Question

There are three big public health issues in infancy. Let's discuss them as they apply to US families: breastfeeding (or not); where, how & when does the baby sleep; and concerns about immunizations.

Jump into the discussion by picking at least one of the issues (you don't need to address all three). You can talk about what the issues are, your opinions, research on the topic, your concerns or questions.

Answer 1

BREASTFEEDING:

Breastfeeding reduces many different health risks for mothers and children, numerous barriers to breastfeeding remain—and action is needed to overcome these barriers.

Lack of knowledge:

Most women in the United States are aware that breastfeeding is the best source of nutrition for most infants, but they seem to lack knowledge about its specific benefits and are unable to cite the risks associated with not breastfeeding.For example, a recent study of a national sample of women enrolled in WIC reported that only 36 percent of participants thought that breastfeeding would protect the baby against diarrhea.Another national survey found that only a quarter of the U.S. public agreed that feeding a baby with infant formula instead of breast milk increases the chances the baby will get sick.

Even though breastfeeding is often described as “natural,” it is also an art that has to be learned by both the mother and the newborn. Skills in how to hold and position a baby at the breast, how to achieve an effective latch, and other breastfeeding techniques may need to be taught. Not surprisingly, some women expect breastfeeding to be easy, but then find themselves faced with challenges. The incongruity between expectations about breastfeeding and the reality of the mother’s early experiences with breastfeeding her infant has been identified as a key reason that many mothers stop breastfeeding within the first two weeks postpartum.Many women rely on books, leaflets, and other written materials as their only source of information on breastfeeding,but using these sources to gain knowledge about breastfeeding can be ineffective, especially for low-income women, who may have more success relying on role models.The goals for educating mothers include increasing their knowledge and skills relative to breastfeeding and positively influencing their attitudes about it.

Poor family and social support:

Women with friends who have breastfed successfully are more likely to choose to breastfeed. On the other hand, negative attitudes of family and friends can pose a barrier to breastfeeding. Some mothers say that they do not ask for help with breastfeeding from their family or friends because of the contradictory information they receive from these sources. Fathers can also be a positive influence. A randomized controlled trial of a two-hour prenatal intervention with fathers on how to be supportive of breastfeeding found a far higher rate of breastfeeding initiation among participants’ partners (74 percent) than among partners of controls ( 14 percent).

Embarrassment:

A study that analyzed data from a national public opinion survey conducted in 2001 found that only 43 percent of U.S. adults believed that women should have the right to breastfeed in public places. Restaurant and shopping center managers have reported that they would either discourage breastfeeding anywhere in their facilities or would suggest that breastfeeding mothers move to an area that was more secluded.When they have breastfed in public places, many mothers have been asked to stop breastfeeding or to leave.Such situations make women feel embarrassed and fearful of being stigmatized by people around them when they breastfeed.Embarrassment remains a formidable barrier to breastfeeding in the United States and is closely related to disapproval of breastfeeding in public.

Lactation problems:

Frequently cited problems with breastfeeding include sore nipples, engorged breasts, mastitis, leaking milk, pain, and failure to latch on by the infant.Women who encounter these problems early on are less likely to continue to breastfeed unless they get professional assistance. Research has found that mothers base their breastfeeding plans on previous experiences, and resolution of these problems may affect their future decisions about feeding. Concern about insufficient milk supply is another frequently cited reason for early weaning of the infant.One national study on feeding practices found that about 50 percent of mothers cited insufficient milk supply as their reason for stopping breastfeeding.

Successful initiation depends on experiences in the hospital as well as access to instruction on lactation from breastfeeding experts, particularly in the early postpartum period. Most problems, if identified and treated early, need not pose a threat to the continuation of successful breastfeeding.

Employment and child care:

Employed mothers typically find that returning to work is a significant barrier to breastfeeding. Women often face inflexibility in their work hours and locations and a lack of privacy for breastfeeding or expressing milk, have no place to store expressed breast milk, are unable to find child care facilities at or near the workplace, face fears over job insecurity, and have limited maternity leave benefits. Lack of maternity leave can also be a significant barrier to breastfeeding. Studies show that women intending to return to work within a year after childbirth are less likely to initiate breastfeeding, and mothers who work full-time tend to breastfeed for shorter durations than do part-time or unemployed mothers.

Role of health care providers in promoting breastfeeding:

Studies have identified major deficits relevant to breastfeeding in hospital policies and clinical practices, including a low priority given to support for breastfeeding and education about it, inappropriate routines and provision of care, fragmented care, and inadequate hospital facilities for women who are breastfeeding.Obstetrician-gynecologists, pediatricians, nurses and other providers of maternal and child care have a unique opportunity to promote and support breastfeeding. Pregnant women and mothers consider the advice of healthcare providers to be very important with regard to their decisions about breastfeeding.