If Amanda Rodriguez could do it all over again, she would do her homework and select a different hospital for the birth of her first child, one that was much more supportive of nursing.
Rodriguez, then 23, had a traumatic birth experience. Her son was trapped in the birth canal, which led to a large amount of tearing and blood loss. She ended up having more than 100 internal and external stitches, which left her unable to nurse her new son until he was almost 24 hours old. The nurses had already given him a bottle and were not supportive of stopping bottle feeding so that she could help her son learn to latch on, she said.
“I was very frustrated. The baby was very frustrated. … I remember crying a lot.”
It took a few days before a lactation consultant visited her, said Rodriguez, the founder of the blog Dude Mom and now mom to three boys, ages 7, 10 and 13. Her husband wasn’t allowed to spend the night, and the hospital didn’t allow rooming-in, where the baby stays in the room with the mother.
“The staff gave him bottles behind my back,” she said. “I asked them not to, and they did anyway. And more than one nurse tried to discourage me (‘You’ll be happier if you don’t;’ ‘You’re too young,’ etc.)” from breast-feeding.
After discharge, with the help of her mother, she was able to figure it all out and nursed exclusively for nine months. She chose a different location, a hospital that provided more breast-feeding support, for the births of her second and third sons.
Rodriguez is not alone.
Despite improvements in breast-feeding support at hospitals around the country, a report by the Centers for Disease Control and Prevention finds only 14% of the nearly 4 million babies in the United States are born in hospitals designated as “baby-friendly,” meaning they provide the 10 different steps that have become the global standard for hospital care to support breast-feeding.
Those steps include teaching breast-feeding techniques and feeding cues, limiting feeds that don’t include breast milk, allowing parents to “room-in” with their babies and providing support after a new mom is discharged from the hospital.
“The bottom line is that hospital actions in the first hours and days after birth can make a big difference and can determine for how long babies are breast-fed,” said Dr. Tom Frieden, director of the CDC, in an interview with CNN.
Frieden said there has been some progress. In 2007, 29% of hospitals in the United States offered a majority of the 10 steps to support breast-feeding. That number jumped to 54% in 2013, according to the report.
“There’s that old saying, ‘Well begun is only half done’,” said Frieden. “And if you don’t leave the hospital exclusively breast-feeding, you’re not likely to continue breast-feeding for a significant length of time.”
There are many health benefits to breast-feeding, according to the CDC.
Babies who are breast-fed are less likely to get ear, respiratory, stomach and intestinal infections and are also at lower risk for asthma, obesity and sudden infant death syndrome. And the benefits extend to the mother, too, with women who breast-feed being less likely to get breast cancer, ovarian cancer, type 2 diabetes and heart disease, the CDC said.
So if “breast is best,” according to the health community, why aren’t more hospitals providing breast-feeding support?
I think back to when I had my first child nine years ago. I was committed to breast-feeding but don’t recall ever being given any real education on breast-feeding techniques during my hospital stay. My daughter was also given infant formula by nurses to supplement feedings in those early days. Giving formula to a baby who is being breast-fed, particularly soon after birth, can lower the baby’s ability to breast-feed on demand and can also lower a mother’s milk supply, breast-feeding advocates say.
That issue — where hospitals provide supplemental feedings using formula — is one of the areas where there has been the smallest amount of progress, per the CDC report. In 2013, only 26% of hospitals made sure that only breast milk was given to healthy infants who were being breast-fed and who did not require formula for medical reasons.
“I can say that when my two sons were born, each time, even though it was a very good quality hospital, within hours, by the time I went over to the nursery, somebody had popped a bottle into their mouth for no reason. And so there are a lot of practices that really need to improve,” said Frieden, the CDC director.
Avital Norman Nathman is editor of the motherhood anthology “The Good Mother Myth” and writes frequently about breast-feeding for various online outlets, including SheKnows, where she is a contributing writer.
“I think hospitals have their heart in the right places, but a lot of them go about it in the wrong way,” said Norman Nathman, citing programs at some hospitals that essentially “lock up” the infant formula by restricting hospital staff access and requiring parents to sign a waiver for access.
“While I am 100% pro-breast-feeding and would love for every mom to at least attempt it if it works for them, you can’t lock up formula and have people have to request it in a way that’s shaming because that’s not helping breast-feeding. That’s not going to help any mother breast-feed, to make them worry too much if I can’t breast-feed, am I going to be shamed into my choice?” said Norman Nathman, founder of the blog The Mamafesto.
“I think formula should be available and not in a way that you have to sign a waiver that you’re aware you’re giving your child formula if you need to,” she said.
If a woman decides not to breast-feed or can’t breast-feed, she shouldn’t be made to feel guilty about that, said Frieden. “On the other hand, if a woman wants to breast-feed or wants to try to breast-feed, she should be fully supported.”
Katie Trexler Kern, who had twins nearly 13 years ago, said she got a ton of nurse encouragement to nurse.
“I think because I had twins, they were worried that it might be even more overwhelming to nurse two,” said Trexler Kern, a principal at Evolution Communications Agency in Littleton, Colorado. “So they had someone come to my room and show me how to nurse both at the same time. That was an experience.”
When she left the hospital, she was committed to breast-feeding for as long as she could do it, not just for the nutritional aspects but for the bonding. So even though the experts in the hospital showed her how to nurse two babies at once, she nursed them separately. “Yes, very time-consuming, but well worth it. I lasted about five months.”
Rebecca Hughes Parker, a mom of three, mostly fed her now 11-year-old twins formula and breast-fed her 4-year-old exclusively for a year and a half. She said she got enough nursing support in the hospital but not enough afterward “when the going gets really tough, when you get home with a screaming newborn.”
Hughes Parker, who is managing editor of The Law Report Group, ended up going to a community breast-feeding support group but said there was a small fee associated with it and she had to seek it out.
“It is so easy to think in the beginning that the baby is not getting enough milk when you are nursing. Lactation consultants in the hospital, and later in a support group, really helped me quell that fear,” she said.
Providing post-discharge breast-feeding support is another area that needs significant improvement, said Frieden. Only a third of hospitals in 2013 provided enough support for mothers who were breast-feeding when they left the hospital, according to the CDC report. That support included a follow-up visit and phone call and referrals for additional support.
“A lot of times, hospitals traditionally didn’t think beyond their front door, and yet, increasingly with where we know medicine has to go, they’ve got to be engaged in the community, reaching out to people before admission and after discharge and connecting people with community resources.”
Support for more “baby-friendly” hospitals is not universal. There are plenty of moms who are not anti-breast-feeding but who worry what more breast-feeding support might mean for mother’s individual choices.
One of those mothers is Michelle Noehren, founder of CTWorkingMoms.com. She planned on breast-feeding but after her daughter’s birth, which was traumatic, she had to stop nursing to take medication to deal with the trauma.
That experience taught her to be less judgmental of other people’s choices, because she realized that sometimes not breast-feeding isn’t a choice. It just isn’t possible.
Her concern with the push for more “baby-friendly” hospitals is that more hospitals will be requiring “rooming-in” and no longer offering nurseries. She said such a move actually hurts those moms who don’t want to “room-in” and who might want to try to get a few hours rest during their brief hospital stay before they are home and on duty 24/7.
“In my opinion, this trend away from nurseries is extremely disturbing and is doing a huge disservice to women,” she said in the third of a series of blog posts on this issue. “It’s like we’re forgetting that women’s bodies experience so much during birth. God forbid we need a little rest to recuperate. There is nothing, I repeat nothing, wrong with asking for your baby to be taken to the nursery so that you can rest while you’re still in the hospital. Moms should not be shamed or judged for expressing their needs.”
She added, “Breast-feeding or formula feeding, rooming in or using the nursery — these are personal choices and the only person who really knows what’s best is mom.”
Do you think hospitals should be providing more support for breast-feeding? Share your thoughts with Kelly Wallace on Twitter @kellywallacetv or CNN Parents on Facebook.