In January 2011, Surgeon General of the United States Regina M. Benjamin released the Surgeon General's Call to Action to Support Breastfeeding.1 Professional organizations such as the National Association of Neonatal Nurses,2 the American Academy of Pediatrics,3 and many others recognize the importance of breastfeeding for all infants. The Healthy People 2020 goal is for 82% initiation of breastfeeding with 60% of infants' breastfeeding at 6 months of age and 34% at 1 year.4
The benefits of breastfeeding are well documented in the medical, nursing, and lay literature and well known to healthcare providers. Yet, despite this overwhelming evidence, the rate of breastfeeding in the United States, particularly after the immediate newborn period, is not what it should be. Only 43% of mothers who begin breastfeeding after birth are still nursing 6 months later, and only 22% are still nursing their baby 1 year after birth.4
Why is this? What kind of obstacles do breastfeeding mothers face, and what can we do as healthcare providers? Hospital routines and policies play some role. The surgeon general's report recommends a number of actions that encourage mothers to exclusively breastfeed their infants.1 These include maternity practices that are supportive of breastfeeding, education of staff, and providing trained lactation consultants, among others.1 Providers of obstetrical care must support breastfeeding and educate their patients about it.1
Despite the efforts of healthcare workers, society and cultural attitudes and policies have a role to play as well. Maternal employment is a factor, particularly when mothers have to return to work shortly after giving birth. Lack of universal paid maternity leaves means that some mothers return to work fewer than 6 weeks after giving birth, which certainly impacts the duration of breastfeeding.1,4,5 One provision of the 2010 Patient Protection and Affordable Care Act requires that mothers with children less than 1 year of age be allowed adequate break time to pump and requires a private place, other than a bathroom, in which to do so.5 However, the law does not apply to companies with fewer than 50 employees that can demonstrate that this creates a "hardship." Certainly sitting in a bathroom stall over one's lunch hour or during a 15-minute bathroom break does not facilitate a positive or healthy breast pumping experience. Further work encouraging employers to support breastfeeding is required. Retention and recruitment of female employees should provide some incentive to companies and the cost savings provided by improved health of infants is another incentive.
In addition to support of working mothers, an attitude shift toward breastfeeding is needed. Federal law allows breastfeeding on federal property, and most states have granted the right to breastfeed in public or, at the very least, allow that breastfeeding is exempt from indecent exposure laws.6,7 Despite this, women are still being told by store clerks, court security, waiters, and others that they must retire to a dressing room, a bathroom, or other place out of sight to breastfeed their infants. Public comments in reaction to such stories often reflect the fact that breasts are still considered a sexual object, or that breastfeeding is somehow unsanitary or offensive. Frequent comments compare the "natural" act of breastfeeding with the "natural" act of elimination, suggesting that doing either in public is indecent and unacceptable. This is a ridiculous argument and it is illogical that in 2012 this attitude still prevails. Suggesting that a woman somehow juggle her infant perched on a toilet seat, or hide in a dressing room (likely sitting on the floor) does not encourage more women to breastfeed their infants. In addition to state and federal laws affirming the right to breastfeed, public education is seriously in order.
As neonatal nurses, we have a duty to be educated not only about the benefits of breastfeeding but about how to best support mothers. We also have a duty to speak out on behalf of public policies that support breastfeeding. We have a duty to educate others about the benefits of breastfeeding and encourage change in public opinion regarding breastfeeding. This is 2012. We are not living in the Victorian era, when the sight of a woman's ankle was enough to inflame lust in the nearest male. It is time to get over the idea that the possible glimpse of a woman's anatomy that might happen with a breastfeeding infant is somehow indecent. It is time to speak up and support what is best for mothers and babies.
References