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 World Breastfeeding Week August 1-7 Most everyone has heard the slogan "breast is best, " touting the nutritional benefits of human milk for young children. The American Academy of Pediatrics recommends breastfeeding for at least one year, while the World Health Organization suggests nursing for two years to receive maximum health benefits for both mother and baby. Through World Breastfeeding Week, advocacy groups and government organizations around the globe have an opportunity to highlight another side of breastfeeding -- its economic value. This year, the 120 countries participating in the week of breastfeeding education and promotion focus on the financial benefits of nursing, as well as the cost of not breastfeeding. Breastfeeding offers significant economic advantages to individual families, businesses, and the society at-large. A multi-billion dollar industry, formula costs a family an average of $1,000 per child annually. If formula were the optimum nutrition for an infant, it would be well worth the expense. But, in fact, quite the opposite is true. Research consistently demonstrates that breastfed children are healthier and incur fewer health care costs. The International Journal of Gynecology and Obstetrics estimates that $2 billion could be saved on health care annually in the United States if all women breastfed their infants for just 12 weeks. Janice M. Riordan, Associate Professor at the Wichita State School of Nursing found that there are tremendous potential health care savings from breastfeeding. Analyzing the effect of breatsfeeding on just four diagnoses, her study estimated that breastfeeding would save $1.3 billion in health care. Kaiser Permanente, one of the country's largest Health Maintenance Organizations, recently conducted research to determine the value of providing lactation support to their members and found that increasing breatfeeding rates would yield impressive returns. Their study concluded that infants who were breastfed for a minimum of six months experienced an average of $1,435 less in health care claims than formula fed infants. Though most studies focus on the health advantages to babies, breastfeeding also offers long-term benefits that save countless public and private health care dollars. Recent search suggests that adults who were breastfed as children show lower rates of insulin-dependent diabetes, heart disease, stroke, ulcerative colitis, Crohn's disease, and osteoporosis. Mothers who breastfeed their children suffer fewer incidents of pre-menopausal breast cancer, ovarian cancer, and osteoporosis. As a society, we are morally compelled to find ways to prevent these serious conditions. The fact that money is saved in the process is an added bonus. Promoting breastfeeding is a wise investment for families and health care providers, but it also makes economic sense for employers and the community at-large. Companies benefit from less staff turnover, less absenteeism, improved worker productivity, and increased worker loyalty. If the New Mothers' Breastfeeding Promotion and Protection Act (H.R. 3531) is signed into law, employers will receive a tax benefit for setting up lactation stations so working mothers can pump breast milk and take unpaid breaks to do so. Even folks who don't have children indirectly benefit from increased breastfeeding rates. Healthier babies means lower insurance premiums for everyone. And we all pay a price to clean up the environmental waste created by formula feeding. The manufacturing of formula uses fossil fuels; packaging creates excess trash; additionally, the production and daily cleaning of bottles pollutes our environment. In California, 74% percent of new mothers say they plan on breastfeeding at the time of hospital discharge. Nine weeks later, only 17% are still nursing. Some mothers cease breastfeeding when they return to work, but many more quit because breastfeeding can be more difficult and exasperating than they'd ever imagined. Mothers who have challenges with breastfeeding, and do not access the resources available, will almost always stop. The state has done a good job promoting breastfeeding as the optimum source of nutrition for babies, but is lagging in effective ways to support new mothers. Educating mothers about the benefits of breastfeeding without equal emphasis on helping them succeed gives mothers little more than frustration and guilt. If there were a vaccine that could significantly reduce the rate of childhood death, Leukemia, several types of cancer, meningitis, infections, and allergies, both state agencies and health insurance companies would see the wisdom in promoting its widespread use. If they carefully analyzed the potential savings, they would probably stop at nothing short of offering free inoculations by visiting families door-to-door. Breastfeeding is nature's free vaccine, but sometimes mothers need a little help. Few health plans cover the cost of lactation consulting -- an average of $50 per session. Working with a certified lactation consultant has shown to improve breastfeeding success rates in just one or two visits. According to a study conducted by Los Angeles Power and Water, every dollar invested in lactation support saves $4 in future health care costs. If the California State Legislature passes Assembly Bill 2438, lactation consulting will soon be covered. Long after World Breastfeeding Week has ended, we must continue to promote breastfeeding and support nursing mothers. Given the health and economic benefits, breastfeeding truly is the best investment for a healthy future. Lactation Consultants Can Help Mothers Overcome Breastfeeding difficulties When Dana Golshan was pregnant with her first child, she thought breastfeeding would come naturally. She didn't take classes or read books on nursing because she already knew she wanted to breastfeed. What she didn't know was how many problems she'd have getting started and the support she'd need to continue. She wasn't sure if her daughter was latching on to the breast properly or getting enough milk. Within four weeks, she weaned her baby and began providing formula. Golshan's story is not unusual. In California, 74 percent of mothers choose to breastfeed at the time of hospital discharge, but only 17 percent of women are still nursing nine weeks after birth.* "People have no idea how hard it can be to nurse," says Goldshan. Four years later, when she was expecting her second child, Golshan was determined to surmount the breastfeeding obstacles and enlisted the help of a lactation consultant at the first sign of trouble. This time, her baby had trouble latching on, contracted a yeast infection, and was spitting up after every meal. Lactation consultant, Barbara Eastwood showed Golshan latching techniques, suggested she get a prescription for ointment for the infection, and recommended that she eliminate milk products from her diet. Soon, mother and child were a successful nursing team and continued for ten months. quot;It's so important to have that support," says Golshan. She says she now gives Eastwood's phone number to pregnant strangers and new mothers she sees at Target, and urges them to call for help rather than give up nursing. Most women do not experience problems with breastfeeding says Ruth Wester, deputy executive officer at Wellstart International. "Not all the cases we see are mothers having problems," says Wester. "Some women see lactation consultants because they need a brush up lesson with a new baby, or advice on how to continue breastfeeding when they return to work or school. Or sometimes they have questions about use of medications during nursing or complementary foods, or how to introduce solid foods." Around the world, there are 8,000 certified lactation consultants who assist mothers with breastfeeding questions or problems. Fifty are in San Diego County, working in hospitals, pediatric offices, breastfeeding centers, and private practice. Nancy E. Wight, neonatologist at March Birch Hospital's Neonatal Intensive Care Unit says she sees a direct link between access to lactation consultants and breastfeeding success, even in the most difficult circumstances. "Approximately 90 percent of the women in our NICU who have premature or ill babies are pumping breastmilk," says Dr. Wight. "The incidence is much lower at other hospitals, probably more like 30 percent." She attributes the high rate of breastfeeding success to the 24-hour availability of a lactation specialist, as well as a staff that supports breastfeeding. Eastwood, a registered nurse who runs BarbiCare Lactation Services, says she counsels 50-100 women each month either by telephone or in person. "It makes a tremendous difference if they have someone to call at 9 p.m.," says Eastwood. "Ninety-nine percent of the time, mothers who want to nurse and get the help, can breastfeed." Lactation consulting was conceptualized as a specialty in 1977 by Chele Marmet, a mother who had become known as the person in Los Angeles who could help problem cases. Trained in speech and hearing therapy, Marmet became interested in breastfeeding after her doctors were unable to help with her problems nursing. "They told me to just leave my son in the hospital for a week and let the nuns listen to him cry, but I didn't want to do that," says Marmet. Instead, she learned as much as she could about breastfeeding, pursued a masters degree and started the Lactation Institute with her friend Ellen Shell. "The lightbulb went on as I realized that I was lecturing at hospitals almost full time and still not affecting any real change," says Marmet. "The only way to increase the breastfeeding rates and really help mothers is to have at least one lactation specialist in every hospital." The Institute opened its doors in 1979 with three goals: to train lactation consultants, to provide support for nursing mothers, and to affiliate with a university that would offer a masters degree in the speciality. The Institue has achieved its goals and adheres proudly to its original mission, says Marmet. Kate Weidel says she had envisioned breastfeeding her baby since she was a child herself, but never imagined it would be as challenging as it was for her. "I knew it wasn't going to be like the California eggs commercial where mother and baby are nursing in a rocking chair and it's no problem, but I never imagined it would take seven weeks either, so having a lactation specialist to work with was a lifesaver" says Weidel. She experienced common problems nursing women face: sore nipples and low milk production. Weidel practiced latching techniques while alternately pumping breastmilk. She feared her baby would experience "nipple confusion" -- an inability to differentiate between breast and bottle -- so she got creative. At the suggestion of her lactation consultant, she poured pumped milk into a syringe, then taped the attached tube to her pinky. Her son suckled her pinky for nine days before latching properly to the breast. To increase Weidel's milk production, her doctor prescribed Reglan, though some also recommend Fenugreek herb capsules. Lactation experts suggest increasing frequency of nursing to stimulate milk production. They discourage use of pacifiers and supplemental bottles. Rose deVigne is a lactation consultant at Mary Birch Hospital for Women and the president of the San Diego chapter of International Lactation Consultants Association. She sees high risk mothers and babies after delivery in the NICU. Divinea says the most common complaint she hears from new mothers is latch on difficulty. Women can also experience sore nipples, engorgement, a yeast infection called thrush, mastitis also known as milk fever, and perceived low milk supply. "During growth spurts babies need to nurse more frequently, " says deVigne. "Some mothers feel they have a low milk supply because their babies seem to be nursing constantly, but the more they breastfeeds or pump, the more milk they'll produce. People may advise a mother to supplement with formula during a growth spurt, but that will decrease her milk production and turn a perceived low milk supply into a real one." Even adoptive mothers can breastfeed their babies these days. Martha Myers adopted her daughter at birth and was able to nurse for six months. "I read about women inducing lactation and wanted to breastfeed because I was impressed with the immunological benefits," says Myers. She used a breastpump five times a day for 20 minutes for one week before she produced milk. "Ideally, you do it for a month, but our baby came early." Myers read books about nursing and attended a Le Leche League breastfeeding support group before her daughter arrived. Because Myers had educated herself about breastfeeding, she immediately noticed that her daughter was not latching on properly and called a lactation consultant. In one session, she resolved her problem. The average cost of a session with a lactation specialist is $50 per hour, though some hospitals offer a consultation as part of a mother's postpartum care. In December 1997, the American Academy of Pediatrics recommended that health insurance cover the cost of lactation consulting, but most do not. The International Journal of Gynecology and Obstetrics estimates that two to four billion dollars could be saved annually in the U.S. if all women breastfed their infants for just 12 weeks.** Medical costs for breastfed infants were approximately $200 less per child for the first 12 months of life than those for formula-fed infants. Blue Cross/Blue Shield estimated that if 50 percent of infants were breastfed, the HMO could save up to $140,000 annually. quot;Doctors are trying to support breastfeeding by referring lactation consultants, but it all comes to a halt at the insurance companies, " says Eastwood. "Every woman needs to have access to this service, " says deVigne, who adds that women who can not afford the out-of-pocket expense often cease breastfeeding and have to buy formula, which costs an average of $75 per month. quot;Many insurance companies have told me that a lactation consultants and breast pumps are luxury items, but they're medical necessities," says deVigne. "We've prevented many babies from being readmitted for three or four days. I can see a big difference between $100 for a consultation versus thousands for a hospital stay." La Leche League International offers mother-to-mother support for breastfeeding women at no charge. Mary Maschal, a San Diego Leche League leader says her organization offers monthly support meetings, phone consultations, and referrals to certified lactation consultants. "We're not medical professionals, but we're mothers experienced in breastfeeding who are accredited through La Leche League, the recognized world leader in breastfeeding. We offer information and support," says Maschal. "La Leche League leaders have the training and expertise to help mothers with many problems, and we also can also detect when there is a medical problem that calls for a certified lactation consultant." Though lactation consulting is a relatively new field of expertise, women have offered informal instruction in breastfeeding to each other throughout the ages. "Because formula is used so commonly among American women now, we've skipped a couple of generations in breastfeeding so there's no experience to hand down," says Marmet. "Lactation consultants are so important because minor problems can turn into major problems with inaccurate advice, " says deVigne. "We're kind of like detectives. We pick up risk factors that no one else thinks about and figure out how to resolve breastfeeding problems, so that women who want to breastfeed can enjoy nursing their babies instead of feeling frustrated." Citations for items not noted in text * Pregnancy Risk Assessment Monitoring Program--from April 1997 U.S. Department of Health and Human Services fact sheet ** Labbock MH. Breastfeeding as a women's issue: conclusion and consensus, complementary concerns, and next actions. 1994:47 (suppl):S55-S61 Tips for nursing mothers
Local Resource BarbiCare Lactation Services - 619-484-8819 Grossmont Hospital Women's Center: 619-528-5013 Kaiser Permanente Hospital: 619-525-3243 La Leche League International: 760-727-6563 Mercy Hospital Scripps Health: 619-260-7098 Naval Medical Center San Diego: 619-532-5261 Pomerado Hospital - 619-485-4605 Scripps Memorial Hospital - La Jolla: 858-626-7188 Sharp Community Chula Vista: 619-482-5848 Sharp Mary Birch Hospital for Women: 858-541-4127 Sharp HealthCare Murrieta: 909-696-6040 Tri-City Medical Center: 858-940-7745 UCSD Medical Center: 858-543-7149 Wellstart International: 619-295-5193 Books The Womanly Art of Breastfeeding - La Leche League International The Nursing Mother's Companion - Kathleen Huggins Breastfeeding Pure and Simple - Gwen Gotsch The Breastfeeding Answer Book - Nancy Mohrbacher and Julie Stock Nursing Mother, Working Mother - Gale Pryor Breastfeeding the Adopted Baby - Debra Stewart Peterson Breastfeeding: Biocultural Perspectives-Patricia Stuart-Macadam and Katherine Dettwyler Nursing Your Baby - Karen Pryor and Gale Pryor Bestfeeding: Getting Breastfeeding Right for You - Mary Renfrew, Chloe Fisher, and Suzanne Arms Jennifer Coburn is the author of "Take Back Your Power: A Working Woman's Response to Sexual Harassment", which recently won an honorable mention from the National Women's Heritage Museum book awards and an Outstanding Book Award from the Myers Center for the Study of Human Rights in North America.
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