Confidence in what you're doing is first step to successful breast-feeding


September 29, 1992|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Contributing Writer

"A confidence game" is the way Dr. David Paige describes breast-feeding. After years of research into why some women breast-feed and others don't, Dr. Paige has found that in many instances it's because they lack confidence and support. A pediatrician and researcher at the Johns Hopkins School of Hygiene and Public Health, Dr. Paige specializes in the health of women and children and has strong opinions on how families, agencies and the health-care system could encourage women to breast-feed. He shares some of them here.

Q: Why should women consider breast-feeding?

A: There are many reasons. First, breast-feeding allows the mother and infant an opportunity for bonding that endures after the child is grown. Breast milk is sterile and always available. And perhaps most importantly, there is no better nutrition for the child.

Q: Many children don't ever receive breast milk and thrive on formula. Why is breast milk necessary?

A: Formula is satisfactory and safe. But breast milk is designed for infants, has the right nutritional balance which has evolved over time and provides antibodies that protect the infant from infections. Besides health benefits, the psychological benefit to mother and infant must be emphasized.

Q: When does the mother's body begin to prepare for breast-feeding?

A: In the second half of pregnancy, fat deposition increases in the woman's body and her metabolism begins to get ready for breast-feeding. The fat is available as an energy source, which is transferred to the baby through breast milk. The results are good growth in the child and a weight loss in the mother. Many women see this weight reduction as one of the benefits of breast-feeding.

Q: For how long should the child receive breast milk?

A: Six to 12 months provide good nutrition and an adequate span of protection for babies. But every woman should consider breast-feeding, irrespective of the length of time it continues.

Q: Why don't women breast-feed?

A: Virtually every healthy woman can breast-feed, so most of the reasons why they choose not to are social. For example, many women are uncomfortable about nursing in public. Some worry they won't have enough milk. Others get bad advice from friends, family members and even care-givers. And, most importantly, many women never get the encouragement so important in breast-feeding. That's why it's a "confidence game."

Q: But what about women who cannot breast-feed for whatever reason?

A: Those mothers are in no way less caring or capable. They should be reassured that infant formula can provide proper nutrition and they will have ample opportunities to give the nurture and love every infant requires.

Q: What about women who choose not to breast-feed?

A: Breast-feeding patterns seem to coincide with socioeconomic patterns. Despite the fact that it's free, clean, perfectly balanced and always available, there is an alarming trend, particularly among poor women, not to choose breast milk for their babies. Sadly, it's one more area of their lives in which they receive little support. For example, teen-age mothers rarely are encouraged to breast-feed if they go to school. They can pump their breasts and give the milk to the daytime care-givers just as many women do when they go back to work. It is not usually offered as an option by clinics or private physicians.

Q: What about women who have to go back to work but still want to breast-feed?

A: Infant care and breast-feeding facilities close to work or school are required but not often available. Nevertheless, continued breast-feeding is still possible when a mother returns to work or school. While pumping takes adjustment, understanding and patience on the part of working women and their employers, it is possible. And with help, new mothers can cycle their expression of milk to coincide with their work or school schedules.

Q: When should all of these decisions be made?

A: Breast-feeding should be part of all prenatal care. It is vital that women explore options and build confidence before delivery.

Dr. Matanoski is a physician and professor of epidemiology athe Johns Hopkins School of Hygiene and Public Health.

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