Breastfeeding: One family at a time
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SOUTH CHARLESTON, W.Va. -- Ready to go home with her new baby, Vanessa Walker was still making up her mind. "I'm thinking I'll bottle-feed in the day and breastfeed at night," she said.
Obstetrician Dr. Kiran Patel strolled into her Thomas Memorial room. "Want to hear what I have to say about that?" he asked.
"Sure!" Walker said. "You're my doctor. I love you." Two days earlier, he delivered her baby.
"For the next six months," Patel said, "the best one thing you can do is to feed your baby nothing but your own milk." She nodded and raised her eyebrows. "If you do, you'll give yourself and your baby a great gift," he said, smiling.
"Breastfeeding gives your baby lots of immunities, but let's look about what it can do for you," he said. "It lowers your risk of breast cancer and ovarian cancer... And makes it easier for you to lose weight you gained during pregnancy..."
His little speech took maybe three minutes. He slipped in the fact that nursing the baby lowers a child's risk of obesity, pneumonia, diarrhea, allergies, stomach problems, diabetes, asthma, sudden infant death syndrome, etc. "You'd spend a lot less time at the pediatrician's office or the hospital," he said. "Fewer doctor bills."
"You're making me think," Walker said.
"And it's free," he said, shrugging.
Breastfeeding consultant Jenny Morris was leaning against the wall. "I promise you, I didn't pay him to say any of that," she said. Everyone laughed. Patel and Walker hugged.
"If more doctors would talk straight like that, it would make a huge difference," Morris said, walking down the hall. "Especially if they'd do it before the baby's born. Of course, the way I see it, some breastfeeding is better than none."
'Mothers often aren't sure what to do'
Jenny Morris has a job most people don't know exists. She helps one mother at a time get the hang of breastfeeding, raising West Virginia's low breastfeeding rates one baby at a time.
She is a certified lactation consultant, employed by the Women Infant and Children's program. She is available to WIC mothers 24/7. "It's a crazy job," she said. "About 4,000 mommies have my cell phone number."
Her services could go for $100 an hour on the private market. At Thomas Memorial, and CAMC Women and Children's Hospital, they are free.
She's been at it 14 years. Certain facts keep her going:
The American Medical Association and an array of medical associations -- even the formula industry -- now recommend mothers breastfeed only for six months at least.
"But young mothers pay more attention to their doctor, grandma or friends than they do to the AMA," Morris said.
Each week, she visits breastfeeding moms at CAMC and Thomas Memorial to help them resolve dilemmas that might make them quit.
Contrary to popular myth, "mothers often aren't sure what to do," she said. The first few weeks, a lot give up if someone doesn't help, she said. "There are lots of tricks to it."
She doesn't try to change the minds of women who have decided to bottle-feed. "I concentrate on mothers who say they want to breastfeed or aren't sure."
If a breastfeeding mom is in pain after a C-section or if the baby won't latch, Morris helps shift the baby around to find positions that work. If a mom worries because she doesn't have much milk at first, Morris reassures her that's normal. "You'll have more milk in a few days after your baby's stomach grows," she says. "The more you nurse, the faster it comes in."
Only 55 percent of West Virginia moms now start off breastfeeding, compared to 77 percent nationally. Only 20 percent make it to six months, compared with 47 percent nationally.
"The numbers are growing," Morris says. Nine years ago, it was only one in six. Now it's one in five. "We're talking about changing a culture, not exactly easy," she said.
Ten other southeastern states also have low numbers, the same states that have the highest obesity and chronic disease rates.
Bottle-feeding has been entrenched since the 1940s, Morris said, "thanks in part to advertising by the formula industry." People have the idea that if you breastfeed, you're saying you're too poor to buy formula, she said. "Then there's the fact that breasts are seen as sexual."
About 5 percent of moms can't breastfeed for medical reasons, and "drug-addicted moms should not," she said. "Otherwise, it's nature's gift, stronger than a lot of vaccines."
Higher-income and more-educated moms are more likely to breastfeed, she noted. They're more likely to have jobs that let them pump their milk on the job. "A lot of WIC moms are working moms with low salaries," she said. "Their babies deserve these immunities too."
'Hang in there'
On a recent September day, the first baby Morris visited was fussing, refusing to feed. She suggested the parents turn out the overhead light. The baby quit fussing and showed interest in eating.
In another room, a mom said her baby sometimes wouldn't latch. Morris gently helped her hold her baby less tightly so he could swallow easily. "Try again after he settles down," she said. "Let him lie skin-to-skin. It will calm him and stimulate your milk.
"Each baby's different," she said. "It may be frustrating and exhausting till you establish a routine. Hang in. It will be worth it."
A grandmotherly cheerleader, Morris encourages at least six months of mom's milk only, but supports whatever the mother decides to do. "The first weeks are toughest," she keeps saying. "At first, a baby's stomach only holds a teaspoon and a half, so he'll eat often," she says. "Hold your ground if Grandma's standing there with a two-ounce bottle of formula, saying, 'That baby's starving! He shouldn't eat that often! Feed him this bottle!'
"Bottle-fed babies' stomachs can be stretched," she tells mothers. "The person holding the bottle decides how much the baby takes in. Breast-fed babies quit when they've had enough."
One study found the average bottle-fed baby takes in 30,000 more calories than a breastfed baby by eight months. "We're talking about the beginning of obesity," Morris said.
In almost every room, she talks about colostrum. Moms produce it the first few days. "It's very concentrated milk, full of nutrients and antibodies," she said.
A baby's gut is immature at birth, full of little holes, she says. "The colostrum acts like primer. It seals the gut, and transfers immunities to the baby. You want your baby to have it, even if you have to spoon or syringe it in."
"Sometimes you'll only produce a few drops at first," she said. "That's normal."
"Really?" one mom said. "I thought something was wrong with me."
Morris breastfed her three children. "My first two were easy, but the third taught me how hard it can be at first. But none has ever been sick much, so it worked."
On her way out, Morris stopped by Beth Hedrick's office. The obstetrics director had good news. In July, Thomas started training nursing staff in ways to promote breastfeeding. The hospital's breastfeeding rate went 10 percent in a month. "It's working," she said.
Thomas has one coach on staff. "I'd like another," she said.
Dr. Patel came strolling down the hall. "That talk takes three minutes," he said, "but if the mother decides to breastfeed, it's lifelong benefits for the child." Morris smiled broadly.
Before she left, she checked in with a mom whose baby hadn't been latching. The baby was nursing comfortably.
Reach Kate Long at firstname.lastname@example.org or 304-348-1798.
"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.