It took a day or so of false starts, but newborn Jayden eventually got the hang of it. To the surprise of many new mothers, breast-feeding doesn't come easily to most newborns.
"I had a C-section early Saturday and no sleep all day, so it was a challenge," said Jayden's mother, Carrie Tyler of Nottingham, about her first attempts to breast-feed in her room at Greater Baltimore Medical Center. "But I was pretty determined."
Her efforts put her among the 73 percent of Maryland mothers and 75 percent of new moms nationwide who initiate breast-feeding, according to a new report card from the U.S. Centers for Disease Control and Prevention that measures how many women follow doctor recommendations.
And while the national number met goals set by federal health officials, many new moms aren't as resolute about continuing as Tyler, who says she intends to breast-feed for a year. The rates of breast-feeding at 6 months and a year and rates of exclusive breast-feeding at 3 and 6 months remained stagnant and low, the report card said.
Many in the field agree that bottle-fed babies are not going to be unhealthy, but they point to the prevailing wisdom on optimal nutrition. The CDC, American Academy of Pediatrics and the World Health Organization, among others, recommend that breast milk be fed exclusively to infants for the first 6 months and remain the main source of nutrients the first year.
The CDC says women appear to be interested and knowledgeable about the benefits because so many new mothers start out breast-feeding. Some states even far exceeded the government goals, such as Utah, where almost 90 percent initiated breast-feeding. Mississippi had the lowest number at 52.5 percent.
But there are barriers, including lack of support for new mothers — in obstetricians' offices, in the hospitals where they give birth and in their offices when they return to work, according to Kim Knight, a lactation consultant and the president of the Maryland Breastfeeding Coalition, which offers support to new mothers.
Knight said no hospital in the state sends a consultant to speak with every new mother who delivers, and none sends someone to every new mother's home to check on her progress. Further, many businesses do not have facilities for women to pump breast milk during the workday. There is a requirement for such space included in the federal health care reform law, though there is no timeline and no mechanism for enforcement.
"We think women are getting the message about the benefits of breast-feeding," Knight said. "But a lot more has to be done to support moms who initiate breast-feeding."
The coalition is working with businesses with 50 or more employees to comply with the new law. It has small federal grants of $300 to hand out to those that need help with their space — which Knight said needs to be nothing more than a room with a chair, a table for a pump and an electrical outlet, though some have chosen to add refrigerators, sinks and even pumps, she said.
She cited Under Armour, Northrop Grumman and Aetna as businesses in the state that now offer space for their breast-feeding workers. GBMC, Anne Arundel Medical Center and Johns Hopkins Hospital also were recently given the "Breastfeeding-Friendly Workplace Award" from state health officials. Knight says in return, the businesses can expect lower absenteeism, more productivity and lower health care costs because women who breast-feed tend to have healthier babies.
Next, the coalition is going to be working with teachers' unions to determine ways the state's teachers can comfortably pump at work.
The group is also trying to encourage doctors' offices to refer women to outside resources if they don't have time to coach new mothers having trouble breast-feeding.
"It's a learning curve," she said about the mother's ability to breast-feed. "If the answer at the doctor's is that there is trouble, there should be more outreach."
But she said there would be a payoff. An April report in the journal Pediatrics by two Boston researchers found the nation could save $13 billion annually on pediatric diseases and prevent 911 infant deaths if 90 percent of babies were exclusively breast-fed for the first 6 months.
The CDC says that's because breast milk is easily digestible and contains antibodies that can protect infants from bacterial and viral infections. And those who are breast-fed as infants are less likely to become overweight or obese as they grow.
Marla Newmark, GBMC's lactation coordinator for 21 years, said only in the past 40 years or so have the benefits become widely known and embraced. But she said each generation of mothers still learns that getting the hang of breast-feeding isn't always easy. (Keep at it and get help, she says.) Sometimes there isn't a lot of milk. (She recommends frequent pumping to encourage flow.)
At GBMC, her staff of nine sees every mother who wants to breast-feed — some 85 percent of those delivering there. And GBMC delivers more than 4,500 babies a year, typically ranking it in the top three hospitals in the state.
"It's only if they choose to breast-feed; there's no pushing, though part of us would like to," said Newmark, a mother of 12 breast-fed babies. "As a staff, we see each mother each day to offer help."
The hospital also offers online chats and a phone line for mothers after they leave. GBMC also sells and rents breast pumps.
Newmark believes many women quit out of frustration because they want it to work instantly. And while she will continue to encourage them, she also doesn't want women who can't or won't breast-feed to feel guilty. "There are plenty of healthy bottle-fed babies," she said.
Kariane Lam of Dundalk expects her son, Adam, born Sept. 25, to be one of them. She had planned to breast-feed her first baby, but after a bad car accident a month ago left her on strong muscle relaxants, she decided she didn't want to continue passing the drugs to her baby.
"I wanted to breast-feed because it would be a little healthier for the baby, and the doctors said it would be OK, but I thought it would be safer to bottle-feed and not take a chance," said Lam. "My mother bottle-fed me and my sister, and there were no problems."
New mom Keya Briscoe of Owings Mills had no such impediments to breast-feeding. She said she planned to breast-feed her baby "from Day 1 to give her the best start to life possible." She and husband, Cornelius, brought their 6-day-old baby, Kendall, for a checkup last week at GBMC, and they also stopped in the GBMC store to rent a pump.
Briscoe has an office at NASA, where she'll return to work in the new year, so she plans to continue breast-feeding.
"Breast-feeding is tough," said Briscoe, who took a class and has gotten some aid from GBMC staff. "It makes you feel a lot better when it works."
And Carrie Tyler agreed. As a nurse at Johns Hopkins Hospital, she knew of the health benefits. But when her baby didn't initially take to breast-feeding, GBMC staff recommended she supplement with formula — something she refused.
"I started breast-feeding, but it wasn't enough," she said. "It was definitely frustrating. But we got a lot of support and advice. ... My advice is stick with it."
And, adds husband Michael Tyler, drink a lot of water.
by the numbers
The CDC and other organizations recommend that babies be exclusively breast-fed for the first 6 months and get most of their nutrients from breast milk for the first year.
A new CDC report shows 75 percent of American mothers initiate breast-feeding. About 43 percent are still breast-feeding at 6 months and 22.4 percent are still breast-feeding at 12 months.
In Maryland, 73.4 percent begin breast-feeding. About 45.5 percent are still breast-feeding at 6 months and 17.9 percent are still breast-feeding at 12 months.
Here are some tips for feeding newborns from breastfeeding.com:
+Nurse the baby as soon as possible after birth.
+Make sure the baby is latching on properly to avoid soreness and allow proper milk flow.
+Avoid using artificial nipples.
+Don't limit the amount of time or frequency of nursing.
+Sleep when your baby sleeps.
+Use a sling to make nursing easier. And use pillows to support you and the baby.
+Make sure you drink enough fluids by consuming a glass of water each time you nurse.
+Don't wear tightfitting clothes or bras in the first couple of weeks after birth to let sore nipples heal.
+Report pain to your doctor or lactation consultant.