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Breastfeeding Success: Getting Started
In the beginning - It can be hard! It's ok to feed your baby in public!
It's so natural - No bottles! It's soothing (button)

What Is Exclusive Breastfeeding?
Exclusive breastfeeding means the infant receives only breast milk, no other food or fluid.

What Does Exclusive Breastfeeding in the Hospital Have to Do with Obesity?
More than 20 percent of children between two and five years old are overweight or at risk of becoming overweight.* Experts at the Centers for Disease Control estimate that 15 to 20 percent of obesity could be prevented through breastfeeding.(1) Other studies also show that breastfeeding consistently reduced risks for overweight and obesity.(2) The greatest protection is seen when breastfeeding is exclusive (no formula or solid foods) and continues for more than three months.(3),(4)

In California, most mothers start breastfeeding in the hospital after birth, but many stop in the first few weeks.(5) Mothers need information in the hospital about the benefits of exclusive breastfeeding and support to exclusively breastfeed their babies. In addition, mothers who are uncomfortable breastfeeding in public need private spaces in public places where they can breastfeed.

In California, increasing breastfeeding could mean between 36,000 and 48,000 fewer overweight children and adolescents.(6)

*Infants and toddlers are considered overweight if they are greater than or equal to the 95th percentile for weight-height. Infants and toddlers are considered at risk for overweight if they are greater than or equal to the 85th percentile for weight-height. Children aged two to five are said to be overweight if their body mass index (BMI) is greater than the 95th percentile for their age (Centers for Disease Control and Prevention, Atlanta, Georgia).

Don’t Some Infants Need Formula in the Hospital?
Most breastfed infants do not need any formula supplementation to breast milk. Some (about 10 percent) may have medical concerns that result in the doctor’s recommendation for formula.

Supplementation rates for breastfed infants in Baby Friendly Hospitals (see below for more on Baby Friendly Hospitals) range from 5 to 15 percent, while supplementation of breastfed infants in some hospitals in California is more than 70 percent. In these hospitals, it is likely that formula use is a matter of routine or that hospital policies and practices interfere with breastfeeding initiation.

What If Women Decide to Give Breast Milk and Formula Because They Feel They Cannot Exclusively Breastfeed Their Infants?
It’s best for women who decide to give both breast milk and formula to first establish their milk supply during the first two weeks after birth, then supplement with formula, if they chose. Giving formula too early compromises a woman’s ability to follow through with her breastfeeding decision.

What If Mothers Are Tired and Want to Sleep in the Hospital?
Many mothers are very tired after giving birth and it is tempting for well-meaning hospital staff to encourage mothers to supplement their infants with formula so that they can get some additional rest before they go home. However, for many mothers, the breastfeeding support they receive in the hospital is all the help that they will receive. They need to practice feeding their infants while the knowledgeable support of lactation specialists and nurses is available. Babies who are given formula in the hospital will take less milk from their mothers (an important factor in building milk supply) and will be less interested in feeding.

Limited breastfeeding practice in the hospital may contribute to a mother’s frustration (and fatigue!) when she gets home. Mothers’ rest can be supported in many other ways.

Shouldn’t Mothers Be Able to Ask for Formula Supplementation?
Yes, mothers should be able to make an informed decision about whether or not to provide supplemental formula to their babies. To make such a decision, mothers need to be given information about how giving formula supplements during their hospital stay might affect their early breastfeeding experience and milk supply. This information is particularly important for women who do not have other resources for breastfeeding support after they leave the hospital.

What Does “Baby Friendly” Mean?
The Baby-Friendly Hospital Initiative (BFHI) was developed by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) in the early 1990s in an effort to increase breastfeeding rates and in turn, reduce childhood illness and death. To be acknowledged as Baby Friendly, a hospital must provide the best possible care for breastfeeding mothers and their infants by following WHO’s “Ten Steps to Successful Breastfeeding.” These steps ensure that all mothers receive breastfeeding education and support from well-trained staff. The BFHI has proven to be very successful, with more than 19,000 baby-friendly hospitals and birthing centers worldwide.

As of July 2006, 55 hospitals in the United States had been designated baby-friendly. California currently has 12 baby-friendly hospitals, more than any other state.(7) Research has shown that Baby-Friendly practices succeed in promoting, protecting and supporting breastfeeding. Mothers delivering at baby-friendly hospitals tend to breastfeed longer than mothers delivering at other hospitals.

What’s Needed to Promote Breastfeeding?
WIC recommends:

• Increasing the number of hospitals adopting the California Model Hospital Policies recommended by the California Department of Health Services, based on the Baby Friendly Hospital Initiative. This step will ensure that maternity wards become centers of breastfeeding support. See www.babyfriendlyusa.org/eng/index.html or http://ww.mchdhs.ca.gov/programs/bfp/toolkit/default.htm

• Passing legislation supporting breastfeeding mothers. In California, recent laws have legalized a woman’s right to breastfeed in public, allowed breastfeeding mothers to defer jury duty, required all hospitals and maternal care facilities to provide either lactation services or information on lactation, and required employers to accommodate employees who want to express their breast milk.(8) Issues remain, however, around enforcement of these laws, and more work is needed regarding aggressive marketing of formula to mothers. See http://www.wicworks.ca.gov/breastfeeding/BFResources.html.

• Encouraging companies or employers to set up an on-site lactation programs—at a minimum providing a private and comfortable room to pump and time to do so.(9)

• Providing sustained funding for peer counseling programs to increase initiation, duration, and exclusivity of breastfeeding among low-income women.(8),(10)

WIC providers have helped millions of low-income women start breastfeeding. We can help them continue to breastfeed by working with partners on policy strategies to make hospital, workplace, and community environments more supportive. Together, we can reduce childhood overweight and subsequent obesity. — Laurie True, Executive Director, California WIC Association.

Notes:
(1) Dietz WH. Breastfeeding may help prevent childhood overweight. JAMA. 2001; 285:2506-2507.
(2) Owen CG, et al. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005; 115:1367-1377.
(3) Arenz S, et al. Breastfeeding and childhood obesity—a systematic review. Int J Obesity. 2004; 28:1247-1256.
(4) Harder T, et al. Duration of breastfeeding and risk of overweight: a meta-analysis. 2005;162:1-7.
(5) Li R, Darling N, Maurice E, Barker L, Grummer-Strawn LM. Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey. Pediatrics. 2005; 115:e315-31-37.
(6) Based on Dietz’s estimates concerning increasing breastfeeding and decreasing obesity. See note 1 (Dietz).
(7) Baby-Friendly Hospitals in the US. http://www.babyfriendlyusa.com. Accessed July 2006.
(8) Breastfeeding Works: A breastfeeding task force of the greater Los Angeles breastfeeding coalition. The Law and More: Lactation Accommodation Law (Assembly Bill 1025) - Legal Requirements. http://www.breastfeedingworks.org/labor-code.htm. Accessed July 2005.
(9) Inkelas M, et al. 2001. The health of young children in California: findings from the 2000 California health interview survey, Los Angeles and Sacramento: UCLA Center for Health Policy.
(10) Ogden CL, et al. 2002. Centers for Disease Control and Prevention 2000 growth charts for the United States: Improvements to the 1977 National Center for Health Statistics version. Pediatrics. 109(1): 45–60.