Breastfeeding Blues

I’ve done it in the backseats of cars, in darkened movie theaters, and with my dress hiked up to my chin in a country club ladies room while other wedding guests waited outside crossing their legs. I’ve done it in the back pew at church, in department store dressing rooms, and behind the horse barn at the state fair. Since I’m able to disrobe with one hand, passersby are usually unaware of what I’m doing. But one time, I wound up exposing myself in a Galleria bookstore.

“It’s wonderful what you’re doing,” said the lovely woman who threw herself in front of me while I hurried to cover up. “I did it with all of my kids too.”

Breastfeeding is the missing verb here—though, as many nursing mothers find out, a more explicit physical activity might raise fewer eyebrows. Mothers have been breastfeeding their children since the dawn of time, but the act of stopping everything, sitting down, and lifting your shirt to nurse a hungry baby doesn’t always mesh so well with the pace and protocols of modern life.

Nevertheless, a report from the U.S. Centers for Disease Control this spring said that three out of four new American moms are breastfeeding their infants—the highest rate in decades. And for good reason. This simple act, most experts agree, can strengthen and sweeten the bond between mother and child, boost and buffer a baby’s immune system, lower a baby’s risk of obesity, diabetes, allergies, and asthma, and even raise his or her IQ a couple of points. Breastfeeding helps a new mom burn off the extra baby weight and lowers her risk of breast and ovarian cancer. The money saved on infant formula could be used to start a college savings account.

“There’s really no debate anymore—breastfeeding is better for moms and babies in every way,” says Laura Duckett, an associate professor at the University of Minnesota School of Nursing. That’s why, she says, the American Academy of Pediatrics strengthened its recommendations three years ago, advising new moms to breastfeed their babies exclusively for the first six months of life and to continue breastfeeding for the first year and beyond—“as long as mutually desired by mother and child.” The longer you can do it, the better.

Unfortunately, few new moms make it to that goal. According to the same CDC study, while 77 percent of new moms try to breastfeed, only one in three breastfeed exclusively for six months and only one in five carries on through the first year. There are many reasons a woman might choose to stop breastfeeding. What troubles breastfeeding advocates is the possibility that many women are giving up not because they want to but because they don’t know how to continue.

“We often hear from women who are new to this country that they don’t believe mothers breastfeed in America because they never see it—it’s not out in the open,” says Colly Huberty, a lactation consultant for the Women, Infants and Children program of the St. Paul–Ramsey County Department of Health. Advocates say nursing women need to come out of the shadows (or, in my case, from behind the horse barn) to get the support they need and to serve as role models for the next wave of new mothers.

“It’s the best thing I ever did—not just for my babies, but for myself,” says Duckett, who has studied and promoted breastfeeding for thirty-five years. “The more we learn about the benefits, the more important it is that we talk to women and get the word out.”

Fortunately, breastfeeding happens to be a popular topic of conversation among new moms. When St. Paul author Andy Steiner set out to write a book on the subject, she was surprised by how many women sought her out to tell their stories. What did they want her to know? “That breastfeeding was nothing like they thought,” says Steiner. “It was harder than they’d been told it would be, more challenging—but also more rewarding.”

Among the difficulties Steiner recounts in Spilled Milk: Breastfeeding Adventures and Advice from Less-than-Perfect Moms are leaky nipples, painful letdowns, grandparents who wonder whether their breastfeeding daughters are hippie freaks, and partners who were looking forward to the instant breast augmentation that accompanies lactation but were appalled by what a naturally engorged breast really looks like. “The word bovine came up a lot,” Steiner notes.

Another recurring topic is the stress that new moms experience while breastfeeding—wondering whether they’re doing the right thing, the right way, for the right duration, and for the right reasons. “Women feel guilty and ashamed if they didn’t do it for very long, and they feel guilty and ashamed if they think they did it too long,” says Steiner.

“We really set women up for failure in this country,” says Joanne Slavin, a professor in the food science and nutrition department at the U of M, who believes our “drive-by style of birth and delivery, the way we expect a new mom to go home and paint her house during maternity leave,” is antithetical to a healthy breastfeeding start. Many new moms are discharged from the maternity ward before their milk “comes in,” a complex hormonal process that takes place two to five days after delivery. What’s more, a generation or two ago, a new mother often returned home to the care of female family members and friends, who would help guide the breastfeeding process. But nowadays, Slavin says, “grandmas aren’t around.”

Even if they were—and they supported their daughters’ decision to breastfeed—those grandmas may not have much experience to share. That’s because breastfeeding rates fell during the 1960s and early 1970s, plummeting to a historic low in 1972, just as our current generation of moms were born. Experts say the support and encouragement of a woman’s inner circle is important for breastfeeding success and duration. “If you don’t know many people who breastfeed, it’s less likely you’ll try it or get the support you need,” says Huberty.

Complicating matters is the aggressive marketing of infant formula. According to the CDC, the number of people who mistakenly believe that “formula is just as good as breast milk” nearly doubled between 1999 and 2003, roughly the same time the U.S. formula industry increased its ad spending from $29 million to more than $46 million. Formula routinely given away in the hospital also sends a mixed message about the importance of breastfeeding. A recent study published in the American Journal of Public Health revealed that women who went home with complimentary formula were 39 percent more likely to stop exclusive breastfeeding at ten weeks than women who didn’t receive the freebies.

“One of the problems in the U.S. model of health care is that there’s no money to be made from breastfeeding,” says Slavin; some hospitals, she says, don’t have lactation consultants on staff because their services aren’t reimbursed. At the same time, according to the U. S. Department of Agriculture, private and government insurers spend at least $3.6 billion every year to treat diseases and conditions preventable by breastfeeding.

“It’s a terrible shame,” Slavin says, “because it takes just a little investment of time and attention for the mother and baby to work it out, and there are these critical moments when just a little help can make a world of difference.”

For Kelly Maynard, a St. Paul copy editor, the “critical moments” came a few days after she’d returned home from the hospital with her son, Noel. She worried she wasn’t making enough milk (a common fear among new moms—and often the reason they turn to formula), but Marusia Kachkowski, a St. Paul–Ramsey County public health nurse, weighed the baby and reassured his mother that he was doing fine (breast-fed babies are usually leaner than bottle-fed babies). She also showed Maynard how to make sure the latch between the breast and baby’s mouth was right and advised her to relax and take her cues from the baby. “She was like a sea of calm,” says Maynard, who has breastfed her son successfully for a year. “Who knows what would have happened if she hadn’t been there.”

Small interventions—be they from a La Leche League volunteer, a board-certified lactation consultant such as Kachkowski, or a friend down the street—help many mothers over the first hurdle of breastfeeding. “You usually find these women at their darkest day—their milk is coming in, they can’t remember the directions they got at the hospital, and they’re overwhelmed,” says Kachkowski, who just completed a master’s thesis entitled “Barriers to Breastfeeding in the 21st Century.” “It’s amazing what a little help can do to get a new family on the right path.”

Another hurdle, particularly for moms in Minnesota who return to their paying jobs in greater numbers than those almost anywhere else in the nation, is the transition back to the workplace. Though state law requires employers to allow a nursing woman the time and a reasonable place to pump, the rules can mean different things in different locations. When I worked outside the home, I could excuse myself to visit a designated nursing mom’s room, but a friend had to repair to the least-used bathroom and hope no one walked in on her. “It can be a hassle, but I try to tell women it’s really a very short period of time that you’re inconvenienced,” says Huberty.

Often the final obstacle to completing a full year of breastfeeding is getting comfortable doing it anywhere your baby is hungry. A 2003 Porter Novelli survey found that 37 percent of Americans believed women “should breastfeed in private places only.” But that view seems to be changing. When The View ’s Barbara Walters complained about being seated next to a nursing mother on an airplane, more than 200 “lactivist” moms held a “nurse-in” outside ABC studios. (Any one of the women could have pointed out that, among its many benefits, nursing relieves the air pressure in a newborn’s ears during an airplane’s take-off and landing.)

Protests like that—and the celebrations we’re likely to see during International Breastfeeding Week in August—remind us that breastfeeding moms are a new majority among new moms in this country. “But to me,” says Kachkowski, “just seeing a mother at Rainbow nurse her baby is more important than any big kumbaya event you might see on television.”

Sometimes, she says, she can’t resist giving that nursing mom a little nudge. “I’m so proud when I see uneventful, everyday nursing that I’ll sometimes say, ‘That’s really great what you’re doing—keep it up.’ ”