Breastfeeding rates are on the rise in New Jersey, and the practice is more common among mothers here than in neighboring states or the nation at large, national data shows. That’s thanks in part to efforts by a growing number of hospitals to promote the highly beneficial practice.
But healthcare experts suggest more could be done to encourage breastfeeding, which improves children’s immunity, reduces the likelihood of obesity, and assists development, among other things — benefits that can improve health outcomes and lower medical costs.
And a group of lactation experts, led by the United States Lactation Consultants Association, believes greater state oversight of their profession could help ensure more mothers learn to successfully breastfeed their children for as long as possible. Two states — Rhode Island and Georgia — have moved to regulate the profession based on guidelines from the International Board Certified Lactation Consultants (IBCLC), and dozens of others, including New Jersey, are considering proposals that would do so.
According to the New Jersey IBCLC, more than 90 percent of mothers and babies need help during the first week to make breastfeeding successful. While there are lots of “lactation consultant” services available, the IBCLC insists that, as nationally accredited professionals with years of specialized training and clinical experience, it is the best equipped to work effectively with hospitals, clinics, physicians, and breastfeeding support groups to make sure mothers and babies are breastfeeding correctly, that the child is properly nourished, and that neither have any diseases or physical conditions that could cause problems over time.
A nationwide movement
In 2011, the U.S. Surgeon General issued a “call to action” to support breastfeeding programs nationwide, noting that for much of the past century “America’s mothers were given poor advice and discouraged from breastfeeding.” Powerful advertising from formula companies and social changes, including the role of women in the workplace rather than the home, are among the factors that reduced breastfeeding to an “unusual choice.” This trend has started to reverse in recent decades, the report notes, while calling on health officials to continue to build on this momentum.
Nationwide, 79.2 percent of babies are breast fed at some point; 49.4 percent are still being breast fed at six months, and 26.7 percent at the end of the first year, according to a 2014 report card from the federal Centers for Disease Control and Prevention. In New Jersey, 81.6 percent of babies are breast fed for some period; 56.2 percent are still breastfeeding at six months, and 30.9 percent at 12 months. Rates for New York State were about one percentage point lower on all measures, and Pennsylvania had rates that lagged by as much as eight points.
Garden State hospitals have played a significant role in boosting the state’s numbers through efforts to embrace programs like the “Baby Friendly Hospital”, created by the World Health Organization and UNICEF to encourage breastfeeding and other beneficial maternal-health practices. To help hospitals pursue these goals, the state Department of Health has provided funding to the New Jersey Hospital Association to develop “Healthy Beginnings NJ,” a 183-page publication to help guide hospital leaders in implementing programs.
Among other things, the process involves training all involved on the importance of breastfeeding, ensuring maternity staff is able to educate and assist new mothers with the practice, encouraging mothers and infants to room together, and removing marketing materials from infant formula companies — and only deferring to these products when medically necessary. The guide also encourages hospitals to create support groups for new mothers who have gone home, but it does not spell out requirements for IBCLCs specifically.
“Whether the hospitals choose to seek designation from a specific program (like “Baby Friendly” is up to the individual hospital, but we know that moms who are knowledgeable about the benefits of breastfeeding are more likely to breast feed,” explained Mary A. Ditri, the director of professional practice with the NJHA. “These programs provide resources and best practices toward achieving the goal of successful breastfeeding.”
Achieving ‘Baby Friendly’ status
According to the Baby Friendly USA program, 11 hospitals have achieved the “Baby Friendly” designation so far and nearly two dozen more are working toward these goals. The most recent, University Hospital in Newark, announced its accreditation in January, after nearly four years developing the program. Trained teams there work with mothers to encourage the practice and make sure they understand the advantages. Once they have left the hospital, they can call in anytime day or night for assistance.
“It was a long process but well worth it,” said Ingrid Bruce, University Hospital’s assistant director of OB/GYN and Labor and Delivery. “You have to go through a culture change.”
University Hospital said many of the mothers it works with are young, trying to balance college and jobs. That makes it a challenge to convince them of the advantages of breastfeeding: it’s free, it comes in a sterile container ready for baby’s feeding, and it offers considerable health advantages over formula. The federal Women and Infant Children program, or WIC, which provides formula to low-income mothers will instead provide the same dollar-level of aid in food for the mother if she choses to breast feed instead.
“It’s a struggle, but it’s a struggle that we’re taking on to make our neighborhoods and community better and to keep our kids out of the emergency room,” explained Linda Arnold, a nurse who helped develop the “Baby Friendly” program.
But IBCLCs insist that their training allows them to do more than just promote healthy breastfeeding practices. They are also trained to diagnose problems and identify concerns like cancers or glandular dysfunctions that could lead to greater trouble. Studies show that children who start breastfeeding are more likely to continue, getting more benefit from the practice, and mothers who breastfeed their first child will probably continue with later children.
“It’s not just the breastfeeding itself. It’s the physical exam of the baby, as well as the baby’s cavities,” explained Mary Lou Moramarco, a longtime IBCLC who works in Middlesex, Monmouth, and Ocean counties. These trained consultants perform a “suck test” to ensure the baby has the strength to drain the milk — which doesn’t flow automatically — and must make sure the baby can turn its head properly to reach the breast, she said. “Once we go past the presence of normality, I refer out” to other professionals trained to treat the condition, Moramarco added.
Ensuring a proper education
The Surgeon General also recognized the role IBCLCs can play in improving breastfeeding rates nationwide, noting that even among hospital staff trained in infant-feeding techniques, three out of four felt ill prepared to properly educate mothers on the importance of the practice. Hospitals with IBCLCs on staff have higher breastfeeding rates than those that do not, the report notes, but in most states there are too few to meet the full demand. Action item 11 out of 20 in the report calls for better integration of IBCLCs in maternal healthcare.
(According to the CDC report card, nationwide there are 3.48 IBCLCs per 1,000 live births. In New Jersey, the ratio is 3.42 per 1,000.)
Moramarco and others with the NJIBCLC are hoping to see state officials take action on legislation, (A-1452), that would create a seven-member lactation advisory group under the Board of Medical Examiners that would be charged with developing licensing requirements for lactation consultants based on IBCLC or equivalent standards. The Assembly version, sponsored by Assemblywoman Pamela Lampitt (D-Camden) and Assemblywoman Gabriela Mosquera (D-Gloucester), was approved by a committee in February 2016 and has not moved since; the Senate version has yet to receive a hearing.
As it is, mothers who are struggling to continue breastfeeding at home remain vulnerable to subpar care, Moramarco said. A desperate individual is likely to search the Internet for a quick solution, finding a low-priced lactation consultant, but no guarantee related to that person’s training.
“There’s nothing that protects the words ‘lactation consultant’ right now,” Moramarco explained. As it is, anyone can complete a “39-hour course and a one-hour quiz and they’re out there hanging out a shingle,” she added. “It’s scary.”
In addition to University Hospital, those on the “Baby Friendly” list include: