourage discharged moms to call once they're home. Some, like Amy Adkins, a board-certified lactation consultant who counsels new moms about breast-feeding in her job at Chesapeake General Hospital, even hold office hours.

That's important, because if a woman relies on her obstetrician, pediatrician or family practitioner for breast-feeding advice, she might be in trouble.

In general, those doctors - the three specialities most likely to be consulted about breast-feeding problems - don't know enough about the benefits of breast-feeding or about how to educate and advise women about breast-feeding, according to a study published in the Journal of the American Medical Society in Feburary.

The doctors' lack of knowledge about breast-feeding, the report's authors said, ``poses a true threat to successful breast-feeding initiation and duration.''

When Norfolk obstetrician Theresa Whibley was in medical school, she learned only about the physiological aspects of breast-feeding - how the body produced milk - not the emotional and instructional aspects.

Breast-feeding her own two children was easy, she says. She thought it should be simple for other women, too, so she was frustrated by the many women in her practice who had problems with it. To learn how to teach those women, she took courses and workshops on her own.

Today she tells her patients to take a breast-feeding class, see the the lactation consultant before leaving the hospital and spend their first two weeks at home focused on the baby - with no visitors and as little stress as possible.

``Put a sign on the door telling people you'll see them in two weeks,'' she says. ``Go lie down in the back room and breast-feed, away from people, reading a magazine. Sleep every time the baby sleeps.''

Mainly she encourages women to relax. ``This isn't a huge mystique,'' she tells them. ``The generations have survived; this is all there was for a very long time. It doesn't have to be that big a deal.''

So you've decided to breast-feed. You're home from the hospital, exhausted. And suddenly, what seemed so easy yesterday is just not working. The baby is crying, your mother is telling you he's hungry, and when you look up from one more futile attempt at nursing your eyes fall on the can of formula the hospital sent home with you.

What are you going to do?

If you're a first-time mother, chances are you're going to grab for that formula.

``When a mother does go home with formula, that sometimes gives her a mixed message that we know you're going to fail, so here's some formula for when that happens,'' says one breast-feeding expert at a local hospital, who asked not to be named. Her hospital, like most in the area, includes formula in the discharge package it sends home with new moms.

``For a first-time mother who is very unsure about how breast-feeding is going to go, having (formula) on hand means that even at the slightest problem, they're much more likely to give in to it,'' she says.

In fact, a 1987 study by doctors at Boston City Hospital found that of 343 low-income women, those who received formula when they left the hospital breast-fed exclusively for about 42 days, compared with 60 days for those who didn't.

The prevalent use of formula in hospitals is a problem that UNICEF, the United Nation's Children's Fund, recognized several years ago. UNICEF tries to increase breast-feeding worldwide. In 1991 it began a program called the Baby-Friendly Hospital Initiative to encourage hospitals to support breast-feeding as a part of cost-effective health care for new mothers and babies.

Almost 300 hospitals in 41 states have signed onto with the program, which requires them to follow 10 basic steps, including a promise not to give infants any food or drink other than breast milk, unless medically indicated.

Chesapeake General is the only hospital in Hampton Roads that has signed onto the program, a UNICEF spokeswoman says.

Adkins says the hospital's decision to participate doesn't mean it forces breast-feeding down its patients throats or makes them feel guilty if they don't do it. ``We really promote ourself as being pro-choice,'' she says.

But it does mean that all labor, delivery and postpartum nurses are trained in breast-feeding practices. ``What we hoped we'd achieve would be that moms who choose to breast-feed would be more likely to continue breast-feeding once they left the hospital,'' Adkins says.

``A lot of times practices in the hospital can interfere with breast-feeding in the beginning, like giving babies frequent bottles of formula in the hospital can interfere with the baby's ability to latch onto the breast which would hinder their breast-feeding.''

Even giving a baby a pacifier can inhibit his ability to learn to suck on the breast, which requires a different mouth and tongue placement than sucking on a pacifier or rubber nipple.

Karen Lewis, of Virginia Beach, had always planned to nurse her daughter, Michaela, now 20 months. But she thinks her failure at breast-feeding was due, in part, to the mixed messages she received while hospitalized.

Michaela was born a month early. It was 12 hours after her birth before Lewis finally saw her. By then, the baby had already had a bottle.

Lewis tried to breast-feed but didn't have much success. ``I was hearing that she needs to eat or she can't go home, and when I nursed her, her blood sugar didn't go up enough.''

Lewis says nurses at the hospital suggested she give the baby a bottle. ``It won't hurt her,'' she says she was told. But once Michaela was on the bottle - which delivers milk much faster and quicker than nursing does - she didn't want to go back onto the breast.

Lewis says she saw a breast-feeding expert once while in the hospital - but at 2 a.m., when she was too tired to talk.

When she was home with Michaela, Lewis kept trying to breast-feed, but the baby just wouldn't latch on to her breast. She called her pediatrician who told her: ``Don't be so hard on yourself. Just give her a bottle,'' she says. Soon thereafter, Lewis gave up.

Then Lewis found out that bottle-feeding had its own difficulties. ``People would say to me, `What's wrong with you? Why aren't you nursing your baby?'

``Some people weren't very compassionate to me after what I'd been though. It's very traumatic to have a baby early. It made me firmer in my own belief that you shouldn't be so quick to judge people.''

Now Lewis is pregnant again, and she's determined to try breast-feeding with her next child.

From her experience with Michaela, she knows that book knowledge - which she'd relied on to teach her about breast-feeding - won't be enough. ``You have to have someone to sit down with you and show you.'' ILLUSTRATION: JANET SHAUGHNESSY/Staff



Nearly all local hospitals have lactation consultants on staff. Call

a hospital's maternity unit or its women's center for a contact.

La Leche League has several local chapers in Hampton Roads, and it

runs day and evening support meetings. Counselors are available 24

hours a day to provide help over the phone or in person. For the

location of the chapter nearest you, call Dihann Geier at 548-3794.

Most local health departments run breast-feeding counseling groups

for women in WIC, a government food-supplement program. Contact your

city's health department for more information.

Pediatricians' offices are adding lactation consultants to their

staffs. Ask if your doctor's office has one.

If not, contact the International Lactation Consultants'

Association, at (708) 260-8874 for the name of a certified lactation

consultant near you.

For information on renting pumps, call the Breastfeeding National

Network, run by Medela, a pump manufacturer, at (800) 835-5968.

by CNB