Making the choice to breastfeed

It's been known for some time that only about 30 to 40 percent of inner city moms in New Haven ever start breastfeeding. And though the rates are higher for suburban moms, the overall rate is only about 60 percent—far short of the national goal of 90 percent set by the American Academy of Pediatrics. So there's work to be done on all levels to encourage moms to breastfeed.

There's no question breastfeeding is the best source of nutrition for young infants, helping them to avoid allergies and many infections in the first months of life. It's also good for moms, too, immediately promoting a strong bond between her and her new baby and later in life protecting against some cancers.

Why things have changed
There are several reasons breastfeeding is no longer the norm for many women. That lack of confidence is key. When I speak with new moms about breastfeeding, it's true their level of confidence is very important. Moms might not put it in those words, but rather say something like "babies like formula better."

What heightens the problem is when other women around them, such as sisters or friends, are not breastfeeding either. There's not enough support for some women so they stop. In this particular study, age may have also played a factor, with the average age being 22. Younger moms are less likely to breastfeed.

Breast v. bottle
The notion of babies liking the bottle better brings me to another point. It's important to breastfeed exclusively for at least the first two weeks. Of course, that's also the hardest time for new moms, when they are feeling tired and may experience some nipple soreness and when babies tend to nurse frequently. But there can be problems if a bottle is introduced during this time. The baby quickly learns that yes, the milk will come out of the bottle faster than the breast. So they may fuss more at the breast later. And because the amount of milk produced is closely linked to what the baby takes in, the breasts may not produce enough if a bottle is used, causing the baby to fuss even more. Then mom gets the wrong message, thinking the baby does not like to breastfeed.

Is baby getting enough?
Another common worry among new moms is whether the baby is getting enough milk. It is important for a baby who is breastfed to see the pediatrician often to make sure. It's truly uncommon for a mom not to be able to make enough milk for her baby.

A good rule of thumb we use is that “what goes in must come out.” You can tell how much a baby gets by how much he/she stools. On the first day, expect one time. On the second day, expect two times, up to the fourth day. After that, an exclusively breastfed baby should stool at least four times a day for the first month. If not, bring the baby to the pediatrician for a weight check.

Preventing setbacks
The intentions of the woman were a strong predictor in determining who would and would not stick with breastfeeding. While you are pregnant, you should be thinking about this decision, even if you are planning on returning to work. Short maternity leaves are certainly a deterrent, but I still encourage women to try, even if it's only for a few weeks. And new laws in Connecticut encourage employers to provide a place for women to pump their breast milk.

While you are pregnant, ask your obstetrician if there are any factors that might present a problem with breastfeeding, such as inverted nipples, and what can be done about them before the baby is born. But you don't need to “toughen up” nipples like some people say. That's just one of the many myths that surround breastfeeding.

Where to turn for help
When the baby is born, ask the nurses for help while you are still in the hospital. All of the nurses in Maternity Services at Yale-New Haven Hospital have some training in lactation. And our certified lactation consultants are simply wonderful in helping new moms get over those first anxious moments and really build confidence.

Have someone who is knowledgeable watch you to make sure the baby latches on correctly and is sucking correctly, even if you've done this before, since each baby is different. When you go home, we recommend coming for a follow-up with the pediatrician three to five days after birth. That's also a wonderful time to ask questions about breastfeeding.

• New moms should know that if they aren't feeling confident and need support they should call on their health care provider for assistance in breastfeeding.
• Yale-New Haven has initiated an online forum monitored by experts where new parents can ask questions about breastfeeding.
• Talk with friends who have breastfed successfully.
• La Leche Leagues provide support and education in many towns.

Search out support and you will be rewarded many times over.

Pediatrician Eve R. Colson, MD, is director of the Well Newborn Nursery at Yale-New Haven Children's Hospital and assistant professor of pediatrics at Yale University School of Medicine.

Breastfeeding Support Line (203) 688-6865 Yale-New Haven Hospital Callers leave a message or question on the support line and nurses educated in breastfeeding and counseling return the call.