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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."