- Receiving formula in the hospital
- The mother has changed her mind about breastfeeding
- The mother has concerns about milk supply
- Medical concerns
- Difficulties getting the baby latched to the breast
Is it the freezing cold that makes us hardier? Overall, Minnesota is quite a healthy state, especially for a Midwestern state. Compared to the rest of the country, we rank #1 in the nation for fewest days off for mental illness, and #3 for the fewest days off of work for physical illness. We are also #1 in the nation for fewest deaths from cardiovascular causes. Closer to the point, our babies are born at relatively higher birth weights than 45 other states, and we have a lower rate of infant mortality than many states (#12 in the nation). Only seven states have a better score for the fewest preterm births. (America's Health Rankings)
So it should come as no surprise with our great overall health and birth statistics that we also have relatively high overall breastfeeding rates. In 2016, mothers from Minnesota breastfed 90.1% of our babies at least once. Only 6 states have higher rates for ever-breastfed babies! While this is fabulous, there is still work to be done. While our exclusive breastfeeding rates at both three and six months are higher than the national average, it is still less than impressive that fewer than 1/3 of our babies (31.4%) are still exclusively breastfed at six months. Since many babies begin solids between the fourth and sixth month of age, this may not be particularly surprising. However, looking a bit earlier in life, just a little over half (53.9%) of Minnesota's babies are exclusively breastfed at a mere three months of age (CDC 2016 Breastfeeding Report Card), despite the fact that exclusive breastfeeding for 6 months provides most babies with the best start in life. Even the American Academy of Pediatrics, which has been a relatively muted in its support for breastfeeding throughout its years, published a statement in 2012 recommending again that babies should be exclusively breastfed for the first 6 months of life.
Let's look at local numbers! How do our local breastfeeding rates compare with state-wide rates? Compared to the state as a whole, Washington County is very supportive of breastfeeding. Washington County Public Health and Environment announced in 2013 that it was designated a Breastfeeding Friendly Health Department. An estimated 88% of hospital-born babies are breastfeeding upon discharge from Washington County hospitals. While not all in Washington County, the three HealthEast hospitals (St. John's, St. Joseph's and Woodwinds) are all relatively close to Washington County, and all three have the Baby Friendly Hospital designation. While about 90% of these babies are being breastfed upon hospital discharge, only about 40% of babies are being exclusively breastfed upon discharge. So clearly there is work to be done encouraging mothers to exclusively breastfeed and supporting them so that they are able to exclusively breastfeed, especially through the first week of baby's life.
7.1% of children living in Washington County, MN (an estimated 4,900 children) live below the poverty line; and of Washington County residents as a whole, 7.6% are unable to get adequate food. Pregnant and breastfeeding mothers, as well as infants and children without food security who qualify based on household income may participate in the county WIC (Women, Infants & Children) Nutrition Program.
In 2014 (the latest year with complete information), there were 905 babies in Washington County who were participating in the WIC (Women, Infants, and Children) Nutrition Program. Of these babies, an amazing 88.4% received some breastmilk, identical to the county statistics! By three months, the percentage of babies participating in the WIC Program who were receiving some breastmilk dropped to 44.8% -- half of the original number of breastfed babies.
Focusing even more locally (again in 2014) mothers of babies participating in WIC who resided in Lake Elmo, Stillwater, and Mahtomedi had impressive breastfeeding rates. 91.7% of the babies received some breastmilk, identical to the data from MN as a whole. 40.0% of the babies were still receiving some breastmilk at 3 months of age; 30.4% were still receiving some breastmilk at 6 months of age; and 23.0% were still receiving breastmilk at a year. As with Washington County mothers as a whole--locally, there is a drop of over half the number of breastfed babies in the first three months of life. After the first three months, breastfeeding rates continue to drop, but at a much slower pace.
A 2015 report about Minnesota mothers participating in WIC indicates that the most common predictors for weaning prior to 3 months include:
If baby received formula in the hospital, mother may assume the baby needs formula, or that it is just as good as breastmilk. While mothers will change their minds, it helps to stay the course if someone is supporting your original intention, and letting you know that while it may be difficult at first, breastfeeding does become much easier later on. Concerns about milk supply and getting baby latched are difficulties for which a trained breastfeeding counselor or lactation consultant can provide valuable assistance. Well-baby check-ups may not coincide with the time the mother is experiencing breastfeeding problems, and not all health care providers have the proper education and training to help breastfeeding mothers troubleshoot problems. Many mothers need help understanding how to make the transition from breastfeeding at home to the very different situation of providing baby with breastmilk after returning to work, a situation that often includes pumping or expressing her milk in less than ideal surroundings. Family and friends may not understand the importance of breastfeeding and may undermine her confidence or exert well-intentioned pressure to give formula. Mothers may not know that free breastfeeding support groups are available for help and support, or they may find it difficult to get to the support group on the day and time when it meets.
When I look at these statistics, for Minnesota as a whole, as well as for WIC participants, perhaps not surprisingly, my conclusion is that breastfeeding mothers need the MOST breastfeeding support during the first week (most will be discharged from the hospital within a week), but there is still a great need for support during the first three months of their babies' lives. This is why every mother who wants to breastfeed has a right to the support of a breastfeeding counselor. Breastfeeding counselors visit mothers at the hospital and make house calls, help mothers find solutions to breastfeeding difficulties so that they can reach their breastfeeding goals, and provide a consistent and easily accessible source of support and encouragement. If medical concerns about the baby or breastfeeding issues prove complex, the breastfeeding counselor is trained to refer the mother to a lactation consultant or other health care professional. The breastfeeding counselor has time to devote to the mother-baby that is difficult to find elsewhere.
Every mother has a right to a breastfeeding counselor at least for the first three months of her baby's life. How can we make that happen?
The St. Croix