Frequently Asked Questions about Breastfeeding
How long do doctors recommend that women breastfeed their babies?
The American Academy of Pediatrics (AAP) recommends that mothers breastfeed their infants exclusively for the first six months, followed by continued breastfeeding and introduction of complementary foods to one year or longer.
And what is so great about breastfeeding?
A history of breastfeeding is associated with lower risk in the child for ear and respiratory infections, atopic dermatitis, gastroenteritis, types 1 and 2 diabetes, asthma, childhood obesity, childhood leukemia, necrotizing enterocolitis, and sudden infant death syndrome (Ip, Chung, Raman, Trikalinos, & Lau, 2009). Benefits to the mother include a lower risk for type 2 diabetes, and breast and ovarian cancer (Ip, Chung, Raman, Trikalinos, & Lau, 2009).
The mother’s milk supplies the young infant with needed immunological substances, allowing the baby to focus its energy on developing other vital body parts. Breast milk’s composition changes as the infant matures to meet the infant’s evolving immunological, biological, and developmental needs (Goldman, 2012).
That’s nice, but let’s talk about money. Does breastfeeding save money? Our health care costs are so high!
Absolutely! About $13 billion could be saved annually in pediatric costs in the US if 90% of infants breastfed exclusively for six months (Bartick & Reinhold, 2010) and $18.3 billion (with a lower CI bound of $5.1 billion) in potentially preventable maternal health costs, primarily due to the high value of life prior to age 70 years (Bartick, Stuebe, Schwarz, Luongo, Reinhold, & Foster, 2013).
Really! But don’t most women already breastfeed? So why all the fuss?
Yes, in fact, in the US, four out of five women breastfeed their infants. But how many breastfeed varies by age, race/ethnicity, education, economic class, and other factors. Women who are poor, less educated, unmarried, under 20 years of age, black and recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) had the lowest rates of breastfeeding by six months (CDC, 2012). For example, only 3 out of 5 African American women breastfeed. There is a disparity of 20 percentage points between the percent of white and African American women who breastfeed.
Why is there so much disparity?
In an article on breastfeeding among minority women, Chapman and Perez-Escamilla (2012) state: “Some of the potential causes of poor breastfeeding outcomes among black and Puerto Rican women include breastfeeding ambivalence (7), the availability of free formula from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (8), a high level of comfort with the idea of formula feeding (9), limited availability and lower intensity of WIC breastfeeding support for minority women (10,11), and issues surrounding trust building and perceived mistreatment by providers (12)”.
Is how long you breastfeed important? Or just that you at least breastfed?
Two factors are important: duration and exclusivity. The longer you breastfeed, the more benefit. Also, there is more benefit if you only give your baby breastmilk during the first six months, which is what doctors recommend.
So then, if duration and exclusivity are important, are women breastfeeding for as long as recommended and also exclusively breastfeeding for six months?
Actually, by three months, only 2 in 5 women breastfeed exclusively and by six months, less than one in five do. Less than half of all women are doing any breastfeeding at six months.
What is the problem? Why do so few women continue to breastfeed during those first few months?
One problem is the early supplementation with formula. With increased supplementation, the amount of mother’s milk decreases due to decreased demand from the child, which leads to even more supplementation. In 2011, by 2 days, nearly one-fifth (19.4%) of women who had initiated breastfeeding had already supplemented their milk with formula.
What are the reasons women stop breastfeeding?
Many women do not breastfeed as long as they would like. According to a national survey (IFPS II), 23% of women who breastfed less than three months, 40% of women who breastfed for 3 - 5 months, and 75% of women who breastfed at least 9 months said that they breastfed as long as they wanted (CDC, 2009a)
In one study of reasons for stopping breastfeeding, about half of mothers said they had not enough milk, regardless of the time of weaning (Li, Fein, Chen, & Grummer-Strawn, 2008). This is in spite of the fact that less than 5% of women are biologically unable to breastfeed.
The Surgeon General’s Call to Action (USDHHS, 2011) cites lack of knowledge; lactation problems; poor family and social support; social norms; embarrassment of breastfeeding in public; and employment, child care, and health services barriers as factors limiting breastfeeding.
According to Perez-Escamilla and Chapman (2012), specific breastfeeding barriers for African American women include “breastfeeding ambivalence, the availability of free formula from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a high level of comfort with the idea of formula feeding, limited availability and lower intensity of WIC breastfeeding support for minority women, and issues surrounding trust building and perceived mistreatment by providers”.
What about breastfeeding and work? Is it a barrier for some women? What can be done about it?
The prospect of returning to work is a significant barrier to initiating or continuing to breastfeed, especially for women with no paid maternity leave, poor support at work, and those with hourly wages or with less flexible jobs (USDHHS, 2011). Several studies have found a positive relationship between delaying return to work and breastfeeding duration (Kools, Thijs, Kester, & de Vries, 2006). A review of length of maternity leave and breastfeeding found consistently longer breastfeeding duration with longer maternity leaves (Staehelin, Bertea, & Stutz, 2007). Noonan and Rippeyoung (2011) report on the incompatibility of breastfeeding with work in the United States and that “women who breastfed for longer than 6 months experienced more earnings loss than women who breastfed for less than 6 months or not at all” (p. 325).
So what are we doing to make it easier for women to breastfeed as long as they want?
Legislative changes are one way to help. In the U.S., legislative changes through the Affordable Care Act require health insurers to cover “breastfeeding support, counseling and equipment for the duration of breastfeeding” (U.S. Centers for Medicare and Medicaid Services, 2013) and employers to provide lactation rooms and break times for hourly paid workers during the child’s first year (U.S. Breastfeeding Committee, 2013b).
How can/does community support influence mother’s ability to breastfeed (grandmothers, dads, partners, caregivers etc). What can we do as a community to support our breastfeeding mothers?
The Centers for Disease Control and Prevention (CDC) recommends interventions to help women breastfeed. The following initiatives were copied from: Centers for Disease Control and Prevention. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta: U.S. Department of Health and Human Services; 2013.
Maternity care practices (prenatally through postpartum period) that support breastfeeding include developing a written breastfeeding policy for the facility, providing all staff with education and training on breastfeeding, maintaining skin-to-skin contact between mother and baby after birth, encouraging early breastfeeding initiation, supporting cue-based feeding, supplementing with formula or water only when medically necessary, and ensuring postdischarge follow-up.2–6 Maternity care practices that can have a negative effect on breastfeeding include using medications during labor and giving formula, water, or sugar water to breastfeeding infants when not medically necessary.2,3,7–11
Professional education on breastfeeding of doctors, nurses, midwives, nurse practitioners, nutritionists, lactation consultants, and other health care professionals working in maternity care.
Access to professional support from health care professionals such as doctors, nurses, or lactation consultants is important for the health of the mother during pregnancy, after giving birth, and after release from the hospital. If a mother chooses to breastfeed, this support may include counseling or behavioral interventions to improve breastfeeding outcomes. It may also include helping the mother and baby with latch and positioning, helping with a lactation crisis, counseling mothers returning to work or school, or addressing concerns of mothers and their families.
Peer support programs encourage and support pregnant and breastfeeding women. They are often provided by mothers who are from the same community and who are currently breastfeeding or have done so in the past. It can be provided in several ways. The two most common and effective methods are peer support groups and individual peer support from a peer counselor. Women who provide peer support receive specific training. They may lead support groups or talks with groups in the community or provide one-on-one support through telephone calls or visits in a home, clinic, or hospital. Contact may be made by telephone, in the home, or in a clinical setting. Peer support includes emotional support, encouragement, education about breastfeeding, and help with solving problems.
Workplace recommendations: Support for breastfeeding in the workplace can include several types of employee benefits and services. Examples include the following: • Developing corporate policies to support breastfeeding women. • Providing designated private space for women to breastfeed or express milk. • Allowing flexible scheduling to support milk expression during work. • Giving mothers options for returning to work, such as teleworking, part-time work, or extended maternity leave. • Providing on-site or nearby child care. • Providing high-quality breast pumps. • Allowing babies at the workplace. • Offering professional lactation management services and support.
Support for breastfeeding in early care and education Early care and education (ECE) is a term used to describe various types of child care arrangements, including prekindergarten (pre-K) programs, Head Start programs, child care centers, and in-home care. ECE programs play an important role in supporting breastfeeding mothers and their infants by welcoming breastfeeding mothers and making sure staff members are trained to handle breast milk and follow mothers’ feeding plans. Increasing access to ECE programs that support breastfeeding families will help women start and continue breastfeeding.
Breastfeeding education usually occurs during the prenatal and intrapartum periods. It should be taught by someone with expertise or training in lactation management. It may be offered in a hospital or clinic setting, as well as at libraries, community centers, churches, schools, and work sites. Education primarily includes information and resources. First-time mothers report that they find books and written information helpful, while experienced women often rely on their past experience and doctors.75 Although the audience is usually pregnant or breastfeeding women, it may include fathers and others who support the breastfeeding mother. The goals of breastfeeding education are to increase mothers’ knowledge and skills, help them view breastfeeding as normal, and help them develop positive attitudes toward breastfeeding.
Social marketing may be used to promote breastfeeding practices in community, hospital, and workplace settings; educate policymakers about issues related to breastfeeding; and educate the public about healthy infant nutrition practices and support programs. Social marketing is a systematic and strategic planning process that results in an intended practice or program.
Addressing the marketing of infant formula Monitoring how infant formula is marketed to ensure that potential negative effects on breastfeeding are minimized can help reduce barriers to breastfeeding for women who choose to do so.
"Breastfeeding is more than a healthy feeding practice. It is about the empowerment and strength of a community." from “You Don't Know My Story: A Closer Look at the Women of Black Mothers' Breastfeeding Club” retrieved from www.blackmothersbreastfeeding.org