The American Association of Pediatrics recommends exclusive breastfeeding for at least six months, and continuing breastfeeding for at least one year. The World Health Organization recommends breastfeeding for two years, or as long as both mother and child wish to continue. Eight-five percent of women plan on breastfeeding for at least three months. Nearly 80 percent of women initiate breastfeeding. Of that original eighty-five percent, only 32 percent (one-third) meet their breastfeeding goals. About 40 percent of American women are still breastfeeding at three months, and only eighteen percent are still exclusively breastfeeding at six months.
I'm a breastfeeding advocate because of the discrepancy between the percentage of women who wish to breastfeed and the percentage of women who meet their goal of at least three months. Some of these women may discover after birth that breastfeeding is not the right choice for their family. They don't need a breastfeeding advocate (they may need a formula advocate!).
However, the women mentioned above do not make up the full two-thirds of women who do not meet their breastfeeding goals. Why else might women not succeed?
1. Access to breastfeeding support
Breastfeeding might be natural, but it's not always easy for mother or baby. The dyad may need support for a variety of reasons. This assistance may come from peer-to-peer support, such as La Leche League Meetings, lactation counselors, or Internationally Board Certified Lactation Consultants (IBCLCs). However, there are less than eight support people (in all three categories) per 1,000 live births. In other words, each support professional would need to provide support for up to 125 people for all women to have support. And that's the national average. In some states, there are even fewer support systems in place. Between one and five percent of women have the inability to produce milk. For other women, supportive volunteers and professionals may be able to find the reason for insufficient supply and solve the problem if the mother wishes to do so. I have talked to women who were unable to breastfeed and felt that it was due to insufficient support.
2. Maternity Leave Policies
Half of new mothers say that their employment situation affects their feeding decisions. Women who return to work after less than six weeks of maternity leave are more than three times as likely to stop breastfeeding than women who take longer. And each additional week of maternity boosts breastfeeding duration by an average of half a week. The majority of women who quit breastfeeding after returning to work quit within the first month of returning to work. Despite national laws regarding pumping breaks, many women are unable to pump on the job. In addition, only seven states have laws supportive of on-site breastfeeding in childcare settings. By the end of baby's first year, only ten percent of mothers who work full time outside of the home are still breastfeeding.
3. Hospital Policies
The controversial Baby-Friendly initiative promotes hospital practices that support breastfeeding. However, many hospitals still have work to do to support breastfeeding mothers. Although I fully believe that mothers should have guilt-free access to formula if they want/need it, the practice of routinely giving out formula may effect breastfeeding outcomes. Some women need to be able to send their babies to the nursery, but rooming-in does promote feeding on demand, which is important to establish supply in the first day's of baby's life. I believe that hospital arrangements should be flexible, but they also need to be set up in ways that promote a successful start to breastfeeding for those eighty-five percent of women who wish to initiate.
Outdated information has persisted, making women think that they need to breastfeed their newborns on a schedule, introduce rice cereal at four months, and start sleep training early. Nighttime sleep training can be detrimental to the breastfeeding relationship, which is a supply and demand relationship. Although some medications are definitely unsafe for breastfeeding mothers, in some cases alternative medications may be an option. Flat or inverted nipples do not make breastfeeding impossible. Some misinformation can come from health professionals. Growth charts based on formula-fed babies may show a concerning trend for breastfed babies, while an adjusted chart shows that baby is doing just fine. Some women think they need to stop nursing when baby gets teeth (for my babies, that would have meant weaning at four months).
5. Personal Interactions
Although many mothers feel guilt (or have experienced public shaming) for formula feeding, breastfeeding mothers often experience conflict with others. Sometimes it's as benign as well-intentioned family members wanting to give a bottle before the breastfeeding relationship is established. There may be pressure for a mother to go to another room to feed her baby. A pediatrician told me to limit the number of feedings for my breastfed baby. A friend was asked to leave a public location because she was nursing, even with a cover. A stranger told me that breastfeeding in public wasn't safe for my baby (still not sure the logic behind that one). Nursing in a bathroom or in a car, or pumping a bottle and having to keep it cold, are not good options.
I want to make sure that women feel empowered to feed their babies in the way that is right for them and their baby. If you have support, and breastfeeding isn't working for you, you can make the decision to move ahead with formula. If you know from the beginning that you don't want to breastfeed, you have the power to make that decision. Returning to work may make continuing your breastfeeding relationship too difficult so you turn to formula. You have my support (but I'd like to see your workplace change!). I want you to have the right information to make your decision (although I won't assume that you don't already have good information). And I want people to understand how they can be supportive of you, no matter how you feed your baby.