Helping Mothers With Breast-Feeding

It was 2 a.m. and Sallie Poet was desperate.

At the hospital, nursing her new baby had been, at best, an exercise in hopelessness, she said. But now mother and infant were home, and the problem was becoming more critical as little James Davis Nexsen Poet’s birth weight continued to drop.

Exhausted and frustrated, still holding her screaming and inconsolable son, Sallie Poet made what she considers to be one of the most important phone calls of her life.

Dialed the Number

From a friend, she had heard of the San Diego Lactation Program, based at Mercy Hospital. She dialed the number and got a recorded message, informing her that a return call would come during business hours.

Poet tried once more to nurse her son, but the baby wasn’t “latching on” to her breast. Fearing the worst, she concluded, “I have no milk.” Feelings of inadequacy gave way to a need to “get it right.” That night, she said, the baby nursed enough to allow mother, father and himself six hours of blessed rest.

But by 8 the next morning, the problem had reappeared with a vengeance. Her nipples cracked and tender, Poet again rang the lactation clinic. This time Ruth Wester answered the call and within the hour, the Poet family was at her side for the first of several hours of therapy.

The diagnosis by Wester, a nurse practitioner, was swift and sure--engorgement (breasts swollen with milk) and baby sucking improperly. Therapy entailed merely teaching baby the right way to suck and giving mother a big boost in confidence.

Four hours later, James Poet was a champion nurser and his mother no longer felt helpless to quell his cries for nourishment.

The Poets were not the first family to be helped by Wester and her colleague, pediatrician Dr. Audrey J. Naylor, founders of the San Diego Lactation Program. Established in 1977, the purpose of the program is twofold, they said: to educate professionals about the benefits of breast-feeding and to help parents solve vexing breastfeeding problems.

The dedication of Naylor and Wester has not gone unnoticed by those they have helped or by their colleagues.

Chele Marmet, coordinator of the Breastfeeding Clinic at UCLA and director of The Lactation Institute and Breastfeeding Clinic in Encino, said she sought the guidance and support of Naylor and Wester when she opened the Encino clinic six years ago.

‘A Lost Art’

“They’re well-regarded, highly thought of nationally and internationally,” Marmet said. “This is a new profession. Though women have been breast-feeding thousands of years, it’s a lost art. We’ve lost a generation of mothers who can teach women how to breast-feed. Babies suck instinctively--and that’s it. Proper breast-feeding is not innate--it’s learned.

“Since breast-feeding is a confidence game, women really do need education and support,” she continued. “You need somebody when you run into problems and feel trouble. Most physicians don’t have the training. Naylor and Wester are among the very few of the most highly trained experts in a tiny field.”

Marmet said only three cities in the country offer clinical help to nursing mothers in distress--Los Angeles, Cleveland and San Diego. (USC Medical Center also offers a breast-feeding clinic one day a week.)

A Budding Partnership

Naylor and Wester, both 53, were trained in Los Angeles. Naylor attended medical school at UCLA. Wester spent 18 years at UCLA, part of that time as head nurse of the Marion Davies Children’s Clinic where she met Naylor, who shared her growing interest in preventive medicine. A partnership was born.

Wester, an articulate woman with straw-colored hair and a passion for sailing, said many doctors “don’t think breast-feeding matters. Many haven’t taken the time to read. You wouldn’t believe the number of doctors who say, ‘That’s OK, a little formula won’t hurt.’ ”

Wester and Naylor disagree. They believe a breast-fed baby is sounder nutritionally, more resistant to disease and allergy, ahead of bottle-fed peers in psychosocial development and has better teeth.

Naylor noted that the incidence of breast-feeding among upper- and middle-income families is now 60% when leaving the hospital. The number falls six months later. Among lower-income families, the figure--on leaving the hospital--is less than 40%.

Dr. Beverly Winikoff, director of The Population Council, a New York-based research and technical assistance organization for family planning and health, calls the San Diego program the best of its kind in the world.

‘The Model Clinic’

“I think they’re great,” she said in a telephone interview from her home in Manhattan. “They have the model clinic and breast-feeding training program for the country . . . . They perform a terribly important service, which happens to be supported nowhere near like it should be. It deserves much better.”

Winikoff recently sent a group of doctors and nurses to San Diego to spend 10 days with Naylor and Wester. The reaction of the medical community was, she said, “so typical--everyone laughed. They said there wasn’t 10 days of information to learn on breast-feeding. I’d say 10 days is hardly enough.”

The medical Establishment is slow to embrace breast-feeding and programs to facilitate it, Winikoff said. “It takes time,” she said, “which the medical community thinks it doesn’t have. In a quick-fix culture such as ours, a bottle is very appealing.”

In Naylor’s words, breast-feeding is “a sensitive physiology,” one with a built-in problem: “When it isn’t going well, and the mother gets anxious, worried and tired, the physiology doesn’t work well. It’s usually at those times that someone gives the baby a bottle.” It is, she added, a convenient, “addictive” tool.

Winikoff agrees. “There’s a nice film from UNICEF just out,” she said. “In it there’s a line like this: ‘If I told you there was a product free of charge, that could cut infections by 50%, that happens to be the best source of nutrition for a child’s growth and development, wouldn’t you pay any price on heaven and earth to have it?’ ”

Negative Answer

The answer, she added, is often no. In 1983, in a controversial cost-cutting move, the UC San Diego Medical Center scrapped Naylor and Wester’s program. It was soon picked up by Mercy Hospital and Medical Center, only a few blocks away in Hillcrest. Even there the future of the program is clouded. Funding trickles in from grants and outpatient care but it is always in danger of being cut.

Besides international and domestic work, teaching and therapy, Naylor and Wester spend hours advising mothers with “special problems.” Among their clients in recent weeks was Mary Platter-Rieger, who has an abnormality of the pituitary gland that prevents her from producing milk. Naylor and Wester suggested utilizing a system whereby a small bag filled with donor breast milk allowed her baby the breast-feeding experience (by sucking the breast and a well-concealed tube simultaneously).

There have been other success stories involving an adoptive mother who, without injections, generated enough milk to feed a newborn; a quadriplegic; a hemiplegic, and a baby with a bilateral cleft palate. Naylor was even summoned to Marineland in Palos Verdes to help an infant whale learn how to nurse.

Naylor, a tall, thin woman with a gentle professorial manner, preaches the philosophy that breast-feeding is “natural, but not necessarily automatic.”

She is what one colleague called “a missionary--one the world should listen to.”

Dr. Joel Snyder, a pediatrician in East San Diego County, was teaching at UCSD Medical Center when Naylor’s program was axed. He had studied with Naylor and Wester for five years, mastering many of the lactation techniques that he now uses in private practice.

Snyder said the Naylors and Westers of the world are “few and far between,” but are a necessity in a society that no longer has “Aunt Tilly and Grandma showing us how to breast-feed.” The extended family is gone, “Grandma lives area codes away, and chances are Aunt Tilly used the bottle anyway.”

The problem may be even worse in other countries, where “we’ve exported a kind of medical care and medical education--and the formula that goes with it,” said Naylor. “You see it all over.”

Near Bali, Indonesia, it is common to see billboards rising out of rice paddies, bearing ads for formula, said Wester. In Guatemala and other Central American countries, a “formula room” (often paid for by companies that produce the formulas) is considered by some hospitals to be as worthy as, say, the latest CAT-scan, she added.

Problems With Formula

On their trips abroad to teach other doctors about breast-feeding, Wester has taken many photographs. One shows the rancid river water in Indonesia, used for the mixing of formula, she said; another shows a Guatemalan girl whose smile is marred by a mouthful of rotting teeth--a casualty, doctors say, of formula.

Often, said Wester and Naylor, they were surprised to discover the tiniest stores in the deepest outback would have only the bare necessities--but almost always stocked infant formula.

Now, in small ways, the picture is changing, they said. Third World countries are accepting the idea that breast-feeding can save lives, as evidenced by a drop in infant mortality. (In many countries, the figure still hovers near 90%.)

Doctors from as far away as El Salvador and the Philippines are flocking to the San Diego clinic to learn to teach others, they said. “They’ve all gone home and done really exciting things,” Naylor added. “They’ve changed the way things are done in those hospitals.”