Four weeks ago, Anna delivered a healthy boy. As I entered the exam room, she had tears in her eyes and a look of despair.
Before I could ask one question, she confided, "I've failed as a mother and a woman."
Despite lots of help and exposure to lactation specialists and nurses, Anna had not been able to breast-feed. Her breasts were not producing enough milk. Her advisers insinuated that she wasn't really trying, although she was doing everything they told her and more.
Anna felt guilty for not being able to do what it seemed like every other woman could do. To make matters worse, the experts told her she was depriving her son of a nutritional head start on life.
While formula milk is simply food, breast milk is a complex liquid containing food, immunological protection and hormones important for the baby's growth. Breast-fed babies have a lower chance of developing diarrhea and respiratory infections. In developing countries, breast-feeding is critical, but even in the United States, there are long-term benefits. Older children and adults who were breast-fed have lower rates of obesity, ear infections, diabetes, asthma, adult high blood pressure, adult high cholesterol and some cancers.
For all these reasons, most medical groups recommend breast-feeding children for a least six months. Yet the majority of U.S. women do not choose to breast-feed, a concern for public health experts and the medical community.
Jan Babb, a researcher and director of maternal and child health in Yolo County, notes that 43 percent of Californian women elect to breast-feed – a higher rate than in much of the country but low compared with Norway and some African countries, where 65 percent of women breast-feed.
Some hospitals are working to teach new mothers about breast feeding and achieve a designation as a UNICEF "baby friendly" hospital. But there are significant barriers.
For financial reasons, most women are discharged before they are even able to breast-feed. Once discharged, it is often two to three weeks before they next see a medical professional. In addition, in a survey conducted by the CDC, 70 percent of hospitals reported sending women home with free samples of infant formula – the clear message being that medical experts think it's good.
Some hospitals don't have lactation experts, mostly to lower overhead. Lactation experts teach a woman far more than just how to breast-feed. They teach how often to feed, how to perceive hunger, how to cope with colic, how to deal with breast pain and how to prevent infections.
Some women still hang onto myths or perceptions, especially the one that links breast feeding to poverty. In past advertising, formula manufacturers equated formula feeding to sophistication and wealth.
Even among those women who agree to start breast-feeding, most will stop after one month. In Babb's studies, she found that nearly half the women did so because they returned to work – even though employers must accommodate breast-feeding.
Sometimes the medical community can be overzealous in attempts to push people to do what we insist is good. Anna gave breast-feeding a noble attempt, and it just didn't work.
What may work for many new mothers may not be good for every single person. The vast majority of formula-fed babies will grow into healthy children and adults.
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Reach him at drwilkes@sacbee.com.
