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Maryland seeks to improve support for mothers to breast-feed

Breast-feeding didn't come easy at first for Sharalyn Webre, who struggled through five months with her first child.

But with more experience, patience and family support, feedings were less complicated with her next two children, including a baby girl born last week at Greater Baltimore Medical Center.

Now, for the first time, Maryland health officials are pushing all hospitals in the state to create policies to smooth the process for even more new mothers like Webre. They say breast milk is better for a baby's health and too many mothers are switching to formula feedings.

Officials hope that improving support for breast-feeding inside and outside the hospital will not leave mothers to figure out it for themselves. Recommendations include requiring lactation nurses at hospitals, promoting exclusive breast-feeding and encouraging immediate bonding between baby and mother. The state also wants hospitals to stop giving out free formula samples that they say may entice mothers to give up on breast-feeding in a moment of desperation.

"For some moms and babies, breast-feeding is simply just not a natural thing," said Fran Phillips, deputy secretary for public health services for the Maryland Department of Health and Mental Hygiene, which led the work group that developed the recommendations. "They need coaching. They need support from trained staff."

About 78.5 percent of mothers in Maryland, and 74.6 percent nationwide, initiate breast-feeding, but many find it harder than public service announcements may make it seem. Babies don't always "latch" to the breast correctly, and some mothers don't always produce enough milk. Keeping up with a baby's constant feedings can be tiresome.

It's not uncommon for some mothers to become overwhelmed and give up on breast-feeding altogether. Others may start to supplement with formula, which health officials say isn't ideal. The Centers for Disease Control and Prevention, the American Academy of Pediatrics, the World Health Organization and others recommend that breast milk be fed exclusively to babies in the first six months and as a main source for the first full year.
While the state has made progress over the years in the number of mothers who initiate breast-feeding, that number dwindles as babies get older. In Maryland, only 45.2 percent of babies are still breast-feeding at six months.

Forty-year-old Webre said that when her first child was born eight years ago, she had trouble producing milk. The baby started losing weight and hospital nurses gave him formula as a supplement. The former child care provider, now a stay-at-home mom, believes that made it harder for him to breast-feed over the long run. When she got home, Webre said, she received little help around the house from her then-boyfriend, which made the time-consuming practice of breast-feeding hard.

Webre eventually married someone else, whom she calls more supportive. He is a strong believer in breast-feeding, so he helps around the house. When her second baby was born 20 months ago, she said, she felt less stress about breast-feeding.

"I had a lot more experience," she said. "I had a lot more know-how."

Webre gave birth to a third child last week and said that experience has also been much more pleasant.

"The antibodies they get from me are so much better than anything they will get from formula," Webre said. "Breast-feeding is an awesome thing to do, and I recommend other moms do it."

Scientific research has found that breast milk is the optimal food for babies, reducing the risk of infections and chronic diseases such as diabetes. Breast-feeding can also have health benefits for mothers, including lower rates of uterine and breast cancers. Even the formula makers say breast-feeding is the best choice and their products should be the alternative for women who can't.

Breast-feeding also has a positive economic impact: The CDC has found that low rates of breast-feeding add $2.2 billion a year to medical costs. The U.S. surgeon general has also made it a priority to increase breast-feeding across the country.

Many states such as Maryland are pursuing voluntary programs, while California and New York have policy mandates. Maryland's recommendations are based on 10 steps for successful breast-feeding created by The World Health Organization and UNICEF.

The Maryland Department of Health and Mental Hygiene thinks the best way to improve the breast-feeding experience, and get more mothers to start the practice, is at the hospital level where most babies are born. They appointed a work group of hospitals, doctors and health experts to draft a set of guidelines for which they are now seeking public comment.

The state is recommending that every hospital have at least one board-certified lactation consultant and establish education programs for mothers before and after pregnancy. Education should include showing mothers how to get babies to latch properly and how to position babies on the breast correctly.

The state also wants hospitals to encourage exclusive breast-feeding and skin-to-skin contact between baby and mother right after birth. That means delaying birth and weight measurements until an hour after the birth. If babies don't breast-feed right away, the state recommendations say, formula shouldn't be used as a supplement. Instead, mothers should be encouraged to pump and feed babies breast milk with syringes.

There also needs to be more support once mothers leave the hospital, the state recommendations say. It is often at home, where mothers don't have a nurse helping them along, that they may be tempted to give a baby formula when breast-feeding becomes difficult.

To cut down on this temptation, the state recommendations are asking that hospitals voluntarily stop giving out coupons and free samples of formula in goody bags mothers get when they leave the hospital.

A representative with the formula industry disagreed with the assumption and said formula is not what causes mothers to stop breast-feeding.

Candice Gulden, a spokeswoman for the International Formula Council, said societal pressures and lack of work support are what stop mothers from breast-feeding. She points out that breast-feeding rates are going up even as the samples are given out.

"We think giving out a sample is educational and no one is saying you have to give this to your baby," Gulden said.

Gulden said there also needs to be support for mothers who try breast-feeding and determine it's not right for them, or for those who can't breast-feed for medical reasons. Those women should not be left out in the breast-feeding debate, she said.

"Breast-feeding and formula are both good options," Gulden said. "Breast-feeding is certainly preferred, but a good nutritional alternative is infant formula."

Some Maryland hospitals are already looking to ban the free samples.

"We are actively evaluating the free samples," said Henry J. Sobel, department chair of women's and children's services at Anne Arundel Medical Center. "We haven't made the final decision yet, but there is a lot of support for doing it."

Sobel said the hospital mostly agrees with the state's recommendations and already has several programs in place, including prenatal feeding classes run by lactation consultants and a "warm line" — a nurturing sort of hot line — that mothers can call if they are having problems once they get home.

"We are supportive of the initiative but think there just has to be care that there is flexibility," Sobel said. "The benefits of breast-feeding are undeniable. It's just a matter of going about it the right way. But at the same time we want to make sure parents are making the right choice for themselves."

Greater Baltimore Medical Center is also looking to stop giving out samples.

"It's like we're saying we think it's all right, and we don't want to give that impression," said Marla Newmark, GBMC's lactation coordinator. The hospital has lactation programs in which mothers who breast-feed are seen by a specialist every day in the hospital after giving birth. There are also classes and a warm line.

Most Maryland hospitals are practicing some or much of what the state is recommending, but Phillips said there is much room for improvement.

"I don't know any hospital that meets all the criteria," Phillips said. "Some meet some of them and some is better than none at all. But we can do better."

Mercy Medical Center in Baltimore trains all the nurses who work with mothers about breast-feeding and offers support groups. Mercy's lactation consultants visit physician offices to make sure their message is being passed on during women's doctor's appointments. Nurses also call mothers two weeks, six weeks and six months after they give birth to talk about breast-feeding.

"We want to give them support, and we want to encourage them," said Michele Schwarzmann, Mercy's director of maternal child health. "The literature has shown women are successful at breast-feeding when they have support."

Jasmine Wilson, 21, gave birth to a baby boy last week at Mercy. She had read about the benefits of breast-feeding and her doctor also told her about them. Fortunately, she was one of the lucky ones who didn't have initial problems.

"He latched on right away," she said.

Source: By Andrea K. Walker, The Baltimore Sun

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