Bot­tle or breast?

Calif. hos­pi­tals urge moms to fa­vor nurs­ing in­fants over for­mula feed­ing

The Republican Herald - - HEALTH - By aNNa GormaN

MON­TE­BELLO, Calif. — Wendy Wan, 31, said Amer­i­can in­fant for­mula is ad­ver­tised in her na­tive China as the most nu­tri­tious food for a new­born.

“It sounds like it’s pre­mium,” Wan, who gave birth in early May at Bev­erly Hospi­tal here, said.

Wan said she was skep­ti­cal of the ads and had planned to feed her baby son only breast milk. But when her milk failed to come in quickly, she didn’t hes­i­tate to sup­ple­ment it with for­mula.

“I pre­fer breast­feed­ing, but I think it’s al­most the same,” she said from her hospi­tal bed the day af­ter her son was born. It’s not the same. The Amer­i­can Academy of Pe­di­atrics rec­om­mends ex­clu­sive breast­feed­ing for the first six months of a baby’s life be­cause of the well­known health ben­e­fits for both in­fants and moth­ers. Women, like Wan, who start with the in­ten­tion of feed­ing their ba­bies ex­clu­sively breast milk but then sup­ple­ment it with for­mula while still in the hospi­tal are nearly three times more likely to stop breast­feed­ing within two months, ac­cord­ing to one study.

Cal­i­for­nia has made sig­nif­i­cant progress in re­cent years pro­mot­ing ex­clu­sive breast­feed­ing in hos­pi­tals, but many women aren’t stick­ing with it. All but a small frac­tion of women start breast­feed­ing while in the hospi­tal, but nearly one-third in­tro­duce their ba­bies to for­mula be­fore leav­ing, ac­cord­ing to data from the Cal­i­for­nia Depart­ment of Pub­lic Health.

And sig­nif­i­cant dis­par­i­ties — both eth­nic and so­cioe­co­nomic — per­sist. While women of color are ex­clu­sively breast­feed­ing their ba­bies more fre­quently than in the past, they still lag far be­hind whites: In 2016, nearly 82 per­cent of white moms gave their in­fants only breast milk in the hospi­tal, com­pared with 60 per­cent of black moms and 65 per­cent of Asian and Latina moms, ac­cord­ing to the depart­ment’s data. (Data for in­di­vid­ual race groups ex­clude per­sons of His­panic eth­nic­ity, who can be of any race.)

Wide gaps also sep­a­rate Cal­i­for­nia’s coun­ties and hos­pi­tals. Some fa­cil­i­ties re­ported ex­clu­sive breast­feed­ing rates of more than 90 per­cent and oth­ers less than 25 per­cent. Some of the hos­pi­tals with the low­est rates are in lower-in­come com­mu­ni­ties. The statewide av­er­age is 69 per­cent.

“Where you de­liver … and what race you are have a huge im­pact on breast­feed­ing,” Arissa Palmer, ex­ec­u­tive direc­tor of the non­profit ad­vo­cacy group Breast­feed LA, said. “Those are bar­ri­ers that we haven’t touched the sur­face on.”

In an ef­fort to di­min­ish the dis­par­i­ties and im­prove the health of ba­bies, state law re­quires hos­pi­tals to im­ple­ment con­crete mea­sures to pro­mote breast­feed­ing no later than 2025.

Re­search shows that breast­feed­ing ba­bies can re­duce their risk of obe­sity, di­a­betes and asthma. It can also lessen the chance of heart dis­ease and can­cer in moth­ers.

Na­tion­ally, non-His­panic black ba­bies are sig­nif­i­cantly less likely to breast­feed than non-His­panic whites or His­pan­ics, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion. Mis­sis­sippi, West Vir­ginia, Louisiana and Ar­kan­sas have the low­est breast­feed­ing rates in the U.S. Colorado, Ore­gon, Idaho and Wash­ing­ton have the high­est.

About 60 per­cent of women in the U.S. stop breast­feed­ing be­fore they had ini­tially in­tended to, the CDC said. Among the rea­sons: wor­ries about their in­fants’ weight, prob­lems with latch­ing, un­sup­port­ive poli­cies at work and lack of ed­u­ca­tion about the ben­e­fits of breast­feed­ing.

An­other fac­tor may be the un­in­tended con­se­quences of pa­tient sat­is­fac­tion scores, Car­men Rezak, ma­ter­nal-child health qual­ity co­or­di­na­tor for AHMC Health­care, a South­ern Cal­i­for­nia hospi­tal chain, said. Be­cause pa­tient rat­ings are tied to hospi­tal re­im­burse­ment, nurses are some­times afraid to deny pa­tients’ wishes. They may not want to tell rel­a­tives they can­not visit, for ex­am­ple, even if more pri­vacy and quiet time do en­cour­age breast­feed­ing, Rezak said.

The pub­li­ca­tion of statewide data on ex­clu­sive breast­feed­ing rates places “pres­sure on hos­pi­tals” to re­ally look at their poli­cies and prac­tices com­pared with their com­peti­tors, Jen Gold­bronn of the state’s pub­lic health depart­ment, said.

One of the best-known ways to in­crease rates of ex­clu­sive breast­feed­ing is by fol­low­ing the “Ten Steps to Suc­cess­ful Breast­feed­ing.” These in­clude help­ing moth­ers start nurs­ing within one hour of birth, not giv­ing for­mula to ba­bies un­less med­i­cally nec­es­sary and in­form­ing all preg­nant women about the ben­e­fits of breast­feed­ing.

The or­ga­ni­za­tion Baby-Friendly USA re­quires hos­pi­tals seek­ing its “baby-friendly” seal to fol­low the 10 steps. In Cal­i­for­nia, nearly 100 hos­pi­tals have that des­ig­na­tion, up from 12 in 2006. The state law re­quir­ing hos­pi­tals to have breast­feed­ing sup­port mea­sures in place by 2025 specif­i­cally names the 10 steps, but also al­lows hos­pi­tals to adopt al­ter­na­tive prac­tices proven to en­cour­age breast­feed­ing.

Tr­ish MacEn­roe, ex­ec­u­tive direc­tor of Baby-Friendly USA, said hos­pi­tals across the coun­try used to dis­cour­age breast­feed­ing in­ad­ver­tently by whisk­ing ba­bies away to nurs­eries. Now, new­borns typ­i­cally stay in the room with the mother and start nurs­ing im­me­di­ately af­ter birth. Urg­ing moms to hold their ba­bies “skin to skin” right af­ter birth helps en­cour­age breast­feed­ing be­cause of the phys­i­cal prox­im­ity, ac­cord­ing to re­search.


The Amer­i­can Academy of Pe­di­atrics rec­om­mends ex­clu­sive breast­feed­ing for the first six months of a baby’s life be­cause of the well-known health ben­e­fits for both in­fants and moth­ers.

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