CALL TO ACTION ON BREASTFEEDING

In the hospital, formula samples are an enormous breastfeeding deterent. Discourage formula companies from giving samples to every patient. Encourage rooming in with babies and mothers. Discourage bottles, pacifiers, formula feeding or sugar water feeding while mothers are trying to intiate breastfeeding. Provide education and support for fathers too since understanding dads encourage breastfeeding mothers to perserve. Lactation consultants in the hospital should examine babies for frenulum abnormalities, tongue length, and other mouth anatomy issues that could affect successful breastfeeding. The sooner those problems are diagnosed, the easier they are to address.

Post delivery care: care providers should make asking about breastfeeding part of the follow up visits and be prepared to refer women to lactation consultants or groups for guidance. Provide breastfeeding-friendly waiting rooms with lots of water, footstools, pillows, etc.

I also think related to this, that it is imperative that health organizations sever ties to the formula industry. I think AAP's ties to industry is one of the single biggest barriers to Baby Friendly. I think conflicts of interest should be explicitly discouraged, and this is the most egregious one-- and there is ample evidence that it harms policy and public health.

Formula supplementation should only occur with expressed permission of the mother.

In a related matter, employers should have incentives to provide flexible work arrangements once a mother returns to work. Telecommunting, alternate work hours, temporary reduction in work hours, etc. should all be encouraged to allow a woman and a company to provide necessary work while still supporting the breastfeeding relationship.

Perhaps a tax incentive for companies who provide paid maternity leave and a different tax incentive for those companies who allow flexible work arrangements would allow a company to provide these necessary

We live in a 'social networking world' these days. Many parents and future parents use these sites to share their lives with friends and families. A mother who has a right to breastfeed her child in public should also be given the right to display a photo of breastfeeding online. In deleting such photos facebook is sending the message to others that breastfeeding is wrong and should be hidden or even not practiced at all. This is not a message that ever should be sent. Deleting theses normal depictions of child feeding is equal to advertising breastmilk substitutes, since photos of feeding a child artificially are accepted on the facebook site.

Unfortunately a lot of moms also give into the peer pressure of formula and doctors and nurses who push it on them starting on the hospital. I feel so badly for this mothers who do not have the support they need to continue the breastfeeding relationship. Formula is pushed at first in the hospitals. Moms are given a bag to take home with them. It's almost too easy to use it when you're tired at 2am with a child who is screaming for you. Breastfeeding is a commitment. I have nursed my son successfully for two years, and we are going strong. I will continue to do so for as long as he wants to.

Tax breaks for employers who provide on-site/near site child care and lactation support services might accelerate adoption of best work-place practices.

A woman's covered breast is giving nourishment to her child, which is the main purpose for having breasts and shouldn't be such a controversial issue. Maybe if it was displayed in the media as acceptable and natural, then people wouldn't make such an issue.

So, I vote for more commercials with breastfeeding moms in them, as opposed to women with breast implants fighting in a courtroom over a bottle of beer.

I have breastfed all 3 of my children for over a year. For the first 6 months of life before they can yet receive solid food, that has meant nursing in public at times. I am comfortable with it and think of it as not much different than giving a bottle. Out of respect for others' potential discomfort with public nursing, I have learned to be quite discreet (meaning that some people may realize I am nursing, but no onlookers are seeing my breast), but I have nonethless been the target of occasional unpleasant comments and many, many unpleasant looks.

I also find that even close friends who have breastfed their children and very intelligent people with no children give me a look when they learn that I am breastfeeding a 14 month old. It's as if they think that my toddler or I are deriving sexual pleasure from nursing at that point. I find it confounding.

I think much of this discomfort and hostility is related to the oversexualization of the female breast in our culture. The breast is portrayed, first and foremost, as such an object for men's viewing and playing pleasure that many have difficulty moving past that to realize that it is also the source of optimal nutrition for our offspring. More magazine ads, TV ads, and billboards that show the same amount of breast we routinely see in bikini ads and movies, but with a nursing baby latched on, would go a long way in fixing this problem. It just involves changing our culture's associations with the breast.

Research has shown that when women are given free samples of formula they are more likely to supplement rather than exclusively breastfeed. Pregnant mothers are bombarded with free samples and information from formula companies throughout pregnancy, in the hospital at the time of birth, and at the pediatrician's office afterwards. Instead of allowing hospitals and doctors offices to provide free diaper bags full of formula, why not provide true

We don't want to go backwards in women's rights in the workplace, but we need to look at the impact on future generations. Our country is facing many health crisis that could potentially be solved by supporting lactation and maternal bonding.

We don't want to go backwards in women's rights in the workplace, but we need to look at the impact on future generations. Our country is facing many health crisis that could potentially be solved by supporting lactation and maternal bonding.

NICU nurses need FAR, FAR more education on breastfeeding assistance with newborns and premature newborns. Most of the nurses discouraged me from breastfeeding (it was easier for them to deal with formula and they liked to know exactly how much formula the baby was getting), and then they offered out of date advice.

A 2004 Harvard study of 168 nations revealed that 163 had some form of paid maternity leave; the United States (along with Lesotho, Papua New Guinea and Swaziland) was not one of them. The U.S. Family and Medical Leave Act provides for 12 weeks of job-protected leave, but it only covers those who work for larger companies.

Not only is 12 weeks just not enough time (both physically and emotionally) for a mother to be home with her newborn child, but it also leads to many mothers to wean much sooner than they would if they were afforded the chance to stay home longer with their young infants. Many mothers choose to switch to formula when they return to work for a number of reasons (time, convenience, lack of pumping space/time in the workplace, etc.); and many of these mothers would probably be more than happy to both stay home and breastfeed longer. Unfortunately, our society rewards the ambitious working woman, but penalizes her if she also wishes to stay home and breastfeed her babies for longer than the prescribed 12 weeks. It is a sad situation and there are countless mothers, babies and families who suffer needlessly because of it.

Thank you,

Heidi Boyd

Make those data as widely available as possible for researchers, public health professionals, and other interested parties.

Mary Applegate, MD MPH Associate Dean for Academic Affairs University at Albany School of Public Health 1 University Place Rensselaer, NY 12144-3456 518/402-0283 fax - 518/402-0329 mapplegate@uamail.albany.edu

Also, tongue-tie has been a problem in many infants, not enabling them to latch-on properly. I think that this situation is often overlooked or simplified as not a big enough problem to address.

Currently, with UNpaid maternity leave, many women struggle to take time off of work- and many (lower AND middle class) cannot afford 12 weeks off without pay. Thus, they return to work earlier which, in turn, shortens their duration of breastfeeding.

By implementing Paid maternity leave, we can help lower and middle class mothers stay home longer with their infants. This will lengthen breastfeeding rates. While this may threaten some businesses who would prefer mothers to take very little time off... in actuality, this type of policy will likely increase recruitment and retention of female employees. Added benefits will be healthier children- decreasing societal costs of ill or unhealthy (i.e. obese) children.

Thank you, Jennifer Bevacqua RN MS CPNP-Ac/Pc CCRN Pediatric Nurse Practitioner

Mothers encountering breastfeeding difficulties after the baby is born cannot rely on the provision of evidence based breastfeeding support by either their HCP, or the infant's HCP. Mothers assume that the obstetrician and/or pediatrician will provide competent breastfeeding information and support, but often it is the physician's lack of basic breastfeeding knowledge that sabotages breastfeeding support.

At the hospital where I work, we are making a concerted effort to provide research/evidence based breastfeeding training to our MCH staff, and to encourage staff to utilize this training in their clinical practice. This however, sometimes seems futile, when the physicians are not also committed to evidence based practices.

Women need more choices in order to establish a satisfying work-family balance. Paid maternity leave certainly needs to be extended beyond six weeks. Six weeks is just barely enough time to overcome many nursing problems, let alone introduce a breastpump into the routine, let alone establish a strong, healthy bond with your new child. In addition, mandatory paid paternity leave would help encourage breastfeeding as well. In the first couple of weeks, nursing alone can be more than a full-time job, and it will work best if the father is present to reduce stress by helping with other aspects of care and household tasks. Perhaps this could be accomplished through some sort of joint mandatory paid leave policy, where working parents are guaranteed the right to a certain number of weeks but can divide it in whatever way works best for them.

Since mandatory paid leave places a heavy burden on employers, we should also extend unpaid leave opportunities for both mothers and fathers. This will allow mothers in particular more flexibility to be available for their children and develop workable nursing routines, without sacrificing their job and income in the future when they are able to return to the workforce.

In my view, however, one of the most important ways the workforce should change to accommodate nursing mothers and mothers in general is to offer more part-time work opportunities in every field. The standard 40+ hour work weeks is the expectation that forces parents to choose between their careers and their families, and that choice is not one that people in this country should have to make on such a regular basis. This priority should be followed closely in importance by the establishment of on-site child care facilities in most work environments, which would allow mothers to take nursing breaks without a breast pump.

On a final note, I believe that expending resources to pressure women to breastfeed cannot begin to substitute for the changes in labor practices I've discussed here. In fact, these efforts can even be counterproductive, as the positive response to Hanna Rosin's Atlantic article has shown.

Women are expected to give birth and be back to work after physical recovery from the birth. Short-term disability policies reflect this, but allowing only 6 weeks of insurance to be taken after a vaginal birth.

What about AFTER the baby is born? Giving birth is only a START to providing a good life for a new baby... not an end.

If we want a healthy society, we MUST cultivate healthy families. Cultivating healthy families means enacting family-friendly policies such as onsite child care, ease of breastpumping at work, and MOST IMPORTANLY, flexibility for working mothers. Europe, Canada, Australia, New Zealand and many other countries/continents have demonstrated that this works nicely!

Of my friends, those who had their babies prematurely face the worst odds with breastfeeding success. Staff in the NICU especially need training on how to support (not actively undermine!) breastfeeding in those challenging circumstances. Making disparaging comments about the lumpiness, small amount, etc. about the colustrum pumped should be prohibited. They need to minimize separation from the mother and ALLOW nursing at the breast whenever possible. This also means creative solutions about allowing a mother to rest near the baby, to respond to baby's cues, which probably means a total redesign of most NICU spaces.

Even this Call to Action is worded incorrectly!! ie,

>Breastfeeding is unquestionably healthier for mothers and >babies compared to feeding with infant formula.

NO -- Breastfeeding isn't

Initiation rates are improving, but duration rates are not. Addressing this concept is important too.

MD's need training in med school on breastfeeding, it's importance to our society & how to help moms or at least refer to lactation consultants when necessary

Physicians have little to gain in hiring a Lactation Professional as there is no reimbursement for providing this service to their patients - so they give opinions based on their own experiences or what they learned years and even decades ago.

Postpartum support needs to be intense in the first month postpartum - but can be offered by telephone or e-mail with scheduled visits when necessary. Evidence shows that if mothers are assisted during this time, they will be able to exclusively breastfeed for longer - which accomplishes better health outcomes for baby and mother.

Mothers who are returning to work or school also need support, and this can be cost-effective for the employer, especially if tax incentives and penalties are present.

On another note, it would be nice to have a growth chart based on breastfed babies, instead of comparing my baby to those fed synthetic food.

I would like to see all delivering hospitals have IBCLCs on staff (International Board Certified Lactation Consultants).

Women's choices need to be respected, the choice to have a home birth is as valid as the choice to have a hospital birth and needs to be treated as such by health care practioners and insurers. Women should not feel that a transfer to a hospital during a home birth should be difficult. The U.S. needs to look at the model Holland uses for birthing, OBs should be used for high risk pregnancy and midwives for uncomplicated births.

In all cases, women and babies should not be separated unless absolutely indicated and skin to skin contact should be encouraged in the hospital immediately following birth.

No separation after C-section.

In-hospital visits from lactation specialist prior to discharge.

In a recent large-scale study published in the British Medical Journal, 96% of women who delivered with a CPM both avoided a C-section and were still breastfeeding at 6 weeks. *96%* Here is a link to that study from the National Institutes of Health database: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15961814

Unlike routine protocol in typical hospital labor/delivery units, Certified Professional Midwives encourage natural births by providing continuous one-on-one support during the entire labor. They encourage the mother to labor and deliver in vertical positions, because laying down restricts the contractions of the uterus, narrows the birth canal, and makes labor more painful. By following vertical birthing techniques, the need for medical intervention and the request for pain relief is minimized -- thus, the chance that labor/delivery flow smoothly in a normal, natural, healthy way is maximized. Thus, that bonding hour after birth critical to successful breastfeeding initiation is protected. The mother/baby are free from external disruptions to their body's natural hormonal balancing system, and the stage is set for instinctual nurturing at the breast. During the following days, mother should be educated on safe co-sleeping arrangements according to the research of Dr James McKenna and Dr William Sears. Mothers who have had natural births free from tearing or surgeries are free to focus energy and attention on breastfeeding during the postpartum weeks, rather than on fresh, painful wounds that make even picking up baby a difficulty.

Any program to encourage breastfeeding will fall short of potential success without addressing the physiological design of hormones that accompany the natural birthing and bonding process. Conclusions of the literature on positive implications for breastfeeding by the use of CPMs and CNMs as primary maternity care providers are quite invariable, as supported by Cochrane reviews: http://www.cochrane.org/reviews/en/ab004667.html Currently, only ten states provide CPMs reimbursement for taking on Medicaid clients, so entire sections of the less-fortunate population are unable to afford access to professional maternity care support that maximizes their chances of avoiding surgery and successfully breastfeeding.

No formula samples or bottles should be given at the hospitals, except in extreme cases where nursing is actually (not theoretically!) impossible.

Newborns who are not in need of immediate emergency care should be given immediately to their mothers, placed on her bare chest and allowed the opportunity to discover her breasts and latch on by themselves. The infant should be allowed to continue to nurse at will. This skin-to-skin contact should be allowed and encouraged for as long as the mother desires, baring medical emergency. Baths, weighing, etc. can wait at least until after the first good sleep together.

Heated (do we call it pasturization for human milk?) milk needs to be carefully researched before becoming acceptable.

Hospital/Post-Delivery Care -- We need more maternity care provided by midwives, who are more supportive of breastfeeding and overall maternal-baby care. We need fewer c-sections, inductions, and instrumented deliveries, as these lead to more discomfort post-delivery and result in more complications with babies, which means babies are separated from their mothers more often. We need more natural deliveries, in general, as this really seems to empower mothers to have confidence in their own bodies. We need more babies placed skin-to-skin with mother immediately after delivery, instead of being wrapped up in blankets and hats. We need babies to remain with their mothers after delivery, instead of being sent to the nursery for labs, monitoring, etc. We need babies to reside in their mother's rooms full-time in the hospital, and we need to eliminate the option of sending babies to the nursery at night, except in unusual circumstances. We need to eliminate formula-company gift bags. We need lactation consultants on-call at the hospital during the night, as this seems to be when most mothers become frustrated with breastfeeding and resort to giving formula. We need fewer circumcisions, since the stress and pain involved often decrease breastfeeding for several hours to a couple of days.

Many of these women come from cultures where breastfeeding is the norm and successfully breastfed one or more children before arriving in the United States. Then, somehow, the child(ren) born here don't get the benefit of their mother's milk and when one investigates why, one learns of these barriers put up by employers:

1. Having to choose between pumping/expressing and eating during meal breaks; 2. No other breaks during the work day for pumping/expressing; 3. Lack of proper storage facilities for pumped or expressed milk; 4. Lack of a clean and private place to express or pump; 5. Employers viewing requests for these basic amenities as 'troublemaking'.

As you may imagine, when the woman in question is undocumented, there is no motivation on her part to try to improve her situation as in doing so she might easily lose her job.

I bring this to your attention because I believe the stereotype of the working, breastfeeding mother is the manager/professional who manages her own time, can store her milk in an employees' lunchroom refrigerator, and may even have an office with a door that locks for privacy while pumping/expressing. It's a pretty picture, but it's not reality for many, many women, and they are the ones whose babies stand to reap the greatest benefit from being fed their mothers' milk.

I urge, when policies/legislation are being formulated, that the framers not forget those mothers in the lowest level service jobs. Their babies deserve mother's milk just like those of middle and upper class mothers. Their employers must understand that and take action to make it possible.

Nurses have got to stop pushing formula on new mothers - telling a brand new mother her baby HAS to eat every 3 hours or else, encourages formula feeding

Renee Callanan, BSN, RN Milkies International reneecallanan@mymilkies.com

In a “Puritan” American society, the image of the exposed breast must become common-placed instead of taboo. This image must be re-associated with maternity, wholesomeness and goodness in lieu of sexual evocation. And, the image of the breast must be pervasive.

To further increase the comfort (because that is the root of the breastfeeding discussion: comfort) the image of the 12- to 24-month old nursing must also be pervasively accepted. Why do we accept so easily the sight of a pacifier and a bottle in the mouth of a 18-month old and not a breast?

Apart from spreading positive breast/breastfeeding image the other requisite change is that of preconceived notions. It has somehow been anchored in the collective consciousness that breastfeeding, especially after 6 months, reduces autonomy, “spoils”, creates a dependence, is psychologically unhealthy. Perhaps new reports and studies need to be issued, not only promoting the positive health aspects of Breastfeeding, but the positive psychological ones as well.

I was lucky that my employer paid for half of the cost of a good breast pump. Many women simply cannot afford a good dual electric breast pump when they go back to work. They want to continue breastfeeding, but they can't make it work. You simply can't use a cheap pump and get enough milk to feed your baby within a reasonable amount of time. I think the government should subsidize breastpumps for women, so everyone can afford them.

I also think that all employers with 50+ employees in one location should be required to provide a suitable lactation room. This means a clean room with a door that locks, power outlets, a comfortable chair and table/desk, and a small refrigerator.

Also, all employers should be required to give breastfeeding women 30-minute breaks every 3 hours, because that's how long it takes to set up, pump for 20 minutes, and clean up.

Rachel Silber, IBCLC, RLC, CCE, CD, CD(DONA), CLE, CPD Lactation Consultant, Perinatal Educator, Doula

#1.All mothers should be required to suckle their infants at birth for 2-3 days, whether they intend to breasfeed or not.This is SOP for animal husbandry and is essential to humanity's survival and viability as a species as well. A national policy on this will insure it's citizen's future well being. #2.6 months federally guaranteed maternity leave, like the national guard. #3.6 weeks federally mandated, IN HOME newborn, maternal and breastfeeding insurance coverage for services by health care and allied health care providers. #4.Hire Hollywood to market breastfeeding as

When I had my baby I was living in the UK. It was made very clear to me by my midwife that breastfeeding was legally protected in all settings, and this made me feel so much better about going out into public with my baby, since I knew wherever I was I could feed him. When you can breastfeed anywhere, breastfeeding becomes MUCH easier than bottle feeding (since you don't need to take bottles along with you when you go out), whereas when breastfeeding cannot be done in public, bottle feeding is the easier option. The ability to go places and get things done with your baby is a huge quality of life issue for new mothers, and I personally know of some women who have stopped breastfeeding because they feel it ties them to home. Nothing could be further from the truth - when you breastfeed, you can go anywhere, anytime because you bring the food with you. The only barrier to this attitudeis the lack of legal breastfeeding protection.

I know from experience as a former breastfeeding mother that it takes six weeks just to get breastfeeding properly established. I was still ready to give up every day at six weeks! Only when my baby was around 2 months did I really start to get the hang of breastfeeding. That was also the time that the weight started to come off (after 8 months of breastfeedings, I ended up 15 pounds lighter than before the pregnancy). As any lactation consultant will tell you, expressing breast milk is difficult under any circumstances, but its almost impossible when a woman starts trying before her milk supply has been properly established through breastfeeding her baby. Plus, many women (me included)can sucessfully breastfeed their baby but can never use the pump.

In light of all this, it makes sense to work towards guaranteeing at least 6 months of paid leave. This would allow women to breastfeed for the 6 month period that the world health organization has identified as critical for a baby to be breastfed in order for it to reap the benefits of better immunities from infection, lesser risks of asthma and cancer, lower rates of ear infections, etc,.

Having a baby in this country, with no paid maternity leave, creates financial hardship for the family. I am pregnant with my second child, and this time around I will not receive any pay while I am on maternity leave. It will be a significant financial hardship for my family, but we are able to make that sacrifice, at least for 3 months. I know of people (including my aunt) who must return to work after just a few days.

Paid family leave is something that many developed countries offer. It would undoubtedly increase breastfeeding, and it would be an important investment in the health of babies and mothers that would last long-term. It would be one of the most effective policies to improve breastfeeding rates, and also relieve the financial burdens placed on new families.

I had my baby in a birth center in the UK where breastfeeding was a top priority of the midwives (I'm American, but was living there for two years for work). The practices they used to help sucessfully establish breastfeeding were as follows:

a) Uninterrupted skin to skin contact of baby and mother for at least one full hour immediately following birth. Science tells us that this contact is critical for getting prolactin flowing. In normal circumstances, there is no reason to separate mother and baby immediately after the baby is born. When my baby was born, he was placed on my chest and we were left alone in a quiet place to bond.

b) Rooming in. My baby never left my sight after he was born. The baby and my husband slept in our room with me at the birth center. This allowed me to try to feed the baby whenever he cried, and to have my husband there to help me.

c) Breastfeeding class. Prior to the birth of the baby, the birth center offered a relaxed afternoon where pregnant women sat down with lactation consultants to learn more about the benefits of breastfeeding and proper techniques. We were also told who we could contact if we needed help once the baby was born and we'd gone home.

d)Educated midwives who supported breastfeeding. The midwives who cared for me truly believed in breastfeeding and had been trained extensively on its benefits and techniques. From what I have heard of labor and delivery nurses in the USA, they are at best uneducated about benefits and at worst hostile to breastfeeding.

As you know, labor, deliver and post-delivery care in the US in general has many, many problems causing it to be far more expensive and have far worse outcomes than the predominately midwife-led care in almost every other indistrialized nation. While this is a much bigger problem than the task you have set out to do, I believe that the initatives to implement the pro-breastfeeding practices I have enumerated above would go a long way to making US maternity care more humane and produce better results in general, and especially in breastfeeding rates.

Being able to express breastmilk to nourish your infant is a basic human right, and there need to be policies supporting this right in the workplace.

What would be better would be 1. undisturbed birth and immediate postpartum with baby on mom's body; 2. baby-led initial breastfeeding; 3. evidence-based postpartum support and education while still in hospital; focus on education to get a good latch.

Also, health professionals could benefit from training about other complimentary care practitioners, especially cranial/sacral therapists and chiropractic care for newborns. I am always surprised when I hear families have spent hundreds of dollars on lactation consultants without solving the problem. I encourage them to seek the help of a cranial/sacral therapist or chiropractor (for the baby) and almost always the latch issue is solved quickly within one or two visits. If we want to deliver excellent care to families we have to reach beyond allopathic solutions at times and embrace other evidence-based care.

After coming into contact with these people who were supposed to be able to help but actually were unhelpful, and being made aware that this is not at all an uncommon experience among mothers, it seems that if a staff member at a clinic or hospital is going to be given the task of assisting and caring for a lactating woman and her breastfeeding baby, they actually need to be aware of how lactation works and how caring for a lactating woman and child is different than caring for a mother who is formula feeding.

Medical workers who are going to be in the position of caring for nursing mothers and babies should be IBCLCs, plain and simple. Staff members who were the hospital's own

D. Jill Mallory, MD University of Wisconsin Department of Family Medicine

Unfortunately, we need to reach these moms when they are pregnant with their first child, not their last. However, due to their youth, and the attitude that often accompanies that age, they are not so interested in information on healthy choices at that time of their lives.

The subject of my dissertation goes very well with your call to action on breastfeeding.

I carried out an empiric study at the international 2008 VELB conference in Vienna,Austria,

Here are my observations and concerns:

Observations:

1) Several women who saw different lactation consultants at different times as part of their hospital stay have reported that these lactation consultants give different, and contradictory, advice.

2) A mother who gave birth at Kaiser (it was not a good experience for her—to say the least—2 days laboring, epidural, pitocin, vacuum extraction on the 3rd try). She and baby were both in shock when they arrived home from hospital. There were some breastfeeding

Here are my observations and concerns:

Observations:

1) Several women who saw different lactation consultants at different times as part of their hospital stay have reported that these lactation consultants give different, and contradictory, advice.

2) A mother who gave birth at Kaiser (it was not a good experience for her—to say the least—2 days laboring, epidural, pitocin, vacuum extraction on the 3rd try). She and baby were both in shock when they arrived home from hospital. There were some breastfeeding

We must find a way to create programs that will give moms the confidence to keep breastfeeding! It's very easy to look up, say, what a fever temperature is for an infant. It's less easy to find out whether your child is getting enough milk. Moms are supplementing because they don't know any better.

And in our beautiful, well-educated nation, that is an embarrassment. Can we at least create an informational website where a mom can go in the middle of the night with info about engorgement, cluster feedings, latch issues and the like?

- physicians would receive education and training in medical school on how breastfeeding works and hear from real moms who have done it;

- women would not be given bags from forumla companies by their OBs or at the hospital;

- formula would be available only by prescription and all the effort and energy of the doctors and nurses would be geared towards figuring out how to make breastfeeding work instead;

- literature would frame the issue in terms of how formula harms babies instead of how breastmilk helps them;

- all women who deliver would have access to lactation consultation more than once during their hospital stays and follow up via phone the weeks after delivery.

The government needs to do research on why women choose to formula feed when this practice has known health risks. Perhaps if we understand this practice, we will have tools for educating women why this practice harms babies.

Working on the assumption that all women will breastfeed leads to some obvious positive changes- education and support should begin immediately, as a part of prenatal care. Education that is primarily the stories of other women (La Leche League style) rather than the common drill of how much better breast milk is than formula would be very helpful- remember, this is operating on the assumption that women will nurse, so there shouldn't be the same focus on the superiority of one over the other. Statistics, studies etc have their place and many women are interested in these things, but I think a greater impact is made by KNOWING another woman who nursed or is nursing. Seeing women nurse their babies, hearing stories or reading, these are the kinds of things pregnant women need exposure to, and less of the guilt-creating bombardment of stats.

NO samples of formula.

Mothers who have birthed their babies should be gently enabled to hold their babies immediately after and put them to the breast as they like. All non-emergency care of the newborn should be postponed for some hours after the birth. This is critical for helping foster a positive nursing relationship early on.

I could go on and on, but those are my two major concerns: changing our assumptions and allowing the mother to nurse soon after birth without interruptions. Thank you for listening.

Meanwhile, in the private sector, I had many mothers not make appointments or not get follow-up help because they felt they couldn't afford it. I charge half of what my colleagues in nicer areas do, yet it is still considered

I speculate that many L&D nurses bottle fed their babies and don't understand the importance of or how to breastfeed. Need to staff more lactation consultants and require breastfeeding classes as part of pre-registration for first time mothers. Need post-partum home visits as well by lactation consultants.

I am a registered nurse. My primary concern when returning to work would be whether I would have someplace clean and private to pump. We have a locker room (with no seating, and is open to all) and a break room (again, open to all). When I asked human resources about pumping at work, they knew nothing about it and referred me to my manager to find a solution to my issue.

In my opinion, HR should be making the effort to find me a clean, private place to pump. It seems like in a hospital filled with nurses (the vast majority of whom are young and female), this is an issue that should have already been addressed, but it's been ignored. My manager ultimately let me use her office to pump, but that's only a good solution because I work every weekend and she isn't around on the weekends. I cannot use an empty patient's room to pump because I do not feel it is sanitary and the rooms do not have doors I can close.

I know some states have laws mandating that a clean, private place be available for pumping, but PA is not one of them. I strongly believe this should be a law that spans all 50 states.

It is hard enough for me to find the time to pump during my 12.5 hour shift. Sometimes I'm lucky if I get to pump once during the entire day. It's unfortunate that the very hard work that goes into making breastfeeding successful with a newborn becomes even more difficult once a mom returns to work after 3 months or less. The WHO and APA recommend breastfeeding (or formula) strictly for the first 6 months, and the challenges of work make this more difficult to make a reality.

Simiarly, more research needs to establish the benefits of feeding formula to babies with jaundice. This practice is highly determental to breastfeeding.

Additionally, doctors need to be reeducated on the different weight charts for infant formula versus breastfed babies. The WHO has published charts for breastfed babies, and it's obvious from comparing them to the AAP charts that formula babies are naturally heavier than breastfed babies, but that doesn't make breastfed babies less healthy! However, it does mean that more moms are pushed to supplement with infant formula, ultimately reducing their supply, and