Maternity Monday: Breastfeeding Barriers and Benefits

When I meet with Ann Kellams, MD and Lynn McDaniel, MD, in the sunny conference room of the maternity floor, they speak eagerly and passionately about the changes taking place in the world of breastfeeding.

preconception, pregnancy and childbirth
Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

“When my father was born, my grandmother was knocked out and put to sleep,” McDaniel says. “She woke up and there was a baby. We forget what it was like.”

There have been a lot of changes.

Certainly, the way our culture has treated pregnancy, birth and breastfeeding has significantly altered throughout the last century, and that change is reflected in hospital practices across the country.

“Even if you had kids 5-10 years ago,” McDaniel notes, “The information and the procedures after delivery are different.” For instance, newly instituted at UVA:

  • All babies are put skin-to-skin with their mother immediately after birth
  • Babies sleep in the same room as their mothers at all times
  • All staff have been trained to support breastfeeding mothers, in the NICU
  • Lactation consultants visit new mothers regularly

Kellams, who directs the Breastfeeding Medicine Program that has lead the way in implementing these types of policies and procedures, has achieved great success:

  • UVA is one of only 12 hospitals recognized by the Virginia Department of Health for its support to breastfeeding moms.

    Breastfeeding experts Kellams and McDaniel
    Breastfeeding experts Kellams and McDaniel “want you to love feeding your baby and feel good about it.”
  • In 2014, a federal survey ranked UVA Medical Center in the top 5 percent of hospitals nationally for its support of breastfeeding.
  • Just last week, the Children’s Hospital earned an international award for its support of breastfeeding mothers.

“We have made major changes to ensure that every mother has the best chance of reaching her feeding goal and that mothers and babies have the smoothest transition possible both after birth and when they go home,” says Kellams.

Even better than the awards and recognition? The health improvements visible in their patients.

With the increased rate of breastfeeding mothers, Kellams and her team “see less weight loss, less jaundice, less babies with fast breathing rates after delivery, more stable conditions all around. We’re optimizing the conditions to make this organic process occur naturally. Removing the barriers that 50 years of medicine put in place.”

Breastfeeding Barriers

About 80 percent of women giving birth at UVA choose to breastfeed. So what is happening with the 20 percent who do not?

Cultural and Historical Context

“Before WWII,” Kellams explains, “If a mother died or couldn’t breastfeed, then mom, sister, friend would breastfeed the child. After WWII, we developed formula, and women started working. Science came in and everyone jumped on the formula bandwagon. And it was expensive, so it was a status thing.”

Breastfeeding Benefits

For the Mother:

  • Lower rates of breast/ovarian cancer
  • Lower rates of type 2 diabetes
  • Quicker return to baseline weight
  • Less postpartum bleeding

For the Baby:

  • Lower rate of infections, especially for premature babies
  • Lowers SIDS rates
  • Lessens diabetes risk
  • Fewer ear infections
  • Fewer allergies
  • Better immune function
  • Better digestion

In countries like Mexico and China, she notes, people perceive formula as a status symbol, because of its costs.

Cultural values around modesty and sexuality also play a role in restricting public breastfeeding.

Stress and Lack of Planning

McDaniel wants mothers to think “pre-conceptually. Post birth can be so stressful, I’d prefer that moms think about this before they deliver, when fatigue, pain, stress make thoughtful decision-making difficult. Get as much info as you can beforehand. You need to come in with a commitment and a plan.”

That’s why the first step in the breastfeeding program begins with prenatal consultations. “We want to give you all the information, so you can make the best choice for you and your baby,” Kellams notes. “As a new mom, you need all the knowledge you can get.”

In fact, Kellams and McDaniel have found that successful breastfeeding can improve a mother’s ability to manage post-partum depression. “Breastfeeding is a protective factor for depression. Instilling mom’s confidence in her body is a way to protect moms against PPD.”

Hospital Practices That Miss the Golden Hour

A huge culprit when it comes to factors that hinder breastfeeding: Hospital practices that remove the baby from mom.

The sooner you feed your baby, the better. Professionals call it the golden hour or power hour, the time right after birth when the largest amount of colostrum releases (the most protein and nutrient-rich part of breast milk) and the highest prolactin level exists in the mother.

If you do the first feeding in the first hour, and keep the baby with the mother, the benefits include:

  • The baby eats more later
  • The baby receives a boost to the immune system
  • The baby’s vital signs are more stable
  • The unit is quieter, due to fewer babies crying

Keeping the baby with the mother, eliminating the need for a nursery, reflects a big shift in best practices. “We used to say you should do this for various reasons, give the mom rest, etc.,” McDaniel says. “But now we know that separating them sets them up for failure.”

Medical or Other Hindrances

According to Kellams and McDonald, not many medical issues exist that completely prevent a woman from breastfeeding. Even procedures like C-sections do not render breastfeeding impossible.

Certainly, being HIV-positive, a drug user, a prison inmate or having some emotional barriers due to abuse could interfere with a breastfeeding plan.

Breast Pumps: Lack of Access

One barrier to sustained breastfeeding occurs if the mother needs a breast pump, either due to a medical condition or to return to work, and can’t afford to buy one.

At UVA, “We are now starting a program where we will have the insurance-approved pumps for mom. If they need to go back to work, we will provide that and it will get billed to insurance. We give prescriptions. WIC comes to the hospital, and they provide pumps. We provide hand pumps. We test pumps if they aren’t working well. Help mothers find a pump to rent before they leave the hospital.”

How UVA Helps

At UVA, we help you manage these barriers to breastfeeding.

Post-Hospital Support

The UVA program also sees mothers after they have returned home. They can help a mother manage:

  • Dealing with medications
  • A dwindling milk supply
  • A baby refusing a bottle
  • Mastitis
  • Soreness
  • Oversupply
  • Nursing when the baby is hospitalized

Supporting Your Choice

“Everyone that starts thinking about breastfeeding worries the doctors will pressure you into it,” notes McDaniel. But that’s not the approach the doctors at UVA take.

Certainly, the benefits to both mother and child clearly make the case for breastfeeding as opposed to formula feeding. But, McDaniel says, “In the end after all the info we give you, your choice is what we’re going to support. The thing we want most is we want you to love feeding your baby and feel good about it.”

Get Breastfeeding Support

Preparing to Breastfeed?

Problems Breastfeeding?

We can help: Call or visit the Breastfeeding Medicine Clinic

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