Breastfeeding

Part of an ad for the Latch On NYC initiative.

It’s a typical labour ward scene:  an exhausted new mother struggles to attach her crying baby properly to the breast. The baby is taken to the nursery, where he is fed infant formula.

This scenario is now far less likely in one city, since The Mayor of New York, Michael Bloomberg, introduced an initiative to improve breastfeeding rates. Known as Latch On NYC, the program promotes breastfeeding while limiting formula use in signatory hospitals to when medically indicated – or expressly requested by the mother.

The fact is, most women want to breastfeed. But despite such platitudes, physical support for new mothers is sorely lacking 

Bloomberg has since been dubbed the Chief of the Breastfeeding Police by women who are outraged that their choice in how to feed their baby is being limited by public officials. They are worried that their babies will starve if they cannot breastfeed them successfully. These are valid concerns – but are they warranted?

Well, not quite. According to the Latch On New York website, formula will not be kept under lock and key in hospitals. Formula will be taken out of gift bags, welcome packs, mother’s rooms and baby bassinets, but will still be available from hospital staff.

The voluntary code sounds very similar to the Baby Friendly Health Initiative (BFHI), which many Australian hospitals have implemented. The BFHI was developed by the World Health Organisation and UNICEF in 1991 and has been implemented in over 150 countries worldwide, where, in some areas, it has been credited with doubling the numbers of women who exclusively breastfeed.

Ninety percent of New York City mothers start breastfeeding. However, by the time the baby reaches two months, only 31 percent of NYC mothers are still exclusively breastfeeding. In Australia, the figure is double that.

The fact is, most women want to breastfeed. They’ve read the books and know that breast is best. But despite such platitudes, physical support for new mothers is sorely lacking.

I was committed to breastfeeding my first child - I even went to breastfeeding classes while pregnant. I was a lactivist who wasn’t yet lactating. I expected a beautiful breastfeeding relationship with my baby. What I didn’t  expect was a revolving door of postnatal midwives, all of whom offered different advice, but none of whom diagnosed a problem with my son’s sucking reflex, which made it very difficult for him to extract enough milk to gain weight adequately. I left hospital with nipple shields but without having been seen by the hospital lactation consultant.

Understanding of the complex relationship between milk supply and demand is also sorely lacking. Many mothers bemoan that their milk didn’t arrive until day three, four or even five. They ‘had’ to give formula or their babies would starve. In fact, it’s normal for milk to take a few days to come in. Babies are usually born with extra fat reserves so that they can manage on tiny amounts of colostrum, which contains antibodies to protect the newborn against disease, as well as being lower in fat and higher in protein than ordinary milk. The cries from a baby in the first few days -  as well as skin-to-skin time and frequent feeding attempts -  will help to bring a mother’s milk on, which is one of the reasons that the BFHI recommends babies rooming in with their mothers.

Once again, rooming in is great in theory, but for women who have undergone a c-section or difficult delivery, being in sole charge of a newborn can be exhausting, even terrifying. Midwives are thinly stretched and patients who don’t have a private room aren't permitted to have a partner or family member stay with them overnight, to bathe and settle the baby or take him on a walk in between feeds so mum can have a rest.

Without even mentioning the cracked nipples and other common but unpleasant early breastfeeding problems, it’s easy to see why breastfeeding is put in the ‘too hard’ basket, or supplemented with formula feeding, especially once a woman returns to work. Paid maternity leave is not mandated in the United States.

Formula (or 'artificial milk', a term most mothers hate) isn't evil. But as science discovers more about the role of breastfeeding in creating healthy gut flora and consequently a healthy immune system, I believe it’s fair that hospitals move to a medically indicated model when it comes to handing it out.

If a woman doesn’t want to breastfeed or feels that she cannot, then please, medical professionals, respect her decision. Don’t lecture or belittle. Allow her access to information while respecting her authority as a mother. And remember that all the slogans in the world don’t compare to a helping hand in the wee hours of the morning.

NYC breastfeeding row: join the conversation in our forum, or comment below.