Women & breastfeeding.

When Amber McCracken, 32, had her first child three years ago, she was all set to breastfeed. She figured it was a perfectly natural process that would come easily. Instead, she had such a terrible time with it that she gave up before her daughter was six weeks old.

"Because I couldn't provide my first child with the important nourishment of breast milk, I felt like a failure as a mom even before I left the hospital," she notes. What so many women don't realize, Ms. McCracken now knows, is that breastfeeding must be learned--by both mother and child.

Nonetheless, American women are getting better at breastfeeding. A 2001 survey found that nearly 70 percent of babies are breastfed in the hospital; about 46 percent exclusively breastfed. Six months later, 33 percent of babies were still breastfed, 17 percent receiving breast milk only.

Those figures, part of the Ross Mothers Laboratory Survey (RMLS), which has been tracking breastfeeding in the U.S. since 1954, represent a record high, say researchers. Even better--groups that were historically less likely to breastfeed, such as women who are African-American, younger and those with only a high school education, also showed significant increases. (19)

But it's taken a lot of work to get there, the RMLS researchers note. They attribute increases to programs such as the peer counseling programs that target low-income women, and the Baby-Friendly Hospital Initiative, a joint effort by UNICEF and the World Health Organization. Hospitals in the initiative agree not to accept free or low-cost breast milk substitutes, feeding bottles or nipples, and implement 10 specific steps to support successful breastfeeding.

What these and other programs like them show, says Michelle Collins, CNM, a certified nurse midwife at Vanderbilt University in Nashville, TN, is that there's a lot of preparation to breastfeeding. "It's not as simple as putting the baby on the breast, and it goes smoothly from there."

She also notes that while the 70 percent figure nationwide looks good, the figures differ dramatically throughout the country. In southern Illinois where she used to live, for instance, barely one in three new mothers tried nursing and half quit by six weeks.

"It's a cultural thing," she says. "If your mom didn't breastfeed you, you probably won't breastfeed your baby, because your mother may not be as supportive of you nursing." Having a support system--whether your family, husband or friends--is also critical, she says.

Just as important is learning how to breastfeed. That involves everything from how to hold the baby and how often to feed the baby, to how to tell if the baby is getting enough milk (hint: wet diapers and weight gain). It also means being prepared for problems, like breast infections or sore nipples. In fact, the most common reasons for stopping breastfeeding are sore nipples, not having enough milk, problems with the baby nursing or feeling that the baby wasn't getting enough to eat. (20)

All those problems can be addressed by a certified lactation consultant, which most maternity wards and some pediatric groups have, notes Ms. Collins. "And expect that it's a learning process," she says. "It may take a good two weeks before you feel comfortable."

Ms. McCracken knows that now. "I was so disappointed to miss out on one of the first opportunities to bond with my baby," she says of her first pregnancy. She's pregnant again, however, and hopes now that she knows more about breastfeeding her attempts to nurse will be successful. "I'm hopeful I have that chance again."

Resources

International Lactation Consultant Association

919-861-5577

www.ilca.org

Provides database of lactation consultants by zip code who provide breastfeeding support and information.

La Leche League

847-519-7730

www.lalecheleague.org

Provides breastfeeding support and educational materials.

National Association for Postpartum Care Services

1-800-453-6852

www.napcs.org

Offers national database of contacts to assist with practical responsibilities and personal needs of families during the post-delivery period.

References

19 Ryan AS, Wenjun Z. Acosta A. Breastfeeding continues to increase into the new millennium. Pediatrics. 2002 Dec;110(6):1103-9.

20 Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics. 2005 Dec;116(6):1408-12.