There is agreement among public health professionals that breastfeeding is best—it has health benefits for both mother and child and is obviously the most economical way to feed an infant. So it makes sense that doctors, hospitals, and other health experts would go to great lengths to encourage mothers to give it their b
e st shot. But how far is too far? At what point do efforts to promote breastfeeding alienate those women who can’t or simply don’t?
The British media is abuzz with this question as news emerges that a new pilot program will pay moms in two low-income areas to breastfeed. The moms will get £120 (about $193) in store vouchers if they exclusively breastfeed for the first six weeks of their baby’s life and an additional £80 (about $129) if they do so for six months. If the program is successful, it might be replicated across the United Kingdom, which has one of the lowest breastfeeding rates in all of Europe. The researchers say they are trying to increase awareness and cultural norms in an area where many women don’t consider breastfeeding.
Dr. Clare Relton of the University of Sheffield’s School of Health and Related Research, which is running the pilot, explained, “Breast milk is perfectly designed for babies and provides all they need for the first six months of their life. Offering financial incentives for mothers to breastfeed might increase the numbers of babies being breastfed, and complement on-going support for breastfeeding provided by the NHS [National Health Service], local authorities and charities.”
Others, however, say that money is not the right motivation, and incentives alone will not really help those women who want to breastfeed but have trouble. I also wonder about the message this sends to mothers (and fathers) who, for whatever reason, end up bottle-feeding infants.
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The first time I nursed a baby was at about 3:00 a.m. on July 18, 2006. I had given birth just before 4:00 the previous afternoon, and had held the baby for a few minutes before they took her to the nursery to check her breathing. A mix-up with my blood work meant I was in the delivery room for nine more hours before finally making it
to my own room . I ate for the first time in well over 24 hours and fell asleep exhausted for less than two hours before a very loud and bossy nurse’s assistant wheeled the clear bassinet into the room, turned on the fluorescent lights, and handed me my tiny baby. She told me I could lay the baby across my chest or hold her like a football. Then she shoved her at my right breast, told me the light had to stay on when the baby was in the room, which meant no more sleep for me, and left. My brand new daughter seemed to latch on to my nipple, as evidenced by the pain, but I had no idea if I was doing it right or if anything was coming out.
The next two weeks were tough. I had an early and painful bout of mastitis with a fever of 101.5. The pain in my nipples was so intense that I used to bang my head against the wall (gently) to try and distract myself for the mandated 15 minutes of nursing. The football hold remained a mystery to me. But eventually we got in a groove. A friend taught me how to nurse while lying on my side, which was a lifesaver since I was almost too tired to sit up. Another friend told me about Lansinoh ointment and ice packs that slipped into your bra. I filled the DVR with good entertainment for the middle of the night. And I found that I really liked nursing and snuggling with the top of my baby’s head.
Then I went back to work, and my breasts and I were no longer available 24/7. My attempts to pump yielded just a few ounces at a time; in a whole day, I could barely pump one full feeding’s worth of milk. I felt like a failure. I had friends who could pump ten ounces in that many minutes and had a freezer full of extra milk. One day, after pumping in my office for 20 minutes and
producing maybe three ounces, I stood up while still tangled in the plastic tubing and knocked over the bottle. I literally cried over spilled milk.
After a few weepy weeks, I let myself off the hook and gave up pumping. The baby was already getting some formula because of my limited ability to pump, and she was fine. We nursed in the morning when she woke up. She got bottles all day long, and then we nursed when
I returned home at dinner time and again before bed. As I added fruits, veggies, meats, and Cheerios to her diet, we dropped first the dinnertime nursing, then the morning nursing, and finally the bedtime nursing. I was sad when it ended but felt we’d had a pretty good run.
The sense of failure, however, hit me harder and faster when her sister came along four years later. She and I never quite hit the nursing groove. For one thing, there was always some pain in my left breast no matter what we did. I discussed it with my OB-GYN, her pediatrician, and a lactation consultant, and no one could figure it out or fix it. (I will add that all of them were pretty dismissive, and the lactation consultant all but declared me an unfit mother when I admitted to having given the baby some formula.) For another thing, this baby was hungry, and my breasts could not keep up. The first time she finished nursing and was clearly still hungry, I cried. But then I mixed her a bottle of formula, held her in my arms and watched her eat without feeling any pain in my left breast. I relaxed, let myself off the hook, and we settled into a rhythm that included both breast and bottle feedings.
Long story short, despite my best intentions to nurse exclusively for as long as possible, I would not have earned any gift cards under the new UK program.
I’m not sure how the researchers are planning on verifying that women nursed exclusively for the first six weeks or the first six months, but it is very likely that some of the women who enroll in the study will, like me, fail to meet the program’s criteria. While losing out on the shopping vouchers may be disappointing, feeling like you’re failing at motherhood so soon could be devastating. That makes me sad for them.
What makes me angry, however, are other programs designed to increase breastfeeding by making it harder for women to access formula. In September 2012, New York City Mayor Michael Bloomberg announced that many of the Big Apple’s hospitals would limit how much formula they hand out to new moms. As part of the program, Latch On NYC, hospitals are encouraging breastfeeding and discouraging formula feeding by making bottles of formula harder to find on the maternity ward, tracking those that are handed out, and informing the women who ask for them about the benefits of breastfeeding. While previous generations of moms left the hospital with bags of free formula samples, 27 of the city’s 40 hospitals agreed to stop handing these out.
Though not quite as draconian as the NYC system
, the American Academy of Pediatrics also has a policy stating that in an effort to encourage breastfeeding, pediatricians should also “not provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.” I understand withholding the company literature out of fear that it might be too persuasive, but the rest of that swag can really come in handy, especially to parents on a budget.
Formula is extremely expensive. The powdered kind costs just over a dollar an ounce, even on the discount website Diapers.com, and the ready-to-use bottles are more. Though breastfeeding is not exactly free—many nursing moms in this country invest quite a bit in accoutrement, like bras that flip down, pillows that position the baby, and pads that prevent shirts from getting wet—these expenses cannot compare to paying for the 20-something ounces of formula the average four-month-old can down in a day. The financial incentive to breastfeed are already there, and taking away those freebies and coupons from bottle-feeding parents isn’t going to swing their decision, but it might make their life harder.
Of course, it could be worse: Bottle-feeding parents could have no bottles. A plan one Venezuelan lawmaker proposed would outlaw bottle feeding (seemingly by banning the bottles themselves). Legislator Odalis Monzon, a member of the ruling Socialist Party, introduced the legislation last summer and explained on state television, “We want to increase the love (between mother and child) because this has been lost as a result of these transnational companies selling formula.”
Venezuela already encourages breastfeeding; it passed the “Law for the Promotion and Support for Breast-Feeding” in 2007. That law, however, has no teeth, so to speak, as it does not impose any sanctions for bottle-feeding. It is not clear what sanctions the new bottle-banning law would impose, nor is it clear at what age mothers would be allowed to use bottles—even babies who are exclusively nursed for the first year often transition to bottles before they move on to drinking out of cups. The law does make exceptions in cases where the mother has died, as well as when a woman has limited breast milk production, “as determined by the health ministry.”
Now there’s an image: To buy a baby bottle or formula, you would need to show the cashier either a death certificate or a breastfeeding report card with a giant “F” on it.
Encouraging women to breastfeed either by giving them incentives or by making formula feeding more difficult runs the risk of alienating women who have trouble nursing. And it turns out that’s most women. In one study, published in the Journal of Pediatrics in September, 92 percent of new mothers said they were having trouble nursing two days after birth. Many said they were having trouble getting the baby to latch, others were in pain, and some said they were not producing enough milk. About 21 percent of these mothers had given up nursing entirely by the second month, and 47 percent had added some formula feeding. Interestingly, all but one mom in the 8 percent who were not having trouble as of day two were still nursing at six months.
This suggests that if we want to help mothers nurse longer, we have to help them figure out how to do it without pain and stress. Lactation consultants can help—as long as they refrain from giving the nasty lectures I got—as can breastfeeding support groups. The Affordable Care Act is also helping by requiring new insurance plans to cover lactation consultants and breast pumps, which can run between $200 and $400, and by mandating that some employers provide (unpaid) breaks for women to pump as well as areas for them to do so other than the restroom.
The best way to support breastfeeding moms, however, is to support breastfeeding moms:
Acknowledge it is not always easy. Sympathize. Empathize. Encourage. Promise it gets better for most people. Make helpful, not critical, suggestions. Teach them new positions. Find them good nipple salves. And then let them off the hook if need be, because it is hard for new mothers to let themselves off the hook.