Nurse Marla Newmark believes in practicing what she preaches.
As a professional lactation consultant, she teaches new mothers to breast-feed.
As a mother, she has 11 children -- the oldest of whom is 21 and the youngest of whom she is still breast-feeding at 5 months.
"Breast milk protects the baby against infections and lessens the chance of allergies. And, I think it makes the baby smell better," says Mrs. Newmark, who works at Greater Baltimore Medical Center.
Indeed health care professionals have been saying for years that breast milk is the baby food nature intended: Its balance of nutrients is the perfect blend. The antibodies that pass from mother to baby through the milk protect the child from respiratory and gastrointestinal infections, so there are fewer colds and episodes of diarrhea. The mother-to-baby bonding that occurs during breast-feeding is an emotional plus for both of them.
But doing what comes naturally isn't all that natural to a lot of women -- and a study published in the journal Pediatrics in October showed a dramatic decline in breast-feeding in the latter part of the '80s -- after increasing throughout the '70s and early '80s. Whereas 61.9 percent of new mothers initiated breast-feeding after delivery in 1982, only 52.2 percent did so in 1989. And just 18 percent continued to breast-feed for six months in 1989, compared with 27 percent in 1982.
The study, which was based on statistics gathered by Ross Laboratories, an infant formula maker, also found the preference for formula feeding was most pronounced among younger, poorer, less educated, unemployed, ethnic-minority women.
To health professionals, this is no surprise. "The statistics have always been low for inner city, undereducated families," says Dr. Virginia Keane, medical director of the pediatric ambulatory center at University of Maryland Medical Center -- and a breast-feeding mother herself. "In the population I see, there's virtually no breast-feeding."
But there's no single reason for the decline, says lactation consultant Susan Will of Sinai Hospital. "If there were," she adds, "we could fix it."
There are, however, two possibilities that head the list. "So many women are planning to return to work -- and they don't realize that it pays to nurse even if it's only for a few weeks," says Mrs. Newmark. And many women don't realize they can continue to breast-feed after returning to the workplace: They can pump and bottle breast milk for other care givers to give to the baby while they're away, and breast-feed directly when they get home.
But, as Ms. Will points out, "The workplace is not always a supportive environment for [pumping] breast milk."
Another probable cause is lack of social-emotional support from family members, says Judy Vogelhut, lactation consultant at Johns Hopkins Hospital. "This generation having babies now doesn't have the support of a mom, or aunt, or someone who has done it."
"Some moms are not getting the family support they need," agrees Renee Marchand, lactation consultant at Franklin Square Hospital. "A lot of mothers and mothers-in-law did not breast-feed, and are not comfortable with the idea."
In addition, doubting their ability to teach their babies to do it right, new mothers may also begin to supplement the breast-feeding with formula; and that, Ms. Vogelhut says, is their "downfall," since the baby's got to learn a different, nipple-only // technique for bottle feeding.
Advice and encouragement could counter those problems, says Judith Yankelove, a local leader of LaLeche League, which offers mother-to-mother aid in breast-feeding. "But sometimes [mothers] don't seek help early enough."
And, says Ms. Will, "There's increased marketing of formula directly to the consumer, with TV ads and direct mailings to the home. If the mother is having any problems at all with breast-feeding, she may decide it's easier to provide 'the next best thing.' "
For poor women, there's a special temptation to switch to formula: If
they're on the WIC (Women, Infants and Children) Supplemental Food Program, they can use their food vouchers to get their formula free.
Health care professionals are making special efforts to reach these mothers. For example, at University of Maryland Hospital, lactation consultant Bernadine Geary is "teaching that if they breast-feed, they get more food for their vouchers; if there are small children at home, that is of greater benefit than getting quantities of formula."
WIC mothers who deliver at Franklin Square Hospital in Baltimore County can also be advised by a cadre of other WIC mothers, trained in the womanly art of breast-feeding. "They've got someone on the same wavelength, someone who speaks their own language and has the same concerns," says Renee Marchand, a lactation consultant at the hospital.
All over the state, in fact, there are special efforts to encourage breast-feeding in all populations. Most Maryland hospitals now have lactation consultants on staff to teach breast-feeding in prenatal classes, offer continuing support after discharge from the hospital.
Post-discharge follow-up is especially important for mothers discharged just a day or two after delivery, because the mother "might not be comfortable with breast-feeding yet," says Ms. Will, at Sinai Hospital.
"Sometimes the mother will say, 'I want to know my baby is getting enough.' Some of them come back, and I see them on an outpatient basis."
Lactation consultants have also been battling the traditional policy of including a sample can of formula in the pack of baby supplies new mothers get at discharge. Several of them say that breast-feeding mothers do not get the formula unless they specifically request it; others say their hospitals are planning to adopt a similar policy.
And they work with other family members, too. "The mother is the one who physically does it," says Mrs. Newmark. "But without the support of her significant others, she will probably fall flat on her face. . . . Fathers today want to be involved, so I educate them about holding the baby, cuddling the baby, changing the diapers, doing the laundry and mothering the mother."
With all the efforts, some area health officials think the results of their efforts are beginning to show. At Franklin Square Hospital records show an increase -- up from 32 percent to 41 percent -- in the number of women who initiated breast-feeding after delivery between 1989 and 1990. And breast-feeding at 6 months went from 10 percent to 20 percent.
"We really believe it's because we are giving them continuous support once they leave the hospital. They're not just dropped into a hole, with no one to call," Ms. Marchand says.