It was my first day seeing patients after my maternity leave. I was excited to have a newborn on my schedule, hoping that my recent experiences as a new mother would help. The first-time mom was struggling to breastfeed her baby and wanted to switch to formula feeding. I asked the mother to breastfeed her son so I could observe and offer assistance.
While watching the mother become increasingly frustrated as her son struggled to latch, it took me back to those first hazy, sleep-deprived weeks after my son Henry was born. Henry was born small for gestational age with a severe tongue-tie, both of which made breastfeeding a challenge.
As a pediatrician, I was well versed in the intergenerational benefits of breastfeeding—infants who are breastfed are less likely to have respiratory and ear infections, be diagnosed with asthma, and die from Sudden Unexplained Infant Death. Mothers can experience short-term benefits from breastfeeding including decreased blood loss after birth and long-term effects such as a decrease in the risk for breast and ovarian cancer, high blood pressure, and diabetes. In addition to the health benefits, a study of the financial implications of infant feeding found that the United States could save over $17 billion a year if 90 percent of babies were breastfed according to recommendations.
Given these known benefits and my desire to breastfeed Henry, I immediately investigated support services available to me when we encountered problems. Fortunately, my insurance paid for a lactation consultant who made weekly home visits. I made Henry an appointment with a specialist who fixed his tongue-tie. My insurance paid for a hospital-grade breast pump, which allowed me to bottle-feed Henry breast milk when he couldn't latch.
A private speech therapist also helped Henry gain more strength and coordination with feeding. Finally, I attended a weekly breastfeeding support group and family helped when I brought Henry to frequent weight checks at our pediatrician's office. Because of this army of support, I was ultimately able to breastfeed Henry and five months later we are still going strong.
In response to the recent news that the U.S. opposed a World Health Organization breastfeeding resolution that in part aimed to limit misleading marketing of breast milk substitutes, the U.S. Department of Health and Human Services has issued several statements that have emphasized that women who cannot breastfeed should be "supported with information and access".
I wholeheartedly agree that we should support and not stigmatize mothers who choose to formula feed. In fact, following guidance from the the American Academy of Pediatrics, I recommend formula feeding in certain circumstances, for example, if the mother is on a few medications such as chemotheraphy or radiation, or if the baby has specific metabolic disorders. However, my experiences have taught me that what many mothers need are more supports to help them initiate and continue breastfeeding. While it is natural, breastfeeding is certainly not always easy.
These supports should not only be easily accessible to pediatrician-mothers and others who know how to navigate the system. In fact, there are well-documented socioeconomic, racial and ethnic disparities in breastfeeding rates. Though the reasons for these inequities are complex, disparities in access most likely play a role.
The first-time mom I observed is covered by Medicaid, which in many states does not reimburse for home-based lactation consultant visits. These visits had helped me achieve breastfeeding success. And unlike my paid maternity leave, the mother is not being paid while she is home with her son. This is an important difference as a recent study found that mothers with 12 weeks of paid leave were more likely to breastfeed. Finally, the mother's work situation did not allow for much time away giving her less of an opportunity to seek support services and work with her son to improve his latching.
Now, more than ever, I'm acutely aware of the challenges that mothers can face in accessing adequate breastfeeding supports. As a pediatrician, I do my best to find mothers like the one I described necessary services, such as free breastfeeding support groups, and spend more time with them on coaching. But until they have equal access to the comprehensive set of services that was available to me, we can't expect all mothers who face initial challenges to be successful with breastfeeding. This message of health equity is the most important message I think we can share following World Breastfeeding Week.
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Stacey Kallem, MD, MSHP, is a researcher at PolicyLab at Children's Hospital of Philadelphia and a primary care pediatrician.