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>> Tom Zinnen: Welcome, everybody, to Wednesday Nite at the Lab.
My name is Tom Zinnen.
Cooperative Extension. I work here at the UW-Madison Biotechnology Center. I also work for UW Extension
And on behalf of those folks and Wisconsin Public Television and the Wisconsin Alumni
Association, thanks again for coming to Wednesday Nite
night, 50 times a year. Tonight I'm delighted to be able to introduce to you We do this every Wednesday
clinical professor in the Department of Family Medicine here at the University Dr. Anne Eglash who is a
in the School of Medicine and Public Health. of Wisconsin-Madison
and a lactation consultant. She spends most of her time practicing clinical medicine family physician
She's the medical director of the outpatient lactation program in Mount Horeb.
breastfeeding medicine teaching with the UW medical students at Meriter Hospital and is heavily involved in
Family Medicine, as well as residents from the Departments of Pediatrics,
and Obstetrics and Gynecology. She's a co-founder of the Academy of Breastfeeding
Medicine and the Mothers' Milk
Bank of the Western Great Lakes, Association of Wisconsin. In addition, she is the medical director of the Mothers' Milk
an emerging donor human milk bank. She sits on the editorial board
for Breastfeeding Medicine
journal and has published several articles pertaining to breastfeeding.
Dr. Eglash also has a regular podcast series pertaining to the
clinical practice of breastfeeding medicine.
Her research interests include
chronic breast pain in nursing woman, nipple shield use among
sharing among lactating mothers. health professionals, and milk
Please join me in welcoming Dr. Eglash to Wednesday Nite at the Lab.
[APPLAUSE]
Anne Eglash: Thank you
for having me. As many of you probably know, this is world breastfeeding week
so this is part of the
And so I thought today, can you celebratiohear me?aring the information about breastfeeding and the importance.
That's better? Okay. Maybe I'll just readjust this.
What I want to do today is talk about why breastfeeding matters Iin the United States.. Because I think we've lost track
of why breastfeeding is important here. I think we still understand that
in Third World countries where breastfeeding is very important
there's not the guarantee of clean water and adequate food.
disasters in other countries And we seem to see more
than we do here. But breastfeeding is very important in this country, and
I'm hoping to convince all of you of that.
United States, and then we'll talk a little bit about how Sobreastfeeding made itsy breastfeeding lost favor in the
We'll talk about who's most at resurgence in the United States.
risk in the United States if not breastfed and the importance of breastfeeding in reducing
chronic illnesses.
We'll also review our barriers to increasing breastfeeding rates in our country.
This is, I just want to share this statue, this was at
Buckingham Palace in London. I was very shocked and surprised
and pleased to see this statue
regarding the history of losing obreastfeeding in our culture Most of the information I'm going to talk about today
comes from Dr. Rima Apple who is a professor in the history of
medicine at the University of Wisconsin. She wrote a wonderful
which was published in 1987, and book called Mothers and Medicine
if any of you have an interest in this history, I strongly advise this book.
So before the 1800s breastfeeding was considered an essential role of motherhood, and women were generally assumed
that breastfeeding, having
children, breastfeeding, nurturing the family was their
One physician quote that major role.
Dr. Apple has in her book is no woman is fit to have a child who is not fit to nurse it.
And women who couldn't nurse
knew that their children would be at risk for death, and so
So before the mid-1800s, they hired wet nurses.
pediatrics was very sparse. phMany babies didn't survive.in There was a very high infant In fact, the whole field of
non-breastfed babies, and the vast majority of babies were mortality rate, especially among
breastfed. So the cure for mothers and
babies was largely within the realm of midwives.
you have read Erik Larson's book But during this time of science emerging, especially if any of
about Devil in the White City he talks all about the world fair
an incredible book. He talks about how science in the 1890s, I thought that was
And of course, we all learned about Industrial Revolution really rein school. so many different ways.
who Dr. Apple focused on in her book, a physician who was very And Dr. Rotch is one physician
interested in infant mortality rates and really thought that
infant feeding had a lot to do
with infant mortality. So his quote reads, a quote from
early life is preeminently the him, "The preventive medicine of
and live. In fact, it is a proper or an improper nutriment which makes human beings to breathe and grow
perfection of the coming race. or mars the profession of the
Infant feeding, then, is the subject of all others which should interest and incite to
research all who are working in the preventive medicine of early
life." So he's basically saying that
feeding is of utmost importance,
especially as they were looking at infant mortality. And at that point, in 1890s,
one-third of infants died before
the age of five. And the majority of these babies
However, he focused on the were being breastfed.
possibility that some breast milk wasn't as good as others.
look at breast milk they And when researchers started to
realized that some women's milk has more protein than others and some has more calories than
others and some has more fat. So there must be something about
their breast milk. women and their qualities and their behaviors that influences
Well, now we know that that variation in women is very normal, and we see variations at
different times of the lactation
period from newborn on and throughout the day we see those variations.
But back then they thought that that was a major reason why some
he was a researcher back in the late 1800s, he would dabble in breast milk may be bad. In addition, people like Nestle,
could be given if they didn't have access to breast milk. cSo there was this emergence of ideas of things that babies
really wasn't within the breast milk substitutes which
scientific realm. And Dr. Rotch said, look, we really need to bring this whole
science of breast milk
substitutes into the scientific realm to understand the best way to make substitutes for breast
milk when breast milk is not
available. So basically breast milk was
They thought that the mammary gland was vulnerable, that the questioned.
mother's state of health affected her breast milk.
So if she was mentally ill, stressed, nervous, over-tired,
didn't eat well, that her breast milk may be poor.
So women were given these specific ways of living and of
eating, ways to go about their lives in order to have ideal
breast milk.
And Dr. Rotch thought, gee, I bet we can figure out what babies are missing and then take
cows' milk and design it just like human milk so that they can
anymore. have a substitute, especially when mom's milk is not good
So what happened is that, so initially when the field of pediatrics emerged the whole
idea with pediatrics was really to get babies to survive and it really focused on infant
But as formula manufacturing feeding.
sort of evolved, it ended up more in the hands of
The manufacturers were very excited that physicians got interested in breast milk substitutes and so sort of the
ball got rolling, and over time it ended up more in the realm of
physicians. And physicians really started to the commercial manufacturers of the formula as opposed to the
things that they could do like step back and look at other things regarding pediatrics,
immunizations and taking care of infections and other sorts of illnesses that infants had.
And I just wanted to show the relationship between an old ad
and a relatively new ad. If you can see this is from like
the early 1900s for Benger's
Food, and here it says mother's milk or Benger's Food. It's nature's intention that the
baby should be fed by the milk
of its own mother. When this is injudicious or impossible the next and nearest
thing is cows' milk modified by Benger's Food.
So here we have Enfamil Lipil, which is a relatively recent, in
the last 10 years, formula. And here it says our closest
manufactured, or I can't see formula to breast milk. And it's hard to see but
So basically infant formula continued to become popular, and nutrients found in breast milk, the added lipids.
there are certain scientific methods that became very
important and made formula
a way this formula was a good thing because there was a reduction in infant mortality And because babies did haveso in
something that was better than
So people thought, gee, this is great, this formula saved, we're order to survive if they didn't have access to mother's milk.
seeing a reduction in infant mortality rate.
However, there were other things
happening at that time, and this was an association and not a
There was also clean water, indoor plumbing, the start of immunizations as well. cause.
advertising of this formula to And so there was a great deal of
families as perfect food for infants in mothering magazines
So this was the beginning. and also in medical journals.
formulas would be appropriate Evfor their patients.0s pAnd physicians were not, ind medical school physicians, there
never has been emphasis on
information on infant nutrition, infant nutrition in medical school. And so physicians learned their
particularly formulas, from formula companies. So at the same time, so there
are other forces that are happening at the same time. We have the down fall of the wet
And again because there is this interest in making sure that the nurse.
woman was perfect in various attributes to make perfect milk,
the idea was that finding a perfect wet nurse was probably
just to use a bottle, especially pretty difficult. And it may be wiser and easier
issues that always were the case with the advent of these rubber teats or nipples. And there were also social
with wet nurses, having to hire them, dealing with their personalities, perhaps jealousy,
perhaps getting involved with their husbands. Who knows what was going on.
difficult situation to have a wet nurse with them. So it was felt to be a very
So bottles just seemed to make sense with formula.
Science continued to become very
important and also, so not just in the manufacturing of things and newer technologies for roads
and other things that you could see and feel, but also in terms of behavior, and if was felt
of our sexual behavior, racial that science could explain some
issues, the difference between races, and also how women should
And so there was this idea that women need to learn how to mother.
And this was a quote from Good Housekeeping in 1911, mother, that it's not instinctual.
knowledge. from A Trained Mother. "Maternal instinct
It's love, patience, and unselfishness...
left alone succeeds in killing But maternal instinct
a large proportion of the babies born into this world."
trust your instinct, that you need to learn how to care for your baby properly. And so many of you probably have
heard of Attic Angels which is
currently an extended care facility for people.
in Madison, founded by But Attic Angels was originally,
Dr. Dorothy Reed Mendenhall back in the early 1900s, around
And this was actually a summertime child health center 1920s.
for their children, but they where women would come and they would get pasteurized cows' milk
also learn how to mother and their children would be checked to make sure they were healthy.
And it made more sense to do it in the summer because, number one, the pasteurized milk is
because of the heat, but also because it would be difficult for them to get to a well-child morcenter in the wintertime.time
So another huge, huge thing which has had ramifications around the world are hospital practices.
And birthing in hospitals really
gained popularity in the 1920s. In fact, our first president who was born in the hospital, I
think many of you people know,
was Jimmy Carter. So prior to that people were largely born at home.
And so the hospitals would use
scientific practices to keep babies safe.
was to make sure that the babies And so one of their big things
were in sterile environments because that would be safer for them so they didn't die or get
sick. And so they separated the babies
schedule. So all the infants were in the right away from the moms. And then infant feeding was
nursery, they were brought out to moms and they would have
X amount of time to feed the
there nursing and who have babies, and then the babies would go back to the nursery. And those of you who are out
The baby needs to be with you. experience with breastfeeding understand that's not how you establish breastfeeding.
The baby needs to nurse quite often. And mom needs to watch for those
early feeding cues which also promotes bonding and brings the milk in faster. And so by having these babies
separated, moms are not establishing the breast milk
supply well. Babies sometimes are not even
figuring out how to nurse.
At the time there was documentation that nurses were cleaning breasts and also
wearing masks and telling moms
to wear masks, and so it was considered very much scientific.
learning how to nurse their babies. And they were encouraged to go But this was how mothers were
keep them on a schedule. home and do the same thing, to
And this was just one picture of one hospital in the 1920s where you can see the babies are lined
up in their cribs.
You can see the scale and the table where the baby's getting bathed and changed and things
like that.
And here again, this small room with the babies all lined up and essentially not being held and
just brought out for tasks and
then put back into their cribs. So pretty much by the 1950s we reach our lowest point of
breastfeeding and formula seemed
ideal at that point. Breastfeeding was pretty
There was a thought that we don't really know what's in breast milk. problematic.
but we do know what's in We have no understanding of it,
formula. And so nutritional deficiencies were identified and thought that
maybe this would be a problem for infant feeding, and if an infant didn't grow well or
infant, breastfeeding was probably the problem. People, again, were concerned about the psychosocial issues
that a woman had so that if she was depressed, anxious, stressed
that her breast milk would not be good.
And there was this loss of
sufficient the first couple days understanding about breastfeeding so even the thought that colostrum was not
and that babies needed to be supplemented just showed how
regarding breastfeeding. there is this loss of knowledge
There was a very heavy advertising by formula
And I understand how hospitals companies.
can decide that breastfeeding is just too much work. It's too difficult.
You have to be there, you have
sure the babies take enough. to spend too much time with the patients and with the babies. You have to worry about making
You can't measure how much the babies are taking.
for staff who are busy. They have a lot of babies to And this became just too much
take care of, a lot of moms to take care.
And physicians lacked the breastfeeding education.
policies in the hospital. So then comes in the natural And guess what? Physicians wrote a lot of the
childbirth movement. So for every action there's an
equal but opposite reaction.
accept as much anesthesia during Fortunately, that was the natural childbirth movement which encouraged women to not
encourage hospitals to allow childbirth. And there was some influence by this childbirth movement to
babies to room-in in mothers' rooms. And probably the most important
thing was the childbirth
education that women underwent before they gave birth. So they knew what was going to
happen to their bodies, and then
they also learned about breastfeeding. We also saw the rise of the
La Leche League in the early
that mother-to-mother support for breastfeeding. And this was a hugely important grassroots movement to provide
And for a lot of women, La Leche League would be the only group
that women had available to learn and to have support in
physician knowledge or any terms of breastfeeding. There's no evidence that
increase in evidence regarding the benefits of breastfeeding had any impact in the gradual
return of breastfeeding rates in
the 1970s and 1980s. So here you can see that the
low back down to the '20s in the breastfeeding rates were quite
1970s. And then there was a rise into
And much of that probably was in the 1980s for breastfeeding.
middle-class Caucasian population. And the rates, and probably in
the immigrant population, too,
was that many of these women continued to nurse. But then it sort of dropped off in the 1980s, and the thought
And then you can see another went back to work and so that decreased the breastfeeding rates.
rise in the 1990s and that probably had to do with WIC,
children program, having with the Women, Infant and
breastfeeding programs available to help women nurse.
Can you explain, do you have Yes.
any indication that the rise of the birth control pill had any influence on breastfeeding
rates?
>> Did the rise of the birth control pill have an affect on
Well, it probably would have breastfeeding rates.
decreased breastfeeding rates because the birth control pill probably would have been given
very early to women postpartum, and the estrogen in the birth control pills would decrease the
figured out that women should only have progesterone only birth control pills. milk supply until physicians
be unrelated actually. So I would think that it would
Because the common knowledge is that women would continue to nurse in order to stave off
pregnancy.
So I think it's unrelated. So again, we saw a gradual
not only from the natural childbirth movement, with less increase in breastfeeding rates,
medication, more knowledge about what's going to happen to one's
bodies, but also there were some
other movements happening. One was called the baby-friendly
And this was started by the World Health Organization and the World Health Assembly. hospital movement in the 1980s.
that hospitals were the biggest barriers to preventing women They recognized around the world
from being successful with breastfeeding.
If women leave hospitals and are
not breastfeeding, they are very unlikely to breastfeed. Now this movement back in the
'80s was probably not important in the United States because we didn't really start revving up
movement in the United States until the mid-2000s. with our baby-friendly hospital
But it gave hospitals ideas on But in other countries that was very important.
things that they could do to improve their breastfeeding rates, especially in the 1990s.
Again, we had the WIC programs
which have done wonderful things in terms of peer counselors and education for families who are
WIC eligible to increase
breastfeeding rates. And then one of the other things
mid-1990s that increased that was important in the
breastfeeding rates was the FMLA act.
stay home and breastfeed and not So women knew that they could
have to go back to work for 12 weeks because their job would be safe.
And this is just an article showing that there was a gradual
done in breastfeeding medicine. Between 1960 and 1969 there were increase in the amount of literature and research being
And then by the 1990s we saw 6,269. So we saw this huge increase in citatiresearch.DLINE.
So does breastfeeding really
And when babies become ill matter now in this country? We have pretty low infant mortality rates.
we can fix them. We can treat their infections and their illnesses with modern
medicine. We also have immunizations, clean water, indoor plumbing. So babies are fairly safe.
Well, let's talk a little bit about the difference between
breast milk and formula. If you look at this slide, this
is formula. It basically is a bunch of
chemicals put and dissolved in water and has no organic matter
in it.
When you look at breast milk, you have lots of organic matter. You have lots of enzymes, you
have hormones, you have fats and
alter one's health. And this is something, this is a provide nutrition, but have living qualities about them that
reason why formula will never be like breast milk unless they
start to engineer all these different factors, all these
cellular factors that are in breast milk.
So what's important to
understand simply is that babies are immature when they are born.
areas. And the immaturity is in all
It's neurologic, it's musculoskeletal, it's gut, it's kidney, it's brain,
it's every organ system,
and breast milk is designed to complement that immaturity. And the best, probably the most
obvious way that we see that is that breastfed babies are much
less likely to become infected the first three months as
compared to a formula-fed baby
because there are all kinds of antibodies in breast milk.
breast milk that's important for But there's so much more in
gut maturity, for brain and retinal maturity, for prevention of infection, for
immunomodulation, which we'll talk a little bit more about, for emotional growth. So all of these are important to
complement. And the analogy I make is let's say that you decide that you're going to just not eat food
anymore but just go on a strict diet of something like Boost or Ensure. You know that if you eat your
five fruits and vegetables a day
you're getting antioxidants, you're getting vitamins and minerals that are natural.
With enzymes, you're getting
anticancer factors. You're getting so much more than just your vitamins and
your protein, and your carbs, and your fats.
than just provide nutrition. And so the difference is that these nutrients do a lot more
of these not only, again, provide nutrition, but they're oligosaccharides, glycoprotein, human milk fats, antibodies, all
actually actively, they all have several, several roles in how
they actually fight pathogens,
modulate the immune system so that babies are not as likely to react and have bad asthma or
allergies or dermatitis.
They're going to grow differently too, and I'll show you a slide later about the
difference in growth in babies
who are breastfed versus formula-fed.
benefit or can we also say that because breastfeeding is So is breastfeeding just a
biggest barriers that we have to beneficial, formula is risky? And I think this is one of the
increasing breastfeeding rates in this country is that we are
breastfeeding benefits. And breastfeeding, if we just talk about breastfeeding always talking about
assumption that formula is good. benefits, we're making this
Formula is fine, formula is good, but breastfeeding is better.
But we can change this
conversation by saying, look, if you don't have these benefits from breastfeeding, you're
taking a risk with
formula-feeding. And that's really the message that has to come out.
And I realize that that can play
a role with guilt issues and fretting by parents who are not able to breastfeed.
But it's informed consent.
having a trampoline in their And as a physician I'm always telling my patients about the risk of smoking and the risk of
backyard, the risk of not wearing a seat belt. They need to understand the risk
of using formula. It's only good medicine to make sure that people understand that.
So what's interesting is that this concept sometimes is difficult to grasp. There was a survey in 2003 where
US residents were asked, is infant formula as good as breast
they didn't agree. milk? And 74% of residents said no,
milk, does that increase the However, when the same group of people were asked, is feeding a baby formula instead of breast
So, again, many people don't chance that the baby will get sick? Only 24% agreed with that.
understand that concept that flipping the risks of breastfeeding can translate into
the, I'm sorry the benefits of
breastfeeding can translate into the risk of formula.
risks. So let's talk a little bit about
The maternal risks of artificial feeding, there are several
important for women's health, as because breastfeeding is so
it is for the baby's health. So probably the most astounding thing is the increased rate of
breast cancer among women who don't breastfeed. And we find that for every year that a woman breastfeeds,
she reduces her risk of breast
cancer by 4.3%. So if she has three kids, each is nursed for a couple years,
she is reducing her risk of breast cancer by 25%. Women who have children and decide not to breastfeed have a
1.5-fold increased risk of ovarian cancer.
And they also have a higher risk of high blood pressure, high
cholesterol, diabetes, and a
greater risk of heart attacks. There's also a higher risk of something called a metabolic
syndrome which is kind of a pre-diabetic pattern with increased waist to hip ratio, higher blood pressure,
higher triglycerides, and a higher blood sugar. For infants we see a higher risk
the first year of life. Particularly what's oftentimes of just any sort of infection in
measured are ear infections. We see two times the risk of ear
infections and 3.6 times
increased of hospitalizations for lower respiratory infections such as RSV, pneumonias,
or bad asthma.
1.3 times increased risk. And what's been interesting is risk of dying for an infant who is never breastfed,
more research coming out showing the increased risk of sudden
infant death syndrome or sudden unexplained infant death syndrome.
We see a marked increased risk About two times the risk.
of obesity in children. And we'll talk more about that in a little bit because that's
one of the main drives for
really increasing breastfeeding rates by a number of organizations.
We see a higher IQ in the first decade in infants who are breastfed and that's controlling
education status and smoking, and all sorts of other issues. for things like maternal
formula fed have a higher risk And we know that babies who are breastfed, babies who are
because I think this has to do of neglect and abandonment, there's just not the bonding. I wanted to show this slide
But there are two growth curves with going on here.sue. And again we'll talk more about that.
The World Health Organization decided that they were going to measure how infants really grow based on making sure
that the infants are fed
in a very ideal way. Meaning that they're breastfed
don't start solids until the for at least a year and they
babies are six months. And compared that to data that
States for a long time which is data for the Center for Disease Control on how infants grow. we've been using in the United
growth data like from the 1970s, And that data is a mixture of
And so what's interesting is 1980s, even the 1960s, and most of those infants were not breastfed.
that in the first six months you can see that the dotted line is oftentimes under the solid line
which means that the breastfed
and you get towards two years, kids actually weigh more than the formula-fed kids. But when you get past six months
solid line is, the solid line weighs less than the dotted difline.ce. YoSo the breastfed kids weighthe
substantially less than the formula-fed kids. And this is something that, again, people are very
interested in, especially as we see these incredibly high rates of childhood obesity. This seems to be something that
could be changed in order to
exclusively breastfed babies decrease that rate. So we also see disparity in health between formula-fed and
with suboptimal immune regulation in babies who are
They have more pathogenic bacteria in their gut, meaning formula-fed.
they have more E. coli, which is more infection-producing,
and less bifidobacteria,
your chest and it produces which is healthy gut flora. We see a smaller thymus gland and the thymus gland sits in
antibodies for infants. It's quite big in infants when they are born, and it gradually
shrinks down as they become adults. And it's much smaller in
breastfed kids because we know formula-fed kids than in
that there are factors in breast milk that stimulate that thymus gland to continue to make
antibodies and work on that immune system.
has atopic dermatitis as a We see more dermatitis. Many of you may know someone who
child, that itchy red rash that happens in the elbows and behind the knees.
We see much more of that in babies who are formula-fed. And we see more type 1 diabetes and a higher risk of leukemia in
babies who are formula-fed. So let's talk about what our
goals are for breastfeeding in this country.
Well, the healthy people
country. movement is a movement by the federal government to establish goals where we want to take our
just going to focus on And so they had the healthy people 2010 goals for all kinds of different things, but I'm
breastfeeding goals. And so now we're beyond that and
breastfeeding goals. we're looking at the 2020
And so the breastfeeding rates that we hope to see at birth, meaning a mother gives birth to
a child and puts that baby to the breast, we're hoping that about 81.9% or 82% of moms will put their babies to the breast.
We're hoping at three months
that at least 46.2% of mothers are just nursing and not giving their babies anything else
such as solids or formula.
We hope at six months that 25.5% of moms are still just
or any formula, and that at least 60% are at least nursing, not giving any solids
34% of moms are still nursing their babies. And here we are, just wanted to show how we compare to the rest
of the country here in
Wisconsin. We have about a 40% to 49%
months. And you can see where we kind of breastfeeding rate at six
sit with our other shades of similar color.
And you can see out west and in Alaska they have much higher
breastfeeding rates, more than 50% of babies are being nursed
at six months.
And then there are some areas in the south that are actually extremely low with
breastfeeding.
Less than 30% are being breastfed at six months. If we look at our report card,
there are a number of different surveys, and, in fact, I just got an email today or yesterday about the report card for 2011
which I didn't open up yet for
Wisconsin. But basically if you look at
2009, hoping to meet those 2010 goals, which we pretty much did, these rates, this is sort of, in
At six months we were hoping we had a 75% initiation rate in Wisconsin and the goal was 75%.
So that's actually not too bad for 50%, we got to 48.6%. At 12 months we got to 25.9%, and we were hoping for 25%.
in Wisconsin, but we can do much better. The big issue is the disparity
in breastfeeding rates in the United States and that's still
blacks have a much lower rate. very significant. You can see that non-Hispanic
Although, that has risen pretty quickly. And in fact, for a long time
it was the increased rates of breastfeeding were largely among
But they still lag significantly African Americans in this country.
important for us to remember is that we have a very high infant mortality rate among African And I think what's most
state. Americans in this particular
numbers, they're actually pretty Particularly in the southeast portion of our state. And if you look at these
mortality rate in Kenosha County, I keep losing my cursor, a call to action. If you look at the infant
who have died. among whites, we have about a 4.83 infants per thousand
And these are rates averaging between 2004 and 2008. And for African Americans
it's 15.14. In Milwaukee County,
So about 16 per thousand 6.56 Caucasian, 15.93 for African Americans.
black infants are dying in Milwaukee County each year. So if we look at Wisconsin
overall and we look at
And so the question is what does the black to white ratio, black babies die at three times the rate as white babies do.
this have to do with breastfeeding?
probably plays a pretty important role, not the main Well, in reality breastfeeding
African Americans in this state is prematurity. So there's a lot of work that has to be done to make sure that
these moms are getting to term
with their babies. But once the babies are born we know that they have low
breastfeeding rates, and some of
these babies could survive if we saw higher breastfeeding rates. We would see lower sudden infant
death syndrome, we'd see less neglect and abandonment.
illnesses, and we would see less We'd see fewer hospitalizations for respiratory and GI
in something called necrotizing enterocolitis, which is one of the main reasons
why premature babies die. They die from gut inflammation
So what are our barriers in this from not having the right food, which is breast milk.
country and in this state to successful breastfeeding? Well, first of all, we still
have a lot of difficulty with hospital practices. Many of the practices that we talked about back in the 1920s
through the 1950s have persisted
in this country. We still have a lack of staff education.
We have staff values that trumped evidence. We have routines that interfere with breastfeeding.
And we'll talk a little bit more
to promote breastfeeding, and abless than 5% of hospitalshe actually have ideal practices in the quality of hospital practice
the routines throughout the day to encourage breastfeeding, to promote breastfeeding. We have medical interventions.
Many physicians know nothing
about breastfeeding. I teach students all the time.
medical schools where they say I teach residents who come from
they have received no lectures on breastfeeding. And so we have physicians
out there who have never been trained in breastfeeding. And so they're making recommendations to women who
perhaps have, let's say, high thyroid function telling them that they need to stop
receive radioactive iodine. Well, that's not necessary. There are other options there. breastfeeding so they can
reasons why a woman medically needs to stop breastfeeding. So usually there are very few
So I tell my patients before someone tells you that, call me.
Lack of social support is still very important in our country.
We'll talk a little bit more about that.
Lack of education within the
persist. lower socioeconomic groups. Employment is still a barrier and formula advertising forces
So the baby-friendly hospital initiative, I spoke a little bit about that before, but these are
steps a hospital can take to
reduce barriers to breastfeeding success.
the baby room-in with mom in the And these are things like having
hospital, making sure that babies are not automatically
supplements, educating the staff being given pacifiers or
and family about breastfeeding and making sure that moms have a
follow-up after they leave the place to go for really close
hospital to make sure things are going well. And so there's actually a
certificate that hospitals can
get to be established as baby-friendly.
this country that are certified, And there are 114 hospitals in
which is very, very few. And seven of those hospitals are
So we have more than your average and especially for the actually in Wisconsin.
size of our state, we're doing really well with our
baby-friendly hospitals.
But the medical system is not doing so well. We still have a lot of
difficulty getting insurances to
cover lactation consultations and covering pumps and other paraphernalia that's sometimes
needed for moms to be successful
with breastfeeding. We have little to no breastfeeding education training
in schools of nursing, medicine,
unintentionally will thwart breastfeeding such as giving professional schools. And physicians still
hospitals have become sort of agents for these formula gift packs. And many physicians and
These are plagues that we're companies giving these gifts. And these are not gifts.
maybe you need that formula. giving to women giving them mixed messages that yes we want you to breastfeed but here,
There's also still a strong lack of social support.
that we don't recognize that. Recently in last couple years Wisconsin finally passed a law I think it's so engrained in us
breastfeeding women which basically implies that that outlaws harassment of
breastfeeding is not normative because who would think that you
need a law to tell someone to stop bothering a breastfeeding
woman. And even with many states having
those laws, it still happens on a regular basis.
And family, even though family and friends may think that they
are encouraging breastfeeding,
sometimes they give really mixed messages so that if a woman's nursing and her friends or
family say, hey, have a couple
drinks. No, I'm nursing. Oh, can't you just pump and
dump? Whereas, the woman really can have one drink and she can just sort of have that drink over the
course of an hour, but why is drinking so important?
I think the biggest thing is infant sleep.
When people start talking about your baby's not sleeping through
the night yet? And your baby's three months
old?
You shouldn't have to get up and do that, you shouldn't have to
And physicians are just as feed.
guilty about that. Your baby's six months? No your baby doesn't need to
feed at six months, you need to just let that baby cry. And sleep is a work in progress that first year.
If a woman allows a baby to sleep throughout the night at four to five months, she is going to lose her milk supply or
diminish that greatly.
She'll get her period back. Her prolactin levels will drop quite a bit.
She's also at risk for
infection. So it's normal for these babies to wake up in the middle of the
night.
They can nurse a baby, get back to sleep, still function the next day.
That's why women in their 20s and 30s have babies and women in
their 70s and 80s don't have babies.
Just these messages that we give
and I'm not, and that actually women really tell women well, gosh, maybe I'm doing something wrong, maybe the baby's winning
has a real negative effect on breastfeeding. Employment is an issue.
Unpaid maternity leaves.
Women want to get back to work earlier because they need the income.
Oftentimes there's not a good place for women to express their
women who are on the move such milk. And this is especially true for
as mail women and police officers. And so communities could do a
better job in providing places
there actually is a clause in there and a law that companies meet their babies to nurse. In our Healthcare Recovery Act
or pump their milk. And I think that many companies ndon't realize this and manyd tiwomen are not empowered tose
confront their Human Resources
But on the other hand, it's a huge benefit to corporations know, this is a law, you're supposed to help me with this.
and there's so much evidence to support breastfeeding. There is so much literature now
that corporations that support breastfeeding women actually
absenteeism because their babies have a decreased rate of
are healthier so the women are missing less work.
because women are so proud that not only can they continue to provide breast milk for the Thbabies but they're alsoon
productive at work and they're
bringing home a paycheck. There's decreased healthcare expenditures not only for the
women but also for the babies because they're healthier.
If a mother has had a baby and And there's improved employee satisfaction.
she can pump and she knows she may have a few more babies and
going to make accommodations for she knows that the employer is
her, she'll stick around. So that's quite important. And we save as a nation.
One estimate is that there's
for at least six months. I like The Lorax, that was one year of my favorite books when my exclusively breastfed
"Unless someone like you cares kids were little.
the last few minutes, what are a whole awful lot, nothing is going to get better, it's not." So let's talk a little, just for
Dr. Benjamin, put out a call to breastfeeding action messages? Well, our new Surgeon General,
obstacles to breastfeeding in January, 2011. And her call was to remove
success and also to decrease disparities among races in
And she encourages breastfeeding.
mother-to-mother support in communities. She encourages hospitals
to become designated
as baby-friendly and that healthcare providers should
care for breastfeeding couples, mothers and babies. Families should give mothers become knowledgeable to properly
provide paid maternity leave and support and employers should
high quality lactation support. And if anyone's interested, if you just Google the Surgeon
General's call to action, you'll
find this information. Just in June, the Institute of
we need to be breastfeeding, Medicine came out and said
we need to breastfeed babies in order to prevent obesity in children birth to five.
And they strongly advocated that
breastfeeding, that babies needed to be breastfed
meaning no formula or solids, and at least for one year. exclusively for six months,
initiative again, just like Dr. Benjamin, and encourages the They encouraged the baby-friendly hospital
hospitals to enforce the World Health Organization code of
marketing of breast milk
substitutes, which I mentioned before, which is to not allow companies in this country to
market directly to patients,
or allow hospitals or doctors to give away free gift packs of formula.
And just in the last couple days, the CDC puts out something
called the morbidity and mortality review every week
which is about a public health
And they also strongly topic and their most recent public health topic this past week was about breastfeeding.
recommended breastfeeding, stating that breastfeeding for
odds for becoming overweight nine months reduces a child's
by more than 30%. Although 75% of US women begin breastfeeding, only 31% are
still breastfeeding at nine months. And suboptimal breastfeeding in the United States results in an
estimated $2.2 billion annually in additional direct medical
to support breastfeeding are costs to our country. Hospital policies and practices
crucial for improving breastfeeding rates. However, as we talked a little
bit about this before,
only 3.5% of hospitals, so it's probably those 114 hospitals that are baby-friendly, actually
have adequate policies in place to support women to make sure that they are leaving the hospital and breastfeeding
successfully. Facilities that provide maternity care need to adopt
such as baby-friendly, these evidence-based practices,
recognizing how breastfeeding is that right start in life to reduce obesity, but we know, at least I know, that obesity is
just a huge issue for chronic disease.
If we can reduce obesity, we can reduce the number of knee
replacements, hip replacements, the amount of hypertension, diabetes, strokes, heart
fibrillation. These are all the things I'm attacks, blood clots, atrial
going to the hospital for on a regular basis to care for, and I
would say at least 50% of what
I'm caring for in the hospital now is obesity related. So this is a very important
issue, and I'm so glad that our government has recognized this. So we've come a long way in the last 50 years.
Not breastfeeding is associated with chronic illness in the United States.
is not normative yet. We still have a lot of barriers to breastfeeding success, and it's important to further
research and discuss the risks
of infant formula-feeding. My final slide: drink human milk.
Thank you very much for having
me. It was a pleasure to speak to y[APPLAUSE] g.