Why do women fail at breastfeeding?

“I gave birth on a Friday. There was no lactation help over the weekend. A pediatrician would only discharge us, if we fed our baby 4 oz. of formula. I was anxious, didn’t know what to do, I fed him the formula and ultimately, I failed at breastfeeding my baby.”

It’s not fair to say women fail at breastfeeding.

Breastfeeding is often intuitive and straightforward, and many women begin breastfeeding easily and effortlessly. Yet, a high percentage of women blame themselves without ever really knowing why breastfeeding their baby didn’t work out.

It’s more accurate to say the USA fails at protecting mothers and we don’t have a chance to succeed.

I’ve been helping mothers breastfeed for over 20 years, and it can be heart-wrenching work. Imagine parents that didn’t receive any breastfeeding education in school health classes, or even breastfeeding education during pregnancy. Many mothers learn to breastfeed without any coaching and suffer in pain because they’ve never actually even seen a woman breastfeeding in real life. They have no idea what they are doing.

Somehow breastfeeding is considered so wonderful, so instinctive, and so natural, that we are expected to just intuitively be good at it.

Most parents do not take a breastfeeding specific class before birth. Most hospital programs are not providing new parents with enough teaching and coaching. Most pediatricians say they support breastfeeding. But if your baby isn’t gaining weight, they are quick to recommend formula, not a referral to a lactation consultant. (The American Academy of Pediatrics has a supportive breastfeeding policy.)

In the first weeks after birth, most parents are not confident that breastfeeding is going well. But, they can’t be sure because they have little, or no experience and knowledge with breastfeeding. And there are few clear benchmarks to measure how well they are doing. Literally everything they hear and see promotes bottle feeding and formula as normal.

So, many women are not meeting their breastfeeding goals.

About 80% of women in the United States leave the hospital breastfeeding. They would like to exclusively breastfeed about 6-12 months. Sadly, by 6 months of age, about 84% of babies are receiving some, or all, formula feeds.

The United States Healthy People 2020 set targets for babies to be exclusively breastfeeding. The targets for 2020 were: 82% of babies “ever breastfed”, 75% at 6 months, and 34% at 1 year. We did not meet this target!

Lack of breastfeeding is a cultural and structural problem.

Fortunately, all kinds of people in the USA are working to increase breastfeeding rates. We are making progress and the change is happening through three channels: 

1. Protection –  This includes laws that protect breastfeeding in public, pumping breaks at work, and paid maternity leave. It also includes education and policy statements for health care practitioners to follow. Also, laws requiring health insurance companies to include lactation counseling and breast pumps with maternity benefits. And importantly, includes limits on predatory marketing of bottles and formula.

2.  Promotion – What do women nursing in public, scientists publishing research, and government agencies creating public service ads have in common? They are all ways we promote breastfeeding. When doctors encourage women to breastfeed, display images of breastfeeding babies in their offices, that’s promotion. World Breastfeeding Month activities raise awareness of the people breastfeeding in the community where they are held.

3.  Support – This includes breastfeeding support groups, doctors referring women to lactation resources. It means training more lactation peer-counselors and consultants. It means that government programs providing breastfeeding information and supplies to the people they serve. This includes the whole parenting and healthcare alphabet: CDC, NIH, FDA, HHS, WIC, SNAP and Medicaid.

What’s keeping moms from doing what’s best for their babies? 

In 2011, the Surgeon General’s Call to Action to Support Breastfeeding identified seven barriers to breastfeeding.

During the past two decades, there has been a huge shift in promoting breastfeeding. Everyone knows that breastfeeding is good for moms and babies. But without a corresponding increase in protection and support, women get overwhelmed when they start breastfeeding, and they stop.

People stop breastfeeding because it’s just too hard to overcome breastfeeding barriers by themselves. It’s too hard to continue breastfeeding when your HCPs, health insurance, workplace and the general public are working against you.

It’s time for radical change in the USA.

We know that paid maternity leave, access to pumping facilities and time to pump at work are good for mothers. And, trained breastfeeding counselors, support groups, accurate information and family education increase the duration of babies breastfeeding.

It’s time for our government to put programs and laws into place. It’s time to ensure that our most vulnerable and most valuable asset, the babies of the USA, breastfeed.

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