Wide disparity found in breast-feeding rates

The new mother was determined to nurse her son, despite her discomfort after a Cesarean section. But a nurse, without asking, fed the infant formula while he was in the hospital nursery. That was upsetting enough, but then, when given the chance to nurse her baby, the young woman couldn’t get her newborn to latch onto her breast.

She was nearing despair in the way that only new mothers can understand when Mayra Morales appeared at her bedside. Morales, a 29-year-old mother of five, described the scene later as a typical day in her job as a breast-feeding peer counselor at St. Francis Medical Center in Lynwood.

“You see moms who think, ‘Oh, no, I’m not going to be able to breast-feed,’ ” she said.

And without support in those crucial first days in the hospital, many of them will give up nursing after they are discharged, children’s health advocates say.

In California, 86% of the women who gave birth in 2006 nursed their newborns in the hospital, according to a report being released today by the UC Davis Human Lactation Center and the California WIC Assn., a federally funded nutrition program for women, infants and children.

Half of them -- 43% of the total -- fed their newborns only breast milk. The other half supplemented with formula.

The gap between breast-feeding a little and breast-feeding exclusively in the first 24 to 48 hours that mothers typically spend in the hospital matters because that’s when a mother’s milk supply is established. The act of nursing causes milk-producing hormones to be released. The more the baby nurses, the more milk the mother will produce, and vice versa.

Introducing formula too early can cause the body to produce less milk, say children’s health advocates, including those at UC Davis and WIC.

Exclusive breast-feeding rates around the state ranged widely, from a high of 93% at El Camino Hospital in Santa Clara to a low of 1% or less at Kaiser Permanente Bellflower Medical Center, Pacifica Hospital of the Valley in Sun Valley and Pacific Alliance Medical Center in Los Angeles’ Chinatown.

Eight of the 15 hospitals with the lowest rates of exclusive breast-feeding were in Los Angeles County. St. Francis Medical Center in Lynwood is one of them; its exclusive breast-feeding rate was 7%, a number that it’s trying to improve through the use of peer counselors from the South L.A. WIC Program.

Hundreds of studies show that breast-feeding reduces children’s risks for infections and chronic diseases, including diabetes, as well as the mothers’ risks for breast and ovarian cancers. To reap its full benefits, the American Academy of Pediatrics, the World Health Organization and a host of other experts recommend feeding infants only breast milk for at least the first six months.

Yet nationwide, few woman breast-feed that long, and whether to breast-feed at all or exclusively and for how long can be contentious topics in parenting circles, rife with righteousness and guilt.

What worries children’s health advocates at UC Davis and WIC is whether the 86% of mothers in California who start out doing at least some breast-feeding are getting the support they need to continue, regardless of how long they intend to nurse.

Sometimes, they say, hospital customs actively discourage breast-feeding, however inadvertently.

“Many hospitals routinely separate mothers from babies very shortly after birth,” said Karen Peters, executive director of the nonprofit Breastfeeding Task Force of Greater Los Angeles. “You can’t breast-feed if you’re separated.”

Rather than wrapping newborns tightly in blankets to calm their cries, nurses should encourage skin-to-skin contact with the mother, which prompts the infant to seek the breast, Peters said. Trained nurses or peer counselors should be on hand to offer tips.

Fear that they are not producing enough milk is the No. 1 reason nursing mothers give for adding formula, according to Dr. Wendy Slusser, director of UCLA’s Breastfeeding Resource Program and a staff pediatrician at the Venice Family Clinic. In rare cases, medical conditions can interfere with milk production and make formula necessary, she said, but usually encouragement and information are all that’s needed.

Nurses and peer counselors who have been trained to support breast-feeding are able to reassure a mother that her milk output will double by the second day and again on the third, Slusser said. They can teach her to judge whether the baby’s had enough to eat by counting soiled diapers.

But not every hospital provides such training. And when nurses themselves are uncertain, Slusser said, “It’s easier to say, ‘Let’s give [the baby] formula.’ ”

Having newborns “room in” with their mothers, encouraging skin-to-skin contact and providing trained breast-feeding counselors are three of 10 steps that hospitals can take to meet “baby-friendly” standards established by the World Health Organization and the United Nations Children’s Fund. One of the other steps, which is proving to be the most controversial, is eliminating gift bags of free formula and other goodies that most hospitals give to departing mothers, courtesy of formula manufacturers.

Advocates of breast-feeding contend that the freebies appear to be a hospital endorsement of formula.

Marisa Salcines, manager of communication for the International Formula Council, said the industry supports breast-feeding as “the optimal form of nutrition.”

“But we also believe that if a mother cannot or chooses not to breast-feed, that formula is the only safe, nutritious and recommended alternative to breast milk,” she said.

Morales, the peer counselor at St. Francis Medical Center, said that about twice a week, she “gets attitude” from new moms who tell her that they’re going to give their babies formula because it’s just as good as breast milk. “Some moms are shocked to learn there’s a difference,” she said. But most of the mothers she visits, she said, want to breast-feed and just need help.

Morales showed the mom who had had the Cesarean how to tuck her newborn’s feet under her arm and hold his body along her forearm, face toward her breast. Called the “football hold,” it eased pressure on the mother’s surgery scar -- and steered the baby’s wide-open mouth toward its target.

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mary.engel@latimes.com

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The report on California hospital breast-feeding rates can be found at the California WIC Assn. website, www.calwic.org