Breastfeeding: Ounces of prevention
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CHARLESTON, W.Va. -- At 25 of West Virginia's 29 childbirth hospitals, when a mother goes home with her newborn baby, the hospital staff hands her a diaper bag full of baby formula -- even if she is breastfeeding.
"We hate that," said nurse Jamie Peden, breastfeeding consultant at Charleston Area Medical Center. "It turns the nursing staff into formula company marketing agents. It also makes mothers think the hospital is encouraging them to feed their babies formula when we're not."
Three years ago, to Peden's relief, CAMC quit giving breastfeeding mothers bags of formula. Instead, they launched a campaign to encourage breastfeeding.
They had reason to do so. Twenty years of research confirms that breastfeeding lowers children's risk of a long list of medical problems, from asthma, allergies and bronchitis to sudden infant death syndrome.
Babies who are breastfed are also less likely to be obese as children, research shows.
"We're in the middle of a childhood obesity epidemic, and we've got strong evidence that formula-fed babies are more likely to become obese children, at greater risk of a wide range of sicknesses and illnesses," said Dr. Jamie Jeffrey, director of CAMC's Children's Medicine Center. "Given that, it makes no sense to be giving nursing mothers bags of formula, does it?"
"It's like the hospital handing heart patients free Big Macs," said Christine Compton, West Virginia Breastfeeding Alliance director. "Or diabetics free doughnuts."
West Virginia has the nation's third-highest obesity rate and the nation's third-highest rate of formula-fed babies. "That's not a coincidence," Jeffrey said.
For decades, hospitals nationwide have given new mothers these bags, supplied by formula companies. "The hospitals sign contracts that say the company will give the hospital all the free formula it needs if the hospital will send every mother home with a bag of formula," Peden said. "It's been standard practice."
It's also been a lucrative practice. Mothers who take home free formula are more likely to give up breastfeeding, research shows. They are also more likely to feed their babies the brand in the gift bag.
Name-brand formula for one baby for a year costs about $2,000. Generic costs around $1,200.
Last year, the nation's largest formula company, Mead Johnson, manufacturer of Enfamil, had a 65 percent profit margin and took in $3.7 billion.
Early in 2012, the American Academy of Pediatrics reviewed 20 years of breastfeeding research and reported that, compared with formula-fed children, children who were breastfed are at significantly lower risk for:
If a mother breastfeeds, it lowers her risk of type 2 diabetes, ovarian and breast cancer and rheumatoid arthritis. Breastfeeding mothers suffer less postpartum depression and lose weight more quickly after delivery.
The American Medical Association and the Centers for Disease Control now urge mothers to breastfeed at least six months if they can. So do the American Academy of Pediatrics, the World Health Organization, and the dietician and obstetrician associations.
Breast milk contains antibodies, immunities and hormones no formula can duplicate, Jeffrey said. She speaks with passion.
"A few years back, we found that 49 percent of our 9-year-old patients were already obese, already at risk of diabetes and heart disease. So yes, I get worked up. Prevention starts with babies."
Boosting bonding, banning bags
More than 600 hospitals have joined a national "Ban the Bag" movement, including two West Virginia hospitals -- St. Mary's Medical Center in Huntington and City Hospital in Martinsburg. CAMC and Greenbrier Valley give bags to bottle-feeding mothers only.
Kanawha County's two birthing hospitals are making changes well beyond formula bags. Instead of whisking new babies away immediately, CAMC and Thomas Memorial Hospital both now bring new babies to their mothers as soon as possible after birth -- even after C-sections -- so they can bond skin-to-skin.
"Research shows skin-to-skin in that first hour makes a big difference in bonding and breastfeeding," said CAMC obstetrics director Denise Burgess.
Both hospitals now employ breastfeeding consultants for new mothers. Both train all nursery staff. "Our breastfeeding rate has gone up 10 percent since we started in July," Thomas obstetrics director Beth Hedrick said.
CAMC is constructing more private rooms so all babies can "room in" with mom and dad to cuddle and feed anytime. All Thomas rooms are already private.
Both hospitals aim to reduce their high rate of C-sections, which research says interferes with bonding and breastfeeding. About 53 percent of Thomas mothers have C-sections, compared with 43 percent at CAMC, 34 percent statewide and 30 percent nationwide.
"These changes will mean healthier children," said Nancy Tolliver, West Virginia Perinatal Partnership director.
Many doctors and nurses were trained "back when people assumed bottle-feeding and breastfeeding were equal options," she said. "It will take time to change directions."
'This is very much a fiscal issue'
Breastfeeding also saves families and governments money because it means fewer doctor and hospital visits and prescriptions, medical records show. In 1995, Kaiser Permanente found that babies who breastfed six months averaged $1,400 less in yearly insurance claims than formula-fed babies did.
State and local governments are noticing.
New York City has launched a citywide effort to encourage breastfeeding, complete with subway posters and TV ads. Mayor Michael Bloomberg convinced 27 hospitals to ditch the bags and require staff to sign out formula as they do medication.
It's a taxpayer issue, he says. According to a 2010 study in the American Academy of Pediatrics journal, Americans could save $13 billion a year in medical bills if 90 percent of babies were exclusively breastfed for six months.
It's also an emotional issue. Government cannot require women to breastfeed like they require a vaccine. Bottle-feeding supporters call Bloomberg a heavy-handed food nanny and say the city is interfering with personal, family decisions and making bottle-feeding mothers feel guilty.
Bloomberg points out that even the formula industry's website says, "Breastfeeding is the preferred and recommended method of infant feeding."
Child advocates cite health inequality. Seventy seven percent of higher-income women start out breastfeeding, compared with 54 percent of lower-income women. White women breastfeed far more than black women do.
According to CDC, low-income and black children have higher obesity and illness rates. About 60 percent of West Virginia's 20,000 new babies per year are born to women whose income is low enough to qualify for Medicaid.
The Trust for America's Health predicts that obesity-related diseases will cost West Virginia an extra $3.6 million by 2030 if the state cannot control the obesity rate.
"This is very much a fiscal issue," said Don Perdue, chairman of the state House Health and Human Resources Committee. "The sooner people see that, the better."
Numbers are improving
Nationwide, 77 percent of newborns now start out nursing, compared to 60 percent in 1979, according to CDC.
In West Virginia, the numbers are lower. Fifty-five percent now start out nursing. At 6 months, it's 28 percent, compared to 47 percent nationally. At one year, it's 15 percent for West Virginia, 26 percent nationwide.
Still, West Virginia's numbers are rising too. The 6-month and one-year percentages jumped 25 percent between 2007 and 2011.
The lowest breastfeeding rates are in the coalfields, which also have the highest obesity and chronic disease rates. Only 14 percent nurse after six months, according to WIC statistics. The highest are in central West Virginia: 29 percent.
CAMC delivers about 3,000 babies a year from all over the coalfields. "A fair number are very young or high risk mothers," CAMC's Burgess said. "Some have had no prenatal care."
"A lot don't see the difference between breastfeeding and bottle-feeding," she said, "but the time to be educated is not when they arrive at the hospital in labor. We need to reach them earlier."
"A lot of young mothers, when they come to us, think bottle-feeding and nursing are equal, that one's no better than the other," said Kay Groves, Summersville WIC office counselor. "Once they hear what breastfeeding can do, many say, 'I want that for my baby.'"
In 2010-11, CAMC asked 162 pregnant women about their choice. Mothers who bottle-fed their babies gave these reasons: lack of confidence that they could breastfeed; convenience; dislike of the idea of breastfeeding; work or school conflicts; past difficulty; a feeling that breastfeeding is not normal; lack of knowledge.
DHHR's highly praised Right from the Start program offers low-income moms help with breastfeeding and practical things they and their babies need. But the program is voluntary and has no advertising budget. Only 3,000 new moms enroll per year, out of about 12,000 who could.
Ultimately, "we need to make sure this is part of common knowledge, especially for teenagers," said Elkins pediatrician Mary Boyd, president of the West Virginia Academy of Pediatrics. "The only way I can see for that to happen is in the public schools."
The schools do not now routinely address the subject, Department of Education spokeswoman Liza Cordeiro said. There is no state public awareness campaign.
Meanwhile, health costs soar. Obesity-related chronic disease cost West Virginians $417 million in 2008, healthcare economist Ken Thorpe estimates. It will top $1 billion by 2018, he predicts.
Since 2007, the Legislature has funded training for about 180 breastfeeding specialists, "but many hospitals still have none," said Cinny Kittle, project director of the West Virginia Breastfeeding Alliance.
Starting in 2013, health care reform requires insurance plans to cover breastfeeding supplies and consultants. Businesses with more than 50 employees must give employees a clean place (not a bathroom) to pump.
The West Virginia Breastfeeding Alliance is conducting breastfeeding trainings for hospitals around the state. The state Bureau of Public Health funded an obesity/diabetes/breastfeeding conference in early 2012.
And most West Virginia hospitals are still sending new moms home with bags of formula.
"The encouraging thing is, people are starting to look at what's happening with babies, in relation to obesity and chronic disease," Jeffrey said. "We'll just keep moving forward."
Reach Kate Long at firstname.lastname@example.org or 304-343-1884.
"The Shape We're In" is a continuation of a project begun with the help of a Dennis A. Hunt Fund for Health Journalism fellowship, administered by the California Endowment Health Journalism Fellowships at the University of Southern California's Annenberg School for Communication and Journalism.