The health and cost saving benefits of breastfeeding are so widely known that nearly 80 percent of pregnant American women enter hospitals to give birth intending to breastfeed their newborns. Despite this intent, numbers trickle off to less than a quarter of this number breastfeeding just six months later.
It’s common to blame short maternity leaves, workplace constraints and lack of community support for this decline. Just last week, a Pennsylvania woman filed a lawsuit against her employer alleging that the glass manufacturer harassed her and impeded her legal right to express milk for her infant at work. (As of press time, the employer had not filed a response in court.) But while mothers turn away from breastfeeding for many reasons, the problem actually starts in hospitals.
The vast majority of hospital staff members can’t provide the education about how to breastfeed just after birth that so many women want, so instead women receive conflicting advice or none at all. While almost all hospitals receive complimentary formula from large companies to give to new mothers, by contrast, few of them educate nurses or physicians on coaching new mothers to put baby to breast.
This lack of training can prevent women from breastfeeding altogether. Almost three-quarters of mothers are separated from their infants in the hospital immediately after birth—especially if the babies are born at night—often on the advice of healthcare professionals, for no medical reason. These practices can discourage milk supply, and without any actual breast milk, breastfeeding is no longer a choice. Without frequent suckling early on, a mother’s milk is less likely to come in because certain hormones just won’t kick in.
The reason why hospital workers don’t share such crucial details with new mothers is that they are not educated to do so, and often they are too busy with other patients to properly inform new mothers about the nuances of breastfeeding. For overworked and stressed providers, it’s easier to suggest bottles and separation in a nearby nursery, and to defer to a next-day “lactation consult,” than it is to explain how lactation works and how to achieve optimal results. Exhausted and unsupported with a screaming newborn, bottles and placement of the baby in a nursery overnight are welcome solutions for confused new mothers, but solutions that are inferior to the breast.
When hospital workers don’t properly inform women about the natural course of breastfeeding, the benefits can be obscured, and misconceptions about a baby’s health can occur. Many mothers don’t know that the minimal milk initially produced is incredibly protective, containing colostrum that lines the newborn’s gut and provides a barrier to infection. Breastfed babies lose a little weight initially waiting for mother’s milk to come in, but this safeguards against obesity later in life. Conversely, newborns given unlimited formula will receive up to eight times the amount of food breastfed infants get, increasing their odds of obesity later in life by nearly 30 percent per 100 grams of weight gained in those early days.
There are some valid medical reasons to supplement breast milk with formula immediately after birth. For mothers with certain infections, on medications, or who are simply not well, separation and alternate feeding are medically necessary for a baby’s survival. For infants born prematurely, to diabetic mothers, or in distress, exclusively breastfeeding may not be practical and may pose dangerous risks including hypoglycemia and jaundice.
To be sure, not all women want to breastfeed. The public health benefit of breastfeeding must be carefully weighed with an individual woman’s personal choice to formula feed, for any reason. There are also very real challenges all people in the workplace face when women need to leave periodically to express milk. But the conversation to tackle these obstacles can’t occur if hospitals don’t start by providing accurate and consistent information to women in the early hours and days after birth, when breastfeeding patterns are set.
A movement of patient empowerment has spurred many pregnant women to educate themselves before they deliver so they are better able to advocate for best practices in hospitals. Others distrust hospitals and opt out of hospital delivery all together—home births in the United States have increased by nearly 30 percent in recent years according to the Centers for Disease Control and Prevention.
Hospitals must improve their care of women by encouraging proper breastfeeding practices immediately after birth. This is the clearest way to increase breastfeeding outcomes months and years into babies’ lives. A fine rubric can be found in the World Health Organization’s Baby Friendly Hospital Initiative, which has improved delivery safety while supporting breastfeeding for 23 years. Worldwide, 20,000 hospitals have adopted these standards, which include extensively educating parents long before birth, training all hospital staff involved in maternity care, minimizing formula use, eliminating hospitals’ formula subsidies and establishing support groups for breastfeeding mothers.
In the United States, despite enormous strides promoting the why of breastfeeding, health care providers are failing to teach the how. Though virtually every American health care organization including the American Academy of Pediatrics, the White House Task Force on Obesity and the CDC have issued recent statements encouraging hospitals to support breastfeeding, only 169 U.S. hospitals comply with the WHO strategy for optimizing success. All hospitals need to train their workers on the physiology of lactation as part of routine post-partum care and Public Health Agencies also need to hold hospitals accountable for their infant feeding policies. Only then will breastfeeding rates and practices improve.
Malika Shah is the Medical Director at the Prentice Newborn Nursery, Northwestern Memorial Hospital; Attending Neonatologist at the Ann & Robert H. Lurie Children’s Hospital of Chicago; and an Assistant Professor at the Northwestern University Feinberg School of Medicine.