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Milking it

To boost breastfeeding, an initiative new to Oklahoma says hospitals must stop undermining their own efforts.

Rachel Curtis October 31st, 2012

A nationwide campaign to increase breastfeeding rates by eliminating the marketing of commercial formula in hospitals is being rolled out in Oklahoma, which ranks 37th in the nation for breastfeeding.

The Ban the Bags program calls on hospitals to cease distribution of formula gift bags to new mothers, which proponents call “pure marketing” that undermines efforts to promote breastfeeding as recommended by the American Academy of Pediatrics and the World Health Organization.

“When a hospital hands out a name-brand formula, it’s considered an endorsement,” said Karen Prior, a Breastfeeding USA counselor in Oklahoma City.

Gift bag critics note that the samples are of premium brands. Hospitals receive them free, but they can cost formula-feeding families $700 more per year than a generic brand.

To date, 24 Oklahoma hospitals are participating in the Ban the Bags program.

Rebecca Mannel, leader for the Oklahoma Hospital Breastfeeding Education project, makes clear that participating facilities will continue to supply formula for moms who prefer it. The University of Oklahoma Medical Center has been bag-free for four years and buys its own formula — the same as any other food product it provides.

Mother’s milk

Breastfeeding in the health community is the result of consistent evidence demonstrating that human milk provides a plethora of benefits to moms and babies, many of which counter ailments that disproportionately afflict Oklahomans.

Take obesity and diabetes, for which Oklahoma ranks seventh and sixth in the nation, respectively. Breastfeeding has been shown to lower the risk of obesity by 24 percent, the risk of Type 2 diabetes by 40 percent and the risk of Type 1 diabetes by 30 percent.

Breastfeeding also reportedly lowers the risk of leukemia (for which Oklahoma ranks fifth highest in the nation) and gastrointestinal disorders. The incidence of acute infections (such as of the lower respiratory tract) drops 72 percent in babies who have been breastfed for at least four months.

Mothers benefit, too. They are more likely to lose their pregnancy weight — breastfeeding burns 500 calories daily — and less likely to develop reproductive cancers and postpartum depression.

Easier said than done

Despite the clear advantages that could alleviate some of the state’s heaviest health burdens, Oklahoma’s rates lag: Among babies born in 2009, 71.4 percent were ever breastfed and 10.4 percent were still breastfed exclusively at six months, compared to 76.9 percent and 16.3 percent nationally.

What’s more, the U.S. rate is one of the lowest among industrialized nations. A 2010 study by the American Academy of Pediatrics estimated that Americans would save $13 billion a year in medical costs if 90 percent of families followed current recommendations.

Mannel and Prior agree that the greatest obstacle to breastfeeding is lack of support.

The first weeks are critical, said Prior. During this time, babies develop muscles to suckle, milk supply is established, and moms learn proper latching and gain confidence to continue. For many, if these techniques aren’t learned at the hospital, they aren’t learned at all.

Even strong starts with health care providers can be derailed by well-intentioned family members who insist on “helping” a mother by supplementing with formula.

Workplaces can present another hurdle, quietly discouraging pumping at work without expressly for bidding it. Although state law requires employers to provide unpaid breaks to pump, it may be up to moms to find a private place to do so.

Culture plays a role as well. “We see a woman breastfeed in public and we think it’s indecent,” said Mannel.

“Yet we see a woman giving a bottle, and we think ‘Oh, she’s feeding her baby. How cute.’” Physical challenges, like painful latching, engorgement, inverted nipples and thrush can be daunting, but Prior believes the majority can be overcome with sufficient assistance.

The days after delivery have the greatest impact, potentially making the difference between a mother who succeeds, and one who gets discouraged after discharge and reaches for the formula she got from the hospital.

Prior likens the practice to giving credit cards to people most likely to default.

“We don’t do this in any other area,” said Mannel. “We don’t give bypass patients, who we’ve spent days educating about exercise and diet, coupons to Wendy’s on their way out the door.”

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