CHANGING THE FORMULA EXPERTS SAY THE BREAST IS BEST FOR A BABY'S GREAT START.

Byline: Evan Henerson Staff Writer

It's considered nature's perfect food, nutrient-rich, cheap and fully capable of sustaining a baby during the first four to six months of life.

With breast-feeding, a baby gets everything he needs and increased protection from numerous illness and diseases; Mom gets an unparalleled bonding experience and health benefits of her own. If a savvy advertising agency could market breast milk, it would have enough data and high-powered endorsements to knock all those ``Got Milk?'' celebrities flat on their white mustaches.

``I tell my students that from one drop of human milk, we can discuss all of human biology,'' said Dr. Lawrence Gartner, professor emeritus at the University of Chicago. ``Biology, chemistry, immunology, cancer prevention. I can take off from there and discuss any aspect of human biology.''

Even the federal government is weighing in, issuing its strongest statement yet that, when it comes to early nutrition, breast is best. In its Blueprint for Action on Breast-Feeding, U.S. Surgeon General David Satcher and the Department of Health and Human Services set a goal to substantially increase the number of women who breast-feed their babies during the first year of the child's life by the year 2010.

The blueprint's goal is to have 75 percent of all new mothers breast- feeding in the early postpartum period; 50 percent still breast-feeding at six months and 25 percent at the end of the first year.

Proponents of breast-feeding welcome the endorsement and don't see it as an invasion of privacy. They say the blueprint is no less appropriate than the Surgeon General warning smokers about the potential dangers of contracting lung cancer.

``Does the government have the responsibility to educate people about using car seats or about immunizing their children?'' said Kathleen Huggins, a lactation specialist at San Luis Obispo General Hospital and the author of ``The Nursing Mother's Companion.'' ``This is the same thing, and I think it's long overdue.''

The most significant challenge facing the Surgeon General's plan is that breast-feeding doesn't easily cross ethnic lines. Whether because of a lack of education, a cultural bias or economic factors, certain ethnic groups are simply less likely to breast-feed, acknowledged Satcher and breast-feeding activists.

African-American women are a particular target. In 1998, the percentage of African-American mothers who breast-fed during the early postpartum period (45 percent), at six months (19 percent) and at one year (9 percent) was ``alarmingly low,'' Satcher said in his introduction to the blueprint. The report goes on to recommend that federal, state and local agencies take whatever steps are necessary to educate women about breast-feeding and to help make the process easier.

``Many women think there's no difference or very little difference between breast milk and artificial milk,'' said Ellen ``Binky'' Petok, a lactation consultant with Encino Tarzana Regional Medical Center whose business is called the Pump Station. ``I don't think our job is to force women to breast-feed. Women who want to breast-feed should be educated on the advantages.''

Although it's viewed as a stronger statement than in the past, the HHS Blueprint is hardly without precedent. The Surgeon General's office has held several workshops on breast-feeding in the past 15 years and has published reports recommending the practice. Three years ago, the American Academy of Pediatrics reworded its policy and recommendations on breast-feeding to make the language stronger.

``Government has been in the breast-feeding business as a public health measure for many years,'' said the University of Chicago's Gartner. ``This is not new.''

But government and medical agencies can only do so much. Education and support, Satcher's report says, must also come from pediatricians, medical schools, hospitals, employers and - whenever possible - family members. Education should lead to more supportive environments for breast-feeding, say activists, everything from company-designated ``mother's rooms'' at offices where working moms can pump in private to additional training of health-care staff on the basics of lactation and breast-feeding counseling.

Medical centers that strongly encourage breast-feeding sometimes have policies that require mothers and babies to ``room in'' together and are often flooded with posters and literature promoting the advantages of breast-feeding.

Candace Wollard Bivona, a graduate student who lives in Van Nuys, would have welcomed such a flood of information and assistance with her newborn son, Grant. Her pediatrician was not able to offer sound breast-feeding advice, she said. Instead, Bivona said, she was encouraged to ``top off'' her breast-feedings with formula.

``She really kind of led me in the wrong direction,'' said Bivona, who has since changed pediatricians. ``When I was clearly having a problem, she really didn't know how to help me and she didn't recommend I see a lactation consultant.''

Bivona sought out Petok for help, paying for her services as well as rental of a breast pump and a high-quality scale to chart Grant's weight gain. Her Blue Cross insurance plan did not cover these items.

``It cost me several hundred dollars,'' said Bivona. ``It raises the questions: Who has the luxury? Which children are going to get the benefits?''

Kaiser Permanente's Woodland Hills Medical Center is already reaching out to every mom and newborn there with its Great Starts program. Annette Broadhurst, a lactation specialist and coordinator of the program, said, in most cases, Great Starts means breast-feeding.

The facility is well ahead of the Surgeon General's goals, boasted Broadhurst. In addition to practices such as rooming in and having mother and baby together during their entire stay, moms and babies at Kaiser meet with Broadhurst at the Great Starts Clinic the day after they leave the hospital. As many as 10 mothers can be cycling through the clinic, working with a lactation consultant or discussing problems and concerns with other mothers. The facility also offers a 24-hour information hotline and various classes.

Before the Great Starts program started in 1996, breast-feeding assistance was limited to help from labor and delivery nurses immediately after delivery and some follow-up sessions in the postpartum unit. Kaiser's breast-feeding initiation success rate was low and new mothers were frequently visiting the emergency room for answers to their breast-feeding questions.

``We put the nurses and lactation consultants into this clinic, and now our statistics are showing that we have incredibly satisfied families and babies, and our pediatric staff is being used for medical problems,'' said Broadhurst, who says her facility has a 90 percent breast-feeding initiation rate and that 60 percent of mothers are still breast-feeding after the first two months.

Such programs - breast-feeding activists say - can help counter-balance the efforts of formula companies that give new mothers gift bags containing samples of instant formula.

``Most hospitals in this country have what I think are unethical agreements with the formula companies to distribute these discharge packs even when the mothers are breast-feeding,'' Huggins said. ``She may not always feel like things are going well, and she may remember that some nurse handed her a cute little bunny bag full of formula.'' But pressure on a new mother can be applied in both directions. Laura Coleman, a Web designer in Van Nuys, said she felt intense guilt when she was not able to breast-feed her son, Ryan. The problem, Coleman said, was an insufficient milk supply, not a lack of desire to breast-feed.

``I wanted everything to be perfect, and I spent a fortune trying to make it work out,'' said Coleman, who reports she is having better luck with her 3-month-old daughter, Lindsay. ``When it didn't work, I felt horrible. Here was my first test of motherhood and I failed it, and the reason I felt that way is because there's such an aggressive push to make women feel like breast-feeding is best.

``The breast-feeding community has to walk a fine line to encourage women to do it and to get women to understand the importance of it without making them feel too bad if they can't or don't.''

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) The healthiest choice

For baby's benefit, federal government encourages breast-feeding for that important first year

Tina Burch/Staff Photographer

(2) New mom Charmaine Hughes of Simi Valley nurses 2-week old daughter Alice at Kaiser Permanente's Woodland Hills Medical Center as part of the Great Starts breast-feeding program.

(3) Great Starts offers infant preparedness kits - complete with literature and tips - to guide mothers on how to breast feed.

Charlotte Schmid-Maybach/Staff Photographer

Box: The Breast-Feeding Challenge