Call To Action on Breastfeeding  
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CALL TO ACTION ON BREASTFEEDING

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ID Interest Areas Topic Comment
2 Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care OB/prenatal and postnatal care should operate from the assumption that all mothers will breastfeed as the norm and all staff both in clinics and hospitals should suppport that notion as well. Breastfeeding should be the standard.

6 Lactation Professional
Nonprofit Organization
Public Health Worker
Health Professional Education, Publications, and Conferences When babies are not gaining weight, I feel that doctors tell mom's to stop BF babies just because they don't know how to help them and they would rather cover themselves and tell the mom to give the baby formula. Medical school should require more educaton in Lactation/Nutrition or MD should be referring to an IBCLC.I also feel that doctors don't seem to try and prescribe medications that are compatible with BF. They just tell the mom she can't BF rather then doing some research on which ones are safe. BF is important too!

9 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Nonprofit Organization
Other Areas: WIC Program
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Post delivery practices in many, if not most, hospitals are strongly anti-bonding and anti-breastfeeding. A baby needs to be with its mother after birth and the mother needs to be with her baby. Eyedrops, weighing, measuring, and bathing do not need to be done right after birth. Many procedures can be done while the baby is lying on the mother's chest. Wrapping the baby up like a cigar with even its little hands cocooned inside the blanket is an exercise in sensory deprivation - the baby should remain connected with the mother - able to feel, touch and smell her. Studies have shown that many of the reasons given for separating the baby from the mother are actually caused or made worse by the separation itself. A baby kept warm on its mother's chest with the help of her body heat and a blanket maintains its body temperature quite well and babies put to the breast immediately after birth and kept close to their mothers tend to have more stable blood sugar than babies kept apart. Even the way babies are suctioned after birth interferes with nursing as the rather rough (sometimes almost brutal) way the doctor shoves the syringe down the babies throat can abrade the tissues. Let's make the baby as important a patient as the mother and tend to its needs. I love the motto from one organization: It's my birthday; give me a hug!

10 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Suggestions for encouraging breastfeeding in these settings include routine examination of nipples during prenatal care. Doctors/midwives can diagnose inverted nipples and alert women that they may need extra help with initiating breastfeeding. Prenatal care providers should also recommend a Breastfeeding 101 class, video, book, or group meeting (LLL, etc.) to every woman and encourage partners/dads-to-be to start getting educated about the committment it takes to breastfeed.

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.

11 Other Areas: FDA employee
Worksite Lactation Support, Onsite Child Care, and Milk Expression New buildings are currently being designed for the Center for Biologics Evaluation and Research. I have requested that a lactation room for the staff be included. I don't know if the request will be granted, since there are many competing priorities for space, but I much appreciate the visibility CDC and NIH have given to the issue. I cited your public health initiatives in my request.

12 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I think the Call to Action has to be very explicit in calling for Baby Friendly. I am negatively impressed by alternatives like the Texas Ten Steps, which has over 60 hospitals, but only 4 have no formula bags, and only 1 (or none) are Baby Friendly, and they have below average mPINC scores.

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.

13 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Paid Maternity Leave This needs to be strongly supported in the strongest possible terms. Not only is it important to breastfeeding, but lack of paid leave is one of the reasons why mothers have higher poverty rates (see MomsRising statement on paid maternity leave). I would emphasize this as a top priority, and also encourage research that shows it is potentially cost saving if it can promote longer durations of any- and exclusive breastfeeding.

14 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Access to Lactation Care and Support Insurers should pay for access to IBCLCs, as they would pay for physical therapy and other allied health professionals. Forcing families to pay out of pocket for breastfeeding support only increases the already-serious disparities in breastfeeding.

15 Concerned Citizen
Use of Banked Human Milk I strongly believe that instead of cow's milk, humans should have access to human milk. Women should be given the option to pump their milk for public consumption.

16 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I believe that employers should be sensitive to breastfeeding mothers by allowing a clean, quiet non-bathroom location to pump. They should allow breaks for milk expression or to breastfeed children directly. Onsite childcare is the best and easiest way to keep breastfeeding mothers engaged.

17 Concerned Citizen
Paid Maternity Leave It's embarrassing that the United States is behind so many other industrialized countries in the world in this respect. Mothers should be paid for 3 months of maternity leave to establish breastfeeding. Research shows that the longer a woman takes maternity leave, the more likely she is to continue to breastfeed. This is easy to understand since it is far simpler to directly breastfeed a baby than it is to pump and then bottle feed the human milk. Paid maternity leave would give all mothers and infants a healthy head start towards establishing a strong breastfeeding relationship.

18 Concerned Citizen
Support for Breastfeeding in Public Settings The International Breastfeeding support symbol (found here http://www.mothering.com/sections/action_alerts/iconcontest/icon-winner.html) is one start to making nursing mothers feel more welcome. A public awareness campaign is needed to emphasize that breastfeeding is not taboo or sexualized, but a way to feed a child. Please consider encouraging nursing mothers of small babies and toddlers too.

19 Breastfeeding Coalition Representative
Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Public Health Worker
Access to Lactation Care and Support Making breastfeeding work without competent professional/peer support is like raising children without a pediatrician/PNP/FNP/PA/etc - or fixing multiple leaks in the wall without a plumber. If I could only choose one area of impact for breastfeeding support, it would be within 48 hours of when a mom and new baby go home.

20 Breastfeeding Coalition Representative
Community Organizer
Other Areas: Breastfeeding Educator
Other Areas Adolescents should be informed of the health beneftis to women and infants within the framework of the health curriculum taught in schools. Breastmilk is a biologically correct source of nutrition for mammals. Information would preferably be introduced at the middle school level. Reaching young adults with correct information normalizes breastfeeding for both males and females. Support of the breastfeeding mother is necessary in a family unit.

21 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Nonprofit Organization
Researcher
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Please include information about postpartum depression, how treatment of depression impacts breastfeeding, and sleep, fatigue in breastfeeding mothers and risk of PPD

22 Community Organizer
Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Providing worksite lactation areas is key for women to be able to contribute to their own economic well-being while providing the best food available to their infant. I think providing onsite child care is important when feasible but there are plenty of job sites that are not appropriate for babies and children. Focusing efforts on providing clean, private lactation facilities will be more effective in supporting nursing mothers as well as more economical over establishing and operating child care facilities.

23 Concerned Citizen
Health Care Provider
Lactation Professional
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Education needs to take place on the detremental effects of maternal and infant separation. More research needs to be pulled out and dusted off showing the long term effects to these babies, one day to be adults. Health care professionals see no worth to keeping baby and mother together. Routine administration of Pitocin is unbelievable, adding to the distressing experience of childbirth for mother and baby. Each postpartum nurse should be required to have extensive lactation training and experience. They should not have bias opinions towards formula feeding. Employees should be repremanded for not supporting breastfeeding or giving formula without medical reason. Exclusive breastfeeding is going by the wayside. The importance is not noticed anymore. The benefits to exclusive breastfeeding should be highlighted in bold. What benefits are lost once that one bottle of formula is given? The mother should know that info. Each mother should be given information related to the risks of forumla feeding and sign a consent form prior to their first feed or before going into labor.

24 Health Care Provider
Lactation Professional
Nonprofit Organization
Access to Lactation Care and Support La Leche League needs to be better represented as a resource for breastfeeding families. Many of the mothers I help in the hospital have never heard of it. Outpatient professional Lactation support is not readily available for everyone, only those that can afford it. It should be a service to anyone without concern for cost. LC support for Spanish and other nationalities is non-existant. More resources need to be made available in the USA. This should be covered by insurance or the government for those unable to pay out of pocket.

25 Concerned Citizen
Lactation Professional
Public Health Worker
Paid Maternity Leave IT IS CLEAR THAT WOMEN WHO WANT TO STAY HOME WITH THEIR CHILDREN SHOULD. ANXIETY AND WORRY AND SUBLEVEL CHILD CARE COULD BE AVOIDED.BREASTFEEDING IS EASIER AND MORE MANAGEABLE. QUALITY OF LIFE IS PERSONALLY DIRECTED.

27 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Formula supplementation should be treated as a pharmaceutical intervention and should only be allowed under certain medical conditions at the direction of a health care provider who can write orders for pharaceuticals.

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

29 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Public Health Worker
Access to Lactation Care and Support I don't feel there's enough women of color promoting breastfeeding. There needs to be resources to have women of color train and receive the credentials needed to advocate increased breastfeeding to underserved populations. In addition, these warm lines can only do but so much. We need more home visiting from lactation professionals.

30 Concerned Citizen
Health Care Provider
Health Professional Organization
Public Health Worker
Peer Support and Education of Family Members and Friends At this point, I don't think educating the moms are not enough. We really need to take it to the next level and start educating support persons like the grandmother and significant other. There's so much peer pressure from these people, that it's too easy for the moms to give up.

31 Public Health Worker
Paid Maternity Leave Paid maternity leave is essential to allow a mother and child time together to bond and establish the breastfeeding relationship. We can't ignore the financial pressures on families and the influence of those pressures on a parents ability to make choices for their child. Many mothers need to go back to work earlier than desired due to financial pressures. This separation from the baby at 6 or even 12 weeks interferes with the ability for mothers to establish milk supply and the breastfeeding relationship.

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

32 Breastfeeding Coalition Representative
Concerned Citizen
Peer Support and Education of Family Members and Friends I believe that breastfeeding needs to be brought to a students attention long before they are to become parents themselves. We live in a world where bottle and formula feeding are what is perceived as normal due to lack of breastfeeding education and exposure to our younger generations. Our schools teach many things on human nature and development, but overlook the subject of breastfeeding. Higher breastfeeding rates are needed in our society and one way of promoting breastfeeding is through education.

34 Breastfeeding Coalition Representative
Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media A battle for breastfeeding is currently being fought and has been active since June of 2007. This is due to the current policy of the deletion of photos that depict breastfeeding, on the social networking site, facebook. (Many of the photos can be viewed at: http://www.tera.ca/photos6.html)

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.

37 Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Worksite Lactation Support, Onsite Child Care, and Milk Expression Onsite daycare (at the parent's expense of course) should be provided in all workplaces that have more than 15 employees who need childcare. Having infants in another building is a huge barrier to breastfeeding. In addition, employers need to explore options such as allowing staff to bring their infants to work with them, keeping them right at their workstations. While it would not

38 Public Health Worker
State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I am a Public Health Nurse who visits mothers/newborns shortly after they are discharged from the birth hospital. One goal of ours is to visit every breastfeeding pair to offer education and support in the home. We do this free of charge. I have noticed that of the pairs that I visit the ones that expect to use/need a pump have the highest success rates. I believe it would help if the mother was prepared more for the usefulness of the pump during prenatal visits or child birth classes. It is difficult to train and hook the pair up with an expensive pump after birth when they had not considered using a pump prior to delivery.

39 Health Care Provider
Public Health Worker
State or Local Government
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) I am a Public Health Nurse for a local government. We do make in home visits to new mothers/infants shortly after they return home from the birthing hospital and we do this free of charge. We take a nice folder with breast feeding education information in the folder as well as other community resource and parenting information. We are very often successful in our support efforts and help for the pair during their transition from the hospital to their own home environment. We strive to decrease the anxiety that a new mother might experience by offering baby weights as often as the mother desires until the pattern of healthy weight gain is established in the infant. We believe this practice is appreciated by the new parents as most of them accept the offer.

40 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Public Health Worker
Other Areas: RN, Pediatric Primary Care Setting
Research and Surveillance Strengthen the benchmarks for breastfeeding support i.e. CDC Report Cards. Please add benchmarks which include what states are doing to reduce disparities in breastfeeding rates among African American and minority women. Fund us! Provide funding to states in order to conduct research which may offer more insight into the barriers associated with bf among African American and minority women in various communities. Provide funding for the implementation and evaluation of wide spread peer support for women/infants at greater risk for early breastfeeding cessation. There is something about the language being used to suggest that a number of states are meeting HP objectives: only some of the women/infants living in those states are meeting the objectives. While increasing bf rates are reason for celebration, the possibility exists that the celebration may actually mask the vast disparity which exists for some women and their children in our communities. Let's get serious about addressing disparities. Thank you for providing a forum for discussion about this important topic.

41 Concerned Citizen
Lactation Professional
State or Local Government
Other Areas: WIC Program
Peer Support and Education of Family Members and Friends In my job as a WIC breastfeeding peer counselor, the first question I ask expectant moms is

42 Concerned Citizen
Lactation Professional
State or Local Government
Other Areas: WIC Program
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media The more people see breastfeeding portrayed as normal and positive in the media, the more comfortable they will become, and therefore, more likely to do it themselves. It wouldn't even need to be discussed, just seen as a normal part of life with an infant/toddler.

43 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care We need to get free formula distribution out of the hospitals and other health provider sites

44 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Access to Lactation Care and Support Lactation professionsls including IBCLCs need to be able to bill and get reimbursed for lactation services

45 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Worksite Lactation Support, Onsite Child Care, and Milk Expression Lactation accommodation ( time and space to pump) should be the available to working mothers and not to just a fortunate few who work for an employer is willing to provide the time and place. Efforts need to be made to have lactation accommodate be apart of required work conditions.

46 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Breastfeeding needs to be portrayed as the norm in infant feeding in all forms of media. Images need to be representative of all ethnic groups and include images of family (father, grandparents) community groups supporting the mother to breastfeed.

47 State or Local Government
Worksite Lactation Support, Onsite Child Care, and Milk Expression Why a Nursing Mothers Room- Breatsfeeding provides important benefits to mother, babies and employers. Breast milk is the most complete infant food and also protects the infant against infections and allergies. Providing working mothers this type of facility gives them the opportunity to extend this bonding period. New mothers can come back to work sooner and are out less frequently to care for sick infants; their babies are heathier. New mothers are happier on the job when they can combine work with breastfeeding.

48 Concerned Citizen
Lactation Professional
Other Areas: medical social worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Establishing breastfeeding guidelines that would require a home visit within 24 hours to check on the family and breastfeeding by a trained lactation specialist, as well as an increase in post-delivery visits with the pediatrician and a lactation specialist in order to provide the mother, child, and family with continued support in breastfeeding.

49 Concerned Citizen
Lactation Professional
Other Areas: medical social worker
Paid Maternity Leave Increasing PML allowing a woman to continue to breastfeeding through the first 6 months of a newborn's life. Also, allowing all employees, regardless of where they are employed and how many people are employed in their agency/organization, the opportunity to take PML.

50 Concerned Citizen
Support for Breastfeeding in Public Settings I found it difficult to find private or even semi-private places in which to breastfeed my son. The best places were the department stores that had nice sitting areas outside the restrooms, not IN the restroom.

51 Concerned Citizen
Other Areas: mother
Support for Breastfeeding in Public Settings I have 4 children and strongly believe in a mothers right to breastfeed-especially in public. Why should a mother have to stuff her baby under a blanket-all year round even in summer so that others can feel 'comfortable'? Breastfeeding is the most natural way to feed babies, it is why we have breasts! I was recently breastfeeding my daughter in the sitting area in a restroom in a department store and very discreetly nursing when a woman burst out

52 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Public Health Worker
Paid Maternity Leave Since exclusive breastfeeding for first 6 months of baby's life is advised, there should be 6 months of paid maternity leave for all working women who breastfeed. This would contribute to well being of mother, baby, and society

53 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Women need to be educated on how the way they birth their baby will impact breastfeeding. Natural or pure birth should be the standard as well as breastfeeding.

54 Concerned Citizen
Other Areas: Childbirth Educator
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Breastfeeding needs to be more encouraged in hospitals. Free formula samples should be banned, and all birth and neonatal care providers need more education about helping women breastfeed successfully, as well as practices which encourage and support breastfeeding.

55 Concerned Citizen
Employer
Support for Breastfeeding in Public Settings Let us do everything we can to support women who choose to do the healthiest thing for their babies, which is to breastfeed them.Being a parent can be hard enough at times, let's not make it more difficult by not accepting breastfeeding in public places and making mothers go hide to feed their children.

56 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Nonprofit Organization
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Breastfeeding in the media is often portrayed rather badly. It's ironic that in our society those that come out and say all the downsides of breastfeeding are the ones that get all the press. Our society views breastfeeding as somewhat sexual, telling us to cover up. But what they don't understand is that we are using our breasts for what they were intended for.

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.

57 Health Care Provider
Lactation Professional
Researcher
Use of Banked Human Milk The use of donor milk for ELBWs infants is supported by the research. This should be become standard of care for all NICUs across the world.

58 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care More midwifery care in all hospital settings would increase breastfeeding rates. All nurses in Labor/Delivery need to be trained to leave newborns with their mothers, and not do

59 Concerned Citizen
Use of Banked Human Milk Why isn't there a tax benefit for mothers (of infants under 1 year) who make a one time donation of 100 oz of milk?

60 Concerned Citizen
Public Health Worker
Peer Support and Education of Family Members and Friends I think that more information should be provided to everyone about the benefits of breast milk from birth and beyond. I was talking to someone the other day that said that milk has no antibodies after a year, which is incorrect. A woman's body continues to make immunoglobulins for each nursing session.

61 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Public Health Worker
Access to Lactation Care and Support 24 hour, 7 day per week lactation support should be available in all hospitals-make it a JACHO requirement All Ob providers (Clinic/private practice) should have lactation support staff in office or available to their patients as consultant

62 Concerned Citizen
Other Areas: fitness and yoga instructor
Use of Banked Human Milk Women who are unable to breastfeed right away or at all should have information about this as a possibility...or to encourage people to do this within their own networks of friends so that mothers who need this option can still have breastmilk for their babies.

63 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Nurses and hospital staff need to be re-trained to understand that human milk is the appropriate alternative to an infant's biological mother's milk. If mother's milk is unavailable for whatever reason, medical staff should be prepared and comfortable utilizing other safe sources of human milk.

64 Breastfeeding Coalition Representative
Concerned Citizen
State or Local Government
Other Areas: WIC Breastfeeding Peer Counselor
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As a breastfeeding mother, a member of a breastfeeding coalition, and a WIC breastfeeding peer counselor, I believe that the health of our children in the U.S. can be dramatically improved with increased breastfeeding rates. As a WIC BFPC, I see women who are eager to try breastfeeding only to be discouraged when hospital staff do not support them in their decision and may even discourage breastfeeding. I would like to see universal and mandatory breastfeeding training for all hospital staff who are involved with prenatal, birth, and postpartum visits. Mandatory training would ensure that clients/patients are given positive messages and correct information regarding breastfeeding. As our breastfeeding rates increase, we will continue to see a rise in the number of healthy children in our country.

65 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care There is little acknowledgment in the medical industry that increased intervention during labor and birth and immediately post-delivery can have negative effects on the breastfeeding relationship. It is no wonder that, with a 30%+ c-section rate, we have such low initial breastfeeding success. There is little understanding about how natural hormones and other physiological processes work in labor, birth and post-partum, and even less understanding of how unnatural interventions effect those. I believe that, in addition to social factors, as long as the birth intervention rates stay as high as they are, breastfeeding difficulty will continue as well.

67 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression It is my strong belief that breastfeeding needs to be supported in all settings. For many centuries, it was the norm. It still should be. It is a way for mother and child to bond, a great source of nutrition and a transmission of immunity. The fact that we do not have paid maternity leave discourages many mothers from continuing breastfeeding, as they can not take the time to be with their child. Additionally, many employers are not pumping friendly. Pumping in a unlighted storage closet or bathroom is far from pleasant, but it is what many mothers must endure if they wish to feed their infant with their own milk. Government incentives and guidelines are a great start to changing the popular thinking in relation to treatment of lactating mothers and mothers in general.

69 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I think there should be medicare and medicaid money linked to baby friendly practices. Hospitals should staff only 1 to 4-5 coplets and there should not be a nursery open. There should also be a ratio of IBCLC's, in that postion only, to a certain amount of deliveries, at least 1 per 1000 deliveries. Hospitals should be regulated by the federal government and finded if not compliant.

70 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Incorporating Baby Friendly Hospital Initiative Steps into JCAH review would accelerate adoption of best newborn care practices

71 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care There should be a postpartum follow up home visit for every new mom by a nurse.

72 Concerned Citizen
Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Codifying ILO recommendations for maternity /postpartum protection would drive needed workplace support for women.

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

73 Concerned Citizen
Paid Maternity Leave While we as a nation clearly would like our mothers to breastfeed for a least a year, we are only willing to provide women and (and sometimes men) 6-12 weeks of unpaid family leave. By mandating year-long paid maternity leaves (as do Canada and a host of other nations), we would provide women the time, space, and supportive-environment in which to successfully breastfeed for at least one year. Breastfeeding while working outside of the home is extremely challenging: finding a place to pump, especially for working-class women who work on factory floors with only 2 15-minute breaks and 1 lunch break in an 8-hour day, is nearly impossible. Taking the time out to pump is generally looked down upon, and juggling pumping with earning an income, taking care of a household, and caring for an infant is difficult in even the best circumstances. If this nation truly cares about family values, it should provide families the support they need to be as healthy as they possibly can be.

74 Concerned Citizen
Use of Banked Human Milk I think this is a wonderful practice and I have donated my extra breast milk to the National Milk Bank. I think they should do more to advertise the availability of these precious resources.

75 Concerned Citizen
Health Care Provider
Lactation Professional
Paid Maternity Leave Paid maternity must be codified - women should not have to return to work before ideally 12 weeks, but certainly not before 6 weeks post-partum when lactation is more fully established. Somehow other industrialized countries have been able to implement

76 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care More OB's and Family Practice physicians need to provide information and encouragement during the antepartum period. More should have RN's on staff for education. So many only have an MA which is just not adequate.

77 Concerned Citizen
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care There is a major disconnect between OBGYNS,Pediatricians, nurses and new mothers in the hospital and before birth. There must be pre-birth dialogue between these practitioners and the patient/client about the benefits of breastfeeding and the shortcomings of formula. The government needs to do more and make these conversations mandatory.

78 Health Care Provider
Access to Lactation Care and Support Reimbursement by insurance companies for lactation consults.

80 Concerned Citizen
Use of Banked Human Milk I think this is a wonderful concept that needs to be implemented in more areas. Many women have an abundance of breastmilk while breastfeeding their child(ren) and it would be great for them to be able to donate to others in need and not just let it go to waste. If there was an organization that specialized in collecting and storing this extra milk and distributing it to babies who NEED it that would be great!

81 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Paid Maternity Leave I would like to see ALL mothers allowed 6 months leave with full pay. That first 6 six months is the crutal period for infant growth and development. All infants should receive breastmilk only during this period and if mothers could be with the infant the baby can be directly breastfeed. After this period the workplace should provide 3 pumping breaks per 8 hr. shift of at least 20 minunets each. The location of a breast pumping area should be with in a 3 min. walk form the employees work area and not a tolet area.

82 Nonprofit Organization
Support for Breastfeeding in Public Settings I defiantly think that if the general public's view of breastfeeding changed more women would do it

85 Concerned Citizen
Paid Maternity Leave Paid maternity leave should be mandatory. Working mothers are forced to leave their babies a lot sooner than they want/should because they can't afford to stay home without pay. Mothers and babies need to have the first couple of months at home together to bond and establish breastfeeding.

86 Employer
Worksite Lactation Support, Onsite Child Care, and Milk Expression Pumping should be able to be done during PAID 15 minute breaks. A diabetic does not have to clock out to take an insulin shot. Employers need to be educated about the benefits of breastfeeding and realize that women who take this time to pump will take less sick days down the road.

87 Concerned Citizen
Paid Maternity Leave Companies or the government should offer some sort of pay for maternity leave. If a woman is breastfeeding, FMLA leave should be extended to 6 months (does not all have to be paid) as this is the recommendation by AAP and WHO when babies should have SOLELY breastmilk.

88 Concerned Citizen
Support for Breastfeeding in Public Settings Too often, we hear of women being practically criminalized for breastfeeding in public. Babies have the right to eat when they are hungry--not just when it is convenient! Breastfeeding in public should be a protected law in all states. It is an issue of human rights.

89 Concerned Citizen
Support for Breastfeeding in Public Settings This should be regulated at the federal level. A woman should have the right to breastfeed her child anywhere she has the right to be.

90 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Decrease the incidence of c-sections in hospital births. Increase the number of hospitals that allow VBAC.

91 Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care For mothers that receive c-sections often the babies are not brought to them for an hour or longer post surgery. The babies then are often sleepy and resistant to nurse and hospital staff often encourages the use of a bottle so mom can rest. It should be standard that the newborn is brought to mom in the recovery area and allowed skin to skin contact with her to encourage the establishment of breastfeeding relationship. When mom is then returned to her psot partum room the baby can then be transported alongside mom.

92 Concerned Citizen
Other Areas: federal government
Other Areas Breastfeeding saves employers sick days, saves the parents money, saves the environment because there is nothing that goes into manufacturing it. Breastfeeding mothers should be offered a tax credit by the government.

93 Concerned Citizen
Support for Breastfeeding in Public Settings It continues to amaze me how disgusted or disapproving people are when they see a woman breastfeeding her baby or toddler, yet, they have no qualms about seeing a scantily clad woman in public or in the media. When did things become so twisted?

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.

94 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Pumping is not as beneficial as breastfeeding. Companies should be rewarded for offering childcare onsite so that women can nurse rather than pump.

95 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Need laws the protect women to be able to have a place to express breast milk in the workplace.

96 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media End advertising. It portrays us all in ways alienating us from ourselves, making us feeders at the trough of profit and dis-information. It pushes behaviors and the ideas that go with them. Wouldn't it be lovely to have beautiful art on signs and walls of these sterile buildings showing our traditional artists including of breastfeeding, changing our minds toward grace and self-loving.!!!

97 Concerned Citizen
Health Care Provider
Support for Breastfeeding in Public Settings There needs to be greater support for breastfeeding out in public. The reality is that all babies eat frequently, breastfed babies usually more so. If women feel that they need to retreat to their cars or often dirty public restrooms to nurse, their inclination will be to stop nursing or never start to begin with. It is too inconvenient. And it sends the message that when we feed our children at the breast, it is shameful somehow and should only be done behind closed doors.

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.

98 Concerned Citizen
Other Areas While most mothers with perseverance and support can have a successful breastfeeding relationship, I am concerned that very few people address the needs of mothers who pump exclusively. Following a traumatic birth experience that resulted in almost 2 days separation from my daughter and 2 months of lactation consultants appointments, I made the decision to pump full time to provide my child with breast milk. Thankfully, I live in Portland, where breastfeeding has more support than in some other US cities. I was unsure however of my legal standing for pumping in public. While I know some people may find this to be a trivial concern, it was a very large and looming concern of mine. In order to maintain a sufficient milk supply I had to pump up to 12 times a day. In order to do anything, work, run errands, go to the grocery store, I had to pump in public. I think there should be more research on the EP'ing mothers and their particular needs.

99 Health Care Provider
Lactation Professional
Public Health Worker
Other Areas I have been involved in lactation since its inception as a clinical area. We would go a long way towards human milk as the only human infant food if infant formulas were available to the general public only by prescription. This forces the HCP as well as the infant's caregivers to think twice about using infant formulas instead of mother's milk.

100 Community Organizer
Concerned Citizen
Access to Lactation Care and Support We spend months teaching our clients,women of all ages and backgrounds, the importance of breastfeeding.We also climb the mountains of fear and low self-esteem with many of our clients until they discover their own strengths and are ready to give birth. They want to breastfeed but they face a hospital experience that has little help to teach and encourage their feeding skills. You can NOT count on an over worked nursing staff to take the time these families need to establish a strong breastfeeding dyaid. Lactation care must be there and ready to help with trained professional and peer support.

101 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Physicians and Nurses have not bought into Breastfeeding as being the best. Funding is not available to educate these influential individuals. Formula companies have in-services once a month driven by their marketing dollars we have nothing as frequent or elaborate to help educate our personnel.

102 Concerned Citizen
Other Areas: Birth Doula
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Ban the Bags!

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

103 Health Care Provider
Lactation Professional
Access to Lactation Care and Support My hospital has cut staffing and has eliminated LC hours to reduce costs. I am staffed as an RN and squeeze in my LC duties when I can.

104 Health Care Provider
Lactation Professional
Health Professional Education, Publications, and Conferences Education is costly and not reimbursed by my employer. I costly but informative conferences paying out of my own pocket.

105 Health Care Provider
Lactation Professional
Use of Banked Human Milk I have no access to a milk bank

106 Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression I have been told that a program is a wonderful idea but there is no money or space to accomplish it.

107 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media How are culture views breastfeeding is a significant barrier for many mothers. Breastfeeding mothers are made to feel that they must be cover-up when breastfeeding and be as discreet as possibly, often causing discomfort to the baby and the mother. Many feel like the must use a restroom when in public to breastfeed which in itself speaks to how we view breastfeeding as a culture. We need to encourage breastfeeding mothers by portraying breastfeeding mothers in all types of publications. One thing that strikes me is it is nearly impossible to even find children's books with breastfeeding mothers. We need to incorporate positive images on television so that women do not feel embarassed or uncomfortable. A breastfeeding mother should not feel like she must use a smelly, uncomfortable public restroom to nurse her child.

108 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Paid Maternity Leave The United States has the worst maternity leave practices out of all the industrialized countries. When women go back to work at 1 week or 3 weeks or 6 weeks the chances of succesful lactation are very small. Even a 12 week maternity leave is a minimal amount of time to truely establish lactation.

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.

109 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Paid Maternity Leave The United States has the worst maternity leave practices out of all the industrialized countries. When women go back to work at 1 week or 3 weeks or 6 weeks the chances of succesful lactation are very small. Even a 12 week maternity leave is a minimal amount of time to truely establish lactation.

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.

110 Concerned Citizen
Other Areas: Birth doula
Paid Maternity Leave The maternity leave in the United States is incredibly stingy compared to most other countries. Many women are not even eligible for any, and even for those who are it is ridiculous to think of a mother leaving her 6 week baby in a daycare or with a nanny. The obligation to return to work so early can have a detrimental effect on the nursing relationship. A mother's milk supply is not even necessarily regulated by then. If you are truly seeking to improve the number and length of time women breastfeed for in this country it is vital that maternity leave be available and extended for all new mothers in order to allow a healthy breastfeeding relationship to be established.

111 Concerned Citizen
Nonprofit Organization
Other Areas: Mama who breastfed!
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I had an unplanned (much lamented) cesarian birth of a beautiful, much celebrated baby boy. My milk was late in coming in, and if I did not have family and in-hospital lactation consultants to advise me, as well as a culture of breast-is-best in the hospital, it would have been very difficult for met to breastfeed. It is essential that hospitals maintain an educated, breast-is-best culture and that in-hospital lactation consultants are available around the clock. Our nation is way behind in paid maternity. It is best for baby, mama, and employer alike for mama and baby to be together in the first six months of life. We need extended, paid leave for mothers, to cultivate workplace cultures that welcome babies and breastfeeding, flexible policies that allow women to work from home. Breastfeeding now saves our nation a bundle in health care costs down the road. The evidence is clear. So let's promote it as the life-saving prevention medicine that it is!

113 Concerned Citizen
Other Areas: mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I would like to see hospitals and pediatricians put more resources into promoting breastfeeding and STOP PUSHING FORMULA on new moms and babies unless it is absolutely medically necessary. A lactation consultant should be a part of the birthing process covered by insurance.

114 Lactation Professional
Public Health Worker
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) There is a dire need for peer counselors in every community in my City. The cost to start a peer counseling program is far less than the healthcare expenditures for diseases like diabetes (Types I and II) and conditions like obesity. Breastfeeding reduces risk for those diseases and conditions.

115 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Please consider raising hospital and birth center reimbursement rates for those who become Baby Friendly.

116 Concerned Citizen
Other Areas: breastfeeding Mom
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Care providers need to assume that you will be breastfeeding and offer support. I had many care providers who assumed that I did not breastfeed, and I never had a health care provider ask how things were going or offer general support.

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.

117 Community Organizer
Concerned Citizen
Paid Maternity Leave The 12-week maternity leave available to most mothers in the United States pales in comparison to what is offered to mothers (and fathers) in the vast majority of other developed nations worldwide.

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.

118 Health Professional Organization
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media The Ad Council spots for breastfeeding (roller derby pregnant women, etc) were brilliant. Since they are already made, why not run them ?

119 Health Care Provider
Use of Banked Human Milk I completely support this. Physicians need to get on board.

120 Concerned Citizen
Other Areas: milk bank donator
Use of Banked Human Milk Publicity! Let people know that it is possible to donate human milk! I threw out hundreds of ounces of milk that I pumped while my baby was in the NICU. I had no use for it and I couldn't figure out what to do with it.

121 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media It would be helpful to the breastfeeding cause if we could somehow (through ad campaigns and public education) change the main-stream view of breasts from a purely sexual part of a woman's body to one that is also nuturing. I think normalizing breastfeeding should be a primary goal.

122 Concerned Citizen
Other Areas: Birth Doula
Use of Banked Human Milk NICUs in every hospital around the country should be stocked with donated or banked human milk rather than formula, as it has been shown that the benefits of breastmilk are particularly crucial to premature babies. Premies receiving human milk get stronger quicker and have fewer complications.

123 Health Care Provider
Paid Maternity Leave Considering that we are among the most advanced countries in the world it makes no sense that we do not support parenting and nurturing with paid maternity leaves. Kids need to come first not last.

124 Public Health Worker
Health Professional Education, Publications, and Conferences A recent journal article showed that more pediatricians now have negative attitudes about BF and a lack of faith in women's ability to effectively BF than in 2004. Women turn to their baby's pediatricians for knowledge and support. We must provide better education to them and skills training regarding human lactaion & supporting BF.

125 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I am a nurse in a hospital in downtown Philadelphia. About 85 % of our clientele is on medical assistance. I think the free formula the hospitals give and the free formula that WIC provides is a major deterent from exclusive breastfeeding. I think this needs to be addressed. It costs the govt alot of money to provide the formula and the increased health care costs of medical costs for formula fed babies are higher than that of breastfed babies

126 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I would like to see more breast-feeding friendly practices at hospitals. I would like to see ALL hospitals REQUIRED to be breastfeeding friendly...no free formula, no pacifiers, no time away from mom (especially in the first few hours), immediate skin to skin contact and breastfeeding initiation, no offering of sugar water, etc. I feel that this would be a big help and boost to enable more moms to be able to initiate breastfeeding!

Thank you,

Heidi Boyd

127 Community Organizer
Health Care Provider
Public Health Worker
Paid Maternity Leave I am the primary wage earner in my family. Because of unpaid maternity leave, my family has had financial problems at the very time we need stability. We no longer live in a world where men are the only primary earners! We need policies that support paid maternity leave for all families.

129 Concerned Citizen
Employer
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care All hospitals in the US should be familiarized with the Baby Friendly Initiative developed by the World Health Organization. It's simple, cost-effective, and great for moms and babies.

130 Concerned Citizen
Employer
Health Care Provider
Paid Maternity Leave Our country is so far behind all other countries in this regard. It is really discouraging. We must refocus on people, rather than business.

131 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I would love our society get to a place (with governmental agencies and the general public's help) where the bottle was not the traditional icon representing babies. I would love not to see formula ads on television and in magazines!! I would love to see the international breastfeeding symbol portrayed in public places. I would love to see PSA's about the wonderful gift of breastfeeding. I would love to see a major cultural shift through-out America where breastfeeding was teh norm and the accepted and

132 Lactation Professional
Other Areas Employers and insurance companies should provide assistance and supprt to breastfeeding families. A few insurance companies have started reimbursing for quality breastpumps for their clients and I do see that making a difference. I would like to see public policies in every state provide this as a benefit for their customers. In Minnesota and Wisconsin where I live and work, the medical assistance programs cover the cost of a quality breastpump. It has convinced mothers who may have not given their baby human milk to reconsider. Our clients from Iowa do not have that luxury. Iowa MA does not even cover the cost of a rental for a baby in the NICU where the research is so clear about what a difference human milk can make. I think this is one area that would help get more human milk to babies for a longer period of time.

133 Concerned Citizen
Employer
Health Care Provider
Support for Breastfeeding in Public Settings Breastfeeding has sustained our species for thousands of years. Why has it become taboo? Public ads and government campaigns would be great. Better yet, a national law protecting a woman's right to breastfeed in public would show that our government supports this life-giving practice.

134 Concerned Citizen
Use of Banked Human Milk Should be offered at WIC offices instead of formula! Take the money we give to Formula companies and pay the mothers who donate it.

135 Concerned Citizen
Support for Breastfeeding in Public Settings Im hoping that this comment wilkl help breastfeeding mom's across the US I am a full term bfing mom & i support it whole heartedly its a passion of mine.I nurse a 32mnth old (2.5)daughter who has hardly ever been sick.

136 Breastfeeding Coalition Representative
Public Health Worker
State or Local Government
Other Areas: Public health school faculty
Research and Surveillance Continue to support CDC and state health departments' efforts to collect breastfeeding data through the National Immunization Survey, birth certificates, and other means.

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

137 Concerned Citizen
Other Areas: Early Childhood Educator
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe access to midwifery care would increase breastfeeding rates. Rooming-in with baby after delivery is also a help to breastfeeding, as is skin on skin contact as soon after birth as possible. Giving bottles and pacifiers to breasfeeding newborns should not be acceptable. I also believe the reduction of routine labor interventions such as fetal monitoring, epidurals, and cesarean sections would increase breastfeeding rates. Its also important to ban formula bag give-a-ways at hospital and dr offices and through US mail as well. It may help to have health warnings on formula cans. Banning formula advertising in general would be a good thing. And of course continuing to educate expectant parents as well as drs and professionals working with parents on the many benefits of breastfeeding is important, but it doesn't seem to be enough. Seeing more moms breastfeeding in society in general to overcome the social taboo it has become would be a huge help.

138 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Should exclude any advertisements from baby formula companies.

141 Other Areas: childbirth educator
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Birth practices effect breastfeeding, I would encourage an action plan to include the benefits of continuous support in labor, including doulas, freedom of movement and the use of comfort techniques and other non-pharmacological approaches to ease the discomforts of labor, shorten labor and reduce the mother's need for epidurals and interventions that often lead to a cascade of interventions that make breastfeeding establishment more difficult. Many of these are summarized in the Lamaze 6 care practices for normal birth and Childbirth Connection's Evidence-Based Maternity Care Report http://www.childbirthconnection.org/article.asp?ck=10575 and their soon to be released Quality Matters Action Plan. It is time that birth and breastfeeding action plans work together to solidify the continuum of optimal MotherBaby care.

142 Health Care Provider
Lactation Professional
Other Areas: employed mother
Paid Maternity Leave WHen I look at the numbers from countries that provide a paid maternity leave, I think about what a difference it would make to mothers in the US. As a lactation consultant (IBCLC), I see so many mothers who stop nursing when they return to work for a variety of reasons. If they had a little longer to stay home, those babies would receive breast milk longer - the numbers from Canada, Sweden, Norway, and Australia are very clear - it does help. I see mothers who return to work or school within 2 -3 weeks after delivery because they cannot afford to stay home and then add the cost of artificial milk to that as well and it is a burden to our families. I also see quite a few mothers who return to work and decide they cannot make ends meet and so they come out of the work force and go on public assistance - what good does that do for anyone? It is sad that in the US, we cannot provide that benefit to our families. I felt fortunate that I could return to work part-time, but not all mothers have that as an option. I think not only would this help with breastfeeding, but with all aspects of parenting and child raising. I implore you to really look at this issue. The first year of a child's life is so important!

143 Concerned Citizen
Other Areas: breastfeeding mom, early childhood educator
Paid Maternity Leave Paid maternity leave would be one of the most helpful and significant things this country could do to promote long term breastfeeding, in my opinion.

144 Concerned Citizen
Paid Maternity Leave I think this should be offered to ALL WOMEN on Maternity not just the breast feeding nazi's!

145 Lactation Professional
Health Professional Education, Publications, and Conferences Extensive and manditory training and teaching about breastfeeding should occur in any medical discipline where physicians and nurses come in contact with women during their childbearing years. The education that occurs currently for physicians in medical school is absolutely inadequate. Breastfeeding is a normal life process and bodily function and deserves every bit as much attention in medical schools and nursing schools as all other bodily functions/systems. Moreover, the study of breastmilk and all it's amazing components deserves equal study as other bodily fluids. Afterall, under a microscope breastmilk does more closely resemble blood than infant formula.

146 Concerned Citizen
Access to Lactation Care and Support IT would be wonderful if every mother who wants to breastfeed could be guaranteed 2 home visits post partum by a breastfeeding specialist who could provide encouragement and advice in the woman's own setting.

147 Concerned Citizen
Support for Breastfeeding in Public Settings Breastfeeding in public should be the norm. There should be literature and signage encouraging and welcoming moms to feed their babies wherever and whenever they need to. EVERY SINGLE STATE should have legislature passed protecting a mother's right to breastfeed her baby in public. There should be PSA's supporting and educating about the need for public support for breastfeeding. There should be consequences (fines, etc) for discriminating against a mother breastfeeding in public.

148 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression It has been my experience as a childcare provider to infants that the number one reason many moms give up breastfeeding before their child is 1 is that they are unable to pump at work as much as they need to in order to keep up their milk supply, which leads to formula supplementation which leads to even less milk production which leads to the end of the breastfeeding relationship. Moms need to be near their babies and breastfeeding in order to maintain the breastfeeding relationship, in my opinion. Feeding expresed milk and formula supplementation is a slippery slope for breastfeeding. Onsite childcare would help alleviate this problem, if and only if, mothers were able to breastfeed their child on deand throughout the day without penalty.

149 Concerned Citizen
Access to Lactation Care and Support I feel very fortunate to have had easy access to affordable lactation consultants in my area. I know that my experience is an exception. There was a regular clinic that charged $10 a visit for a weigh in, feeding consulting and a weigh out three days a week without any registration or appointment necessary. All you had to do was show up. Clinics like these should be attached to all hospitals and urgent care centers. Without the guidance of the nurses there, I would not have been able to breastfeed my child who has Downs syndrome.

150 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression In these trying economic times, often both parents must work. As breast feeding is the least expensive form of feeding a child, it is important to provide every opportunity for the mother to be able to continue to do so.

151 Health Care Provider
Health Professional Education, Publications, and Conferences I am a Family Practice physician who practices Obstetrics. I find that many of my colleagues, especially Obstetricians, but even often Pediatricians do not have a strong background in breastfeeding support. If a mother is having a problem, even a minor one, they immediately suggest supplementation or cessation of breastfeeding. If a mother is on a medication, they often times tell her to stop breastfeeding, when a quick look into a resource book would let them know that the medicine is safely compatible with breastfeeding. In addition, most women make their choice on how to feed their babies during pregnancy and most obstetricians either do not know the benefits of breastfeeding, or do not mention it at all during the woman's prenatal care. We as physicians need improved training in our medical schools and residencies to help better prepare us to help support breastfeeding and breastfeeding moms.

152 Concerned Citizen
Access to Lactation Care and Support Access to lactation support through my son's pediatrician would have been incredibly helpful. We had difficulty beginning to breastfeed and our pediatrician offered us infant formula. We ultimately succeeded at breastfeeding, but only after lots of research and searching out help on our own. A more helpful approach would have been if our pediatrician had immediately referred us to lactation support.

153 Health Care Provider
Lactation Professional
Use of Banked Human Milk As a hospital Lactation Consultant, attempting to avoid formula use, I would encourge reasarch and development of human breast milk so that it is available to supplement babies that need additional food while in the hospital. Right now Breast Milk Banks are few and far between. I would love to see human breast milk as common as bottles of cow's milk formula in the hospital!

154 Concerned Citizen
Other Areas: breastfeeding mom, early childhood educator
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media If we see breastfeeding often, including in the media, then we will come to see it as normal and as a part of our parenting culture if we don't see it then it seems abnormal, therefore, if we want more women to breastfeed then those women need to see other women, portrayed in the media and in everyday life, that are breastfeeding.

155 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As Lactation Consultant in a hospital in Santa Rosa, I continually encourage skin to skin care of our newborns. I discourage formula use or pacifier use in these early days while breastfeeding is being established and discourage routine supplementation of babies in the night nursery. I would recommend that formula be kept as medications are and that it be signed out as a medication with rationale clearly documented on baby's chart regarding formula use.

156 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care From the moment women start shopping at maternity stores, they are offered formula samples. This continues when you get a packet of information from the hospital and/or OB as you choose your care provider and place of delivery. Even in the hospital you are given samples of formula and a diaper bag made by the formula company. Advertising is powerful. Instead of advertising for formula, we must advertise the benefits of breastfeeding, give breastfeeding resources and support local and national breastfeeding organizations (i.e. La Leche League). Other countries require a prescription for someone to buy formula. Perhaps even this extra step would encourage all women to attempt breastfeeding and continue with it.

157 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals in my area are STILL not practicing standard-of-care breastfeeding support during the peripartum period.

158 Health Care Provider
Lactation Professional
Access to Lactation Care and Support As an in hospital Lactation Consultant, I would recommend that all new mothers have a Lactation Consultant assess them prior to disharge home. Many potential breastfeeding problems can be averted with early assessment and intervention. I would recommend that hospitals be staffed according to the guidelines attached. Journal of Human Lactation, Vol. 22, No. 4, 409-417 (2006) DOI: 10.1177/0890334406294166 © 2006 International Lactation Consultant Association Staffing for Hospital Lactation Programs: Recommendations From a Tertiary Care Teaching Hospital Rebecca Mannel, BS, IBCLC OU Medical Center, Oklahoma City, Oklahoma, Rebecca.mannel@hcahealthcare.com Robert S. Mannel, MD Department of Obstetrics and Gynecology at the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, Rmannel1@cox.net A retrospective review of data from a lactation program’s productivity reports at a large tertiary care teaching hospital (4200 births per year) measured actual hours worked by international board certified lactation consultants (IBCLCs) over a 2-year period, allocated the hours to their respective activities, and developed ratios for optimal IBCLC staffing for each component of service delivered. Optimal IBCLC staffing was calculated as follows: mother/baby inpatient requires 1 full-time equivalent (FTE) per 783 breastfeeding couplets; neonatal intensive care unit (NICU) inpatient requires 1 FTE per 235 infant admits; mother/baby outpatient requires 1 FTE per 1292 breastfeeding couplets discharged; NICU outpatient requires 1 FTE per 818 breastfeeding infants discharged; telephone follow-up requires 1 FTE per 3915 breastfeeding couplets or infants discharged; education requires 0.1 FTE per 1000 deliveries; program development/administration requires 0.1 FTE per 1000 deliveries; and research requires 0.1 to 0.2 FTE total. Using the formulas provided, IBCLC staffing can be calculated for desired services based on patient numbers. Key Words: lactation program(s) • staffing • IBCLC staffing

159 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I am a lactation consultant and have been helping women for 39 years. I feel that many maternal services do NOT check women's nipples for being flat or inverted prenatally. This lack of looking can lead to very frustrated women.

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.

160 Health Care Provider
Paid Maternity Leave The shorter the maternity leave, the shorter the duration of breastfeeding. This has been documented in multiple high-quality studies.

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

161 Lactation Professional
Other Areas: RN-community hospital
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Prenatal-I would like OB's/Nurse Practitioners to assess mother's nipples during 2nd half of pregnancy. Flat or inverted nipples could be identified prior to delivery and strategies can be implemented.

162 Other Areas: online lactation supporter and educator
Support for Breastfeeding in Public Settings I am happy to see this initiative here and would like to say that public ad campaigns are desperately needed. Breastfeeding is sadly viewed as a taboo practice now and most people would prefer a feeding mother and child be hidden from view. This is of course completely unacceptable and so damaging to a breastfeeding pair. As a result mothers feel pressure to quit way to soon as they no longer want to remain in hiding and then babies are thrust onto synthetic milk and feeding devices. Cut out boards of mothers nursing strategically place throughout town and in malls as awareness campaign is a great way to encourage the normalization of breastfeeding. After all as we all know human milk is for human babies and they should all be fed that way. Thank you

163 Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Every working mother deserves a Lactation Accommodation room where they work so that they can pump and maintain their breast milk supply. Still many new mothers tell me that their employers are not providing this mandated accommodation.

165 Health Care Provider
Lactation Professional
Paid Maternity Leave If we want new mothers to breastfeed between one to two years, getting them off to a good start is essential. Why couldn't we model our maternity leave programs after Sweden for example that provides leave for mothers and fathers for an extended time.

166 Concerned Citizen
Nonprofit Organization
Paid Maternity Leave Many mothers-to-be, who have to work, have very little maternity leave and then not paid. I think maternity leave should be at least 3 1/2 months so that the normal growth-spurt increases to the milk supply and bonding can be well established.

167 Concerned Citizen
Paid Maternity Leave I strongly believe that this is one of the biggest barriers to breastfeeding - especially long term breastfeeding. Many women, myself included, need to go back to work at least part time after a child is born because the family cannot make ends meet without her income. The stress of going back to work, finding appropriate childcare, and trying to find adequate pumping facilities/time at work is a challenge. Stress is known to have an effect of reducing one's milk supply. In addition, some mothers have difficulty performing for a pump. I was committed to breastfeeding and pumped religiously when I went back to work part time, but I barely eeked out a couple of ounces. Had I not absolutely refused to buy formula and feed that to my child, I would have given up. Paid maternity leave would reduce the mother's stress, allow for time to establish an adequate milk supply ad breastfeeding relationship. It would also reinforce the fact that family is more important that work. Many European countries provide paid maternity leave and have much higher and longer rates of breastfeeding.

168 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care There is a tremendous deficit in the provision of breastfeeding support by Health Care Providers. This lack of support begins in the prenatal period, when most expectant mothers receive little (if any) breastfeeding information from their health care providers, and frequently the information they are given is inaccurate. In addition, more and more expectant parents inform me that not only are they not being referred by their HCP to prenatal classes where breastfeeding information is provided, they are being told that such classes are unnecessary.

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.

169 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Employers need to be more supportive about offering working mothers private areas where they can pump while at work. As a working mother myself, I was fortunate enough to have a private office and the freedom to pump twice/day. I have several friends who weren't as fortunate and who were unable to continue breast-feeding because of this obstacle.

170 Health Care Provider
Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media In Marin County recently, they posted cardboard cut outs of women breastfeeding in public to educate the community about the importance of breastfeeding, and the normalcy of breastfeeding in public places. Our culture and country needs more education to emphasize that breasts are for breastfeeding, not as sexual objects.

171 Concerned Citizen
Paid Maternity Leave As a nursing mother, I am pleased to have experienced the positive effects of changes in medical care and in federal and state laws to promote breastfeeding in the U.S. If the goal is to increase breastfeeding rates even further among American mothers, we must first target paid AND unpaid maternity leave policies. Going back to work has got to be one of the most significant obstacles to long-term breastfeeding. Many women find ways to manage pumping at work, but many others find it onerous or impossible for any number of reasons. The difficulties women face in balancing career prospects with the care of their children have implications for families in many areas other than breastfeeding, as well.

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.

172 Concerned Citizen
Nonprofit Organization
Access to Lactation Care and Support Often the community overlooks the importance of mother-to-mother support groups. I have been involved in La Leche League International for 35 years and have seen MANY, indeed hundreds of women, overcome many obstacles and comments because another woman cared.

173 Health Care Provider
Worksite Lactation Support, Onsite Child Care, and Milk Expression The single largest barrier to breastfeeding, in my opinion, is lack of Work and Family Balance in our culture.

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!

174 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Nonprofit Organization
Health Professional Education, Publications, and Conferences Health professionals have a wide variety of personal and professional experiences with breastfeeding, which often results in confusion on the part of new parents. Mandatory, up-to-date, consistent breastfeeding training must be given to health care providers, especially those who are frequently involved with young families (ie maternity nurses, pediatricians, etc.)

175 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The Baby Friendly Health Initiative is the best model for hospitals to follow in promoting and protecting breastfeeding, yet very few hospitals in the US are Baby Friendly Certified. I think many people in hospitals, like in our society as a whole, see breastfeeding as a 'nice bonus' rather than an important infant health measure. If the US government put a strong emphasis on Baby friendly certification and provided encouragement and possibly incentives, more hospitals would seek this certification. With certification and the education/skills/attitude that come with it, I have no doubt that more moms would leave the hospital with stronger breastfeeding success.

176 Concerned Citizen
Nonprofit Organization
Peer Support and Education of Family Members and Friends La Leche League is SO VERY set up for this way to support women and their families. LLLI is actually an unused resource on many areas. Let us, as a country, really support this organization.

177 Health Care Provider
Paid Maternity Leave One year of maternity leave with 2 to 3 week in paternity leave.If we want in the future to have less cost in health care this is where we should start. In the end the benefits will be for all.

178 Community Organizer
Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care When there is little to no mention of breastfeeding in the curriculum for becoming an RN, one wonders how the nurses are going to be informed and knowledgeable on the subject of breastfeeding. Hospitals are looking for profit, and breastfeeding is not profitable, formula is. They will be beholding to those who give them money (big formula companies do this) and they will be more willing to send home formula samples, coupons, etc. When breastfeeding becomes a required topic in the courses for becoming an RN or a doctor, then we will see a marked improvement in breastfeeding rates. When doctors give free well baby visits to those who are breastfeeding exclusively, that will increase the rates, too! I knew a doctor who did this in southern California many years ago...

179 Lactation Professional
Paid Maternity Leave This is probably the most important issue facing mothers and families. Mothers are just getting to know their babies, and then they have to return to work. Other countries value children and families, and they show it by committing to helping families get off to a good start with paid maternity and paternity leaves.

180 Concerned Citizen
Other Areas: Nursing mom!
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care When my son was born at an urban childrens hospital, I was asked if I was going to breastfeed, and that was marked on his chart, bassenett and wristband. But shouldn't it be the other way around? Shouldn't parents have to sign a release for formula or other suppliments to be given, just like any other medical pharmasudical product or procedure, with the requirement for informed consent?

181 Concerned Citizen
Health Professional Organization
Lactation Professional
Nonprofit Organization
Access to Lactation Care and Support Lactation support for all new mothers is critical for increasing and sustaining breastfeeding. However, there are way too many barriers for non-profit (hospital birthing units) to be able to provide this support since we cannot get reimbursed for the cost of providing this service. Billing is tied to medical reasons and seeing a physician. Lactation services need to be supported for ALL MOMS, not just those infants having medical issues. It makes no sense , nor is it cost effective to mandate a pediatrician visit when what they need is a lactation consult.

182 Public Health Worker
State or Local Government
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I would love to see ads with known celebrities supporting BF, even with pictures of them BF their own children. The child-bearing generation seems to be influenced heavily by celebrities.

183 Lactation Professional
Access to Lactation Care and Support Health insurance coverage for lactation support is a must! Better health begins with breastfeeding.

184 Concerned Citizen
Nonprofit Organization
Health Professional Education, Publications, and Conferences I have been very frustrated that the medical profession comprehends so very little about the MANAGEMENT of normal breastfeeding. I realize that the colleges can not always educate a future doctor or nurse in this, but breastfeeding conferences, etc. can.

186 Concerned Citizen
Public Health Worker
State or Local Government
Health Professional Education, Publications, and Conferences The Doctors and Nurses need BF education. There are too many situations to name where I have heard the mothers being told to just stop BF when ANY problem arises rather than helping them through it. Formula is seen as an equal alternative and it is too easy to fall back on it.

187 Health Care Provider
Public Health Worker
Health Professional Education, Publications, and Conferences When breastfeeding becomes a topic that is required for RNs and doctors, we will see an improvement in the information and knowledge that nurses and doctors give out for breasteeding mothers. When conferences are not put on by or sponsored by big formula companies, we will see better support for breastfeeding. If RNs and doctors do not have good information about breastfeeding, how will they support mothers who want to breastfeed? Maybe we need to stop being beholden to the big formula companies first of all.

188 Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Breastfeeding is so very important, and it is amazing that the only time it is talked about in the media is to sensationalize it. Portrayal of human milk feeding should be so commonplace that it seems like the normal thing to do.

190 Concerned Citizen
Public Health Worker
State or Local Government
Paid Maternity Leave How is it that other countries in this world have such great maternity leave plans, but not the USA? This is a major deterrant from BF for mothers that have tight budgets. I have heard many mothers say they can't BF because they have to return to work soon after the baby is born. Paid maternity leave would help the new mother to relax and enjoy her baby and become successful at BF. How could it be a bad idea?

191 Concerned Citizen
Paid Maternity Leave As a first-time mother, I was fortunate to have saved enough money to stay home with my baby for five months before returning to work. I believe that my child's health and well-being were served by having a full-time mother for as long as possible. It is important for employers to have incentives to provide appropriate maternity leave for all employees, especially those who are not in a position to go without pay while staying at home with newborns.

192 Concerned Citizen
Lactation Professional
Access to Lactation Care and Support Every OB floor should have an IBCLC on staff and properly trained staff to work under him/her. Every OB floor should be requried to watch an actual milk transfer from mom to baby and be able to report to the next shift her findings. NO HOSPITAL SHOULD give infants formula unless Dr. has ordered that infant to have it. EVERY HOSPITAL should be required to charge for formula. All OB floor staff should encourage rooming in and this should be mandatory in every hospital.

193 Concerned Citizen
Lactation Professional
Support for Breastfeeding in Public Settings Every public place should have a place other than the restroom for a nursing mother to sit and nurse her baby and or pump

195 Concerned Citizen
Lactation Professional
Peer Support and Education of Family Members and Friends Every hospital should have their own breastfeeding support group.

196 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Obstetrics care in this country is not currently based on science but on myth, opinion, pocketbooks, fear. Many of the practices found in the average labor & delivery hospital have no value at best and at worst cause harm. Many of those same practices interfere with the initiation and continuation of breastfeeding through delayed milk, drugged mothers/babies, and increased incidence of postpartum depression (quite often actually PTSD). In order to successfully increase breastfeeding initiation and sustainability, we must get back to evidence based maternal medicine.

197 Concerned Citizen
Paid Maternity Leave This is the biggest hurdle to be addressed. FMLA benefits those who can afford to not get paid. I went back to work at 12 wks out of necessity although we were not ready nor for the stress of being separated. My schedule was incredibly hectic. I would need to rise 3 hrs before my work start time; nurse my child; get ready for work & simultaneously care his other needs; nurse again before work; pump or nurse several times at work--often without adequate support/facilities; rush home at the end of the day to nurse again; get dinner; nurse again before going to bed & then collapse in a state of exhaustion to repeat it all over again day after day; week after wk. I asked my employer if I could telework because the duties of my job did not necessitate me being on site every day to no avail. When I went back to work, I ended up with mastitis & had it a total of 3 times in the 1st yr. Had I not been completely committed to BF and to providing what was best for my child, I would have given up at about the time I went back to work. In fact, that is what my SIL did. She bought the pump and was willing to continue but didn't have the support and gave up at 9 wks postpartum. Other industrialized countries are successful in supporting BF & we should look at what they are doing. Many provide 1-2 years of paid maternity leave. It's a travesty that women here don't get one day of federally guarateed paid leave.

198 Public Health Worker
Access to Lactation Care and Support I wish a nurse from the breastfeeding clinic could make some home visits to some moms who don't have the support needed to continue to breastfeed. Some families don't have transportation or access to that to make it to the hospital. DD

199 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Prenatal providers must bring up the topic of BF and encourage it as the norm, provide information to mothers on how breasts are changing too during pregnancy for BF. Hospitals need to get out of bed with the formula companies, as long as they keep handing out free formula and formula related gifts it amounts to an endorsement of these products. Hospital staff must be made aware of how their practices related to, comments about, own ignorance and bias' regarding BF affect the patient. Staff that is going to work in OB needs to be knowledgeable and BF friendly. The hospital's practices right after birth need to be changed so that nothing gets in the way of nursing from the first 1/2 hour of a baby's life on.

200 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Please continue to support this urgent, ongoing need in today's employment environment.

201 Concerned Citizen
Use of Banked Human Milk Banked human milk can be made available that is screened and treated in such a way that a premie or newborn infant could receive the vital nutrients in breast milk instead of formula.

202 Concerned Citizen
Paid Maternity Leave It is clearly demonstrated through myriad research, including this article ( http://www.naturalchild.com/research/maternity_leave.html ) and common sense that paid maternity leave will both enhance opportunities for success with breastfeeding, mother/ infant bonding, and overall ability to parent. It is time for our country to join other countries of the first world with regard to our policies concerning women and children.

203 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) If access to support for breastfeeding in lower socio economic areas, more woman would chose this option for their child(ren.)

204 Health Care Provider
Lactation Professional
State or Local Government
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) I would like to ask that the WIC Peer Breastfeeding Counselling program continue to be funded, and at a higher funding amount. I am currently working as a WIC Peer Counselor. Right now, the grant only covers for me to work 8 hours a week. However, I have over 40 clients at a given time that I am responsible to support. 8 hours a week is not sufficient to do an excellent job of supporting low-income mothers breastfeed. Please continue to fund these grants generously so that these programs can do their jobs well. Thanks.

205 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Access to Lactation Care and Support Mothers should have knowledge of resources to support BF before discharge, BF support staff (IBCLC, CLC) should be available for Mothers who need it, all mothers should be cared for by staff that is knowledgeable about BF and can refer to the consultant as needed.

206 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Nonprofit Organization
Peer Support and Education of Family Members and Friends Statistics indicate that pregnant women make decisions about breastfeeding their babies early on in pregnancy, and with information provided by friends and family. Unfortunately, much of this information is incorrect. If women received information at first and third trimester prenatal appointments that directly addressed this issue, would it improve breastfeeding initiation and duration rates? For example, a brochure titled,

207 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Despite my 100% commitment to breastfeed my child I faced many obstacles in the post-delivery care in the hospital, which included staff nurses telling me incorrect information (with very adamant attitudes), and insisted on separating me from my child for multiple hours. All medical professionals who are dealing with pregnant women, labor, delivery, post-delivery care, and newborns/infants need to have accurate information and policies that promote successful breastfeeding.

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.

208 Other Areas: RN
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I work as an RN on an OB LDRP unit and we are very pro breastfeeding there. With help and support from nurses and lactaction consultants more women are breastfeeding. we can all help each other by standing by breastfeeding and making it the #1 option to feed our babies the natural way. I am very proud to say that I breastfed my son for 13 months and 1 week without one drop of formula.

209 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Health Professional Education, Publications, and Conferences Continuing education on BF should be available for all staff working with lactating women and CEU's should be readily available so that certified staff can get the material they need to maintain certification.

210 Concerned Citizen
Paid Maternity Leave If we truly want to improve the health of mothers and babies and improve our breastfeeding rates, we are in desperate need of paid maternity leave in this country. A large portion of mothers do not qualify for even the unpaid leave the FMLA provides even if they could afford to take that time off with out pay and the traditional six weeks leave rarely gives time to establish breastfeeding. Pumping is not really a good substitute that early for a variety of reasons, not the leave of with is that employers are not supportive. The long term benefits of breastfeeding are well established, despite recent editorials, for both child and mother yet as a culture we've done everything we can to discourage it.

211 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Mother and baby friendly hospitals,where the mothers can have their delivery without interventions,with a Doula and a Midwife. Have and on call Obstetrician for complications. Delivery room with rooming in. Well educated Medical and Nurse staff in breastfeeding. Breastfeeding oriented NICU with Kangaroo care. Legal home deliveries with midwifes so mothers can have their choice of where they can have their baby. With the hospital obstetrician in communication with the midwife in case of a complication.

212 Concerned Citizen
Paid Maternity Leave Paid maternity leave MUST be longer in this country if women are to succeed at breastfeeding. So many women begin breastfeeding their infants but switch to formula when they go back to work, which is often when their baby is only 2 or 3 months old. Formula is expensive and hard to prepare, and a child who is not nursing must be given formula until s/he is one year old, significantly raising childrearing costs for families who already may be struggling if they are the type of family who cannot afford for the mother to stay home. Many women are successful with pumping, but it requires an enormous commitment of time and energy, especially until the baby reaches six months of age and can begin on solid foods. I know many mothers who have stopped nursing their babies at 3 or 4 months because they cannot handle the demands of pumping at work multiple times a day every day. Encouraging employers to have lactation rooms would certainly help, but the most positive (and drastic) step would be to increase paid maternity leave to six months or even a year so that women can be WITH their babies when their babies need them most. A woman's body is made to nurse a child, not to be hooked up to a breastpump, and more milk is actually produced when a baby nurses than when a woman pumps in the absence of her baby. Though I realize that there would protests from employers and many special interest groups if mandated paid maternity leave were lengthened, it is a vital step that this country must take to keep pace with maternity trends in other parts of the developed world.

213 Concerned Citizen
Health Care Provider
Public Health Worker
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) I have long thought that WIC should not provide easy, instant access to infant formula for all who ask. In fact, I suspect in many WIC offices, women don't even have to ask for it, it is handed to them as a matter of course. WIC should provide formula only after the woman has a mandatory consultation with a lactation consultant, pediatrician, or both, to provide education about reasons not to formula feed and help overcome barriers to breastfeeding. Many women are feeding formula because hospitals and WIC portray

214 Other Areas: RN
Paid Maternity Leave We need support to have extended paid maternity leaves to increase success of long term breastfeeding and also optional non paid maternity leave. I was able to take an extra 3 months off work to be able to stay home with my son a full 6 months to establish breastfeeding and because of this I was able to breastfeed him an entire year without any supplementation of formula and I dont know if I would have been as successful if I would have had to go back to work sooner. the longer mom and baby can be together, the higher success rate for long term breastfeeding.

216 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I would like to hear just once when the media is doing it's annual coverage of breast cancer and the race for the cure about the race for prevention. Surely the lack of BF in our culture is correlated to the higher levels of breast cancer, BF is protective and this should be mentioned. We tell people to excercise to prevent obesity, eat healthy to prevent high cholesterol, quit smoking to reduce their risk of emphysema and cancer, why can't we make women aware that bf reduces cancer risk for mom and baby and a whole host of other risks. We need to get the media in on the act because people behave as if it's said on TV or the internet then it must be so.

217 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Home visitation shouild be expanded for all new mothers at home for several months after the birth,especially those who are nursing.Research shows that exclusivity and duration of breastfeeding is increased when there is ongoing support to women.La Leche League is helpful but can't be expected to provide all the support necessary since the nature of being a La Leche League Leader can be transitory depending the nature of the Leader's personal situations. Peer Counseling is another strong tool which should be expanded.

218 Concerned Citizen
Support for Breastfeeding in Public Settings All 50 states should be encouraged to have laws that expressly protect mothers who choose to breastfeed in public. Many states have laws like this on the books already, which is a wonderful trend. However, some states simply have laws that mention the legality of breastfeeding in public, rather than explicitly prohibiting discrimination against breastfeeding mothers. No mother should be made to feel that she cannot feed her hungry child in a public setting, but too often, women are asked to stop nursing or are made to feel guilty for doing so in public, and these comments come from both strangers and from people who work at the location they're visiting, such as employees of a museum, an airport, or a restaurant. I feel blessed never to have had such comments directed at me, but I know many women who have heard them and been disheartened. Fear of nursing in public plagues mothers across this country for many reasons (social pressures, modesty, etc.), but laws to protect these mothers AND public service announcements to promote general awareness about such policies would be two enormously helpful steps in the right direction.

219 Breastfeeding Coalition Representative
Lactation Professional
Public Health Worker
State or Local Government
Access to Lactation Care and Support We have most of the hospitals covered with lactation support professionals and the information is readily available to pregnant women. A major piece that is missing now is care after discharge. Private practice lactation consultants (IBCLCs) and outpatient lactation centers should be supported and encouraged. Insurance coverage for these services would be a key to their success.

220 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Every effort should be made to increase the midwifery model of care for pregnant and nursing women.Midwifery tends to have less interventions into healthy birth with good outcomes.More freestanding birth centers are needed.Healthy, well-screened women need to be empowered to believe that they can birth safely without technical interventions.Safe standards for healthy childbearing are published but are not regularly followed; too many inductions for frivilous reasons,c/sections on request should be stopped.Late preterm babies cost lots of money and have pooer putcomes in health. All of these practices tend to sabotage breastfeeing initiation,exclusivity and duation.

221 Concerned Citizen
Other Areas: Mrs. Lee County International 2009
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I feel that it is necessary for ALL areas of medicine from OB/GYN, Nurses, Hospital Staff, Pediatricians, etc. to have the SAME knowledge and training on the benefits of breastfeeding. I know that when I have talked to various doctors ranging from various degrees in medicine that the same knowledge is not consistent on breastfeeding. Most of them do support breastfeeding, but I feel that the sectors are not working together. It seems that the OB/GYNs are just concerned with the mother and her health for breastfeeding and that the pediatricians are just concerned with the babies and their health for breastfeeding. I just think that the gaps between need to come together in order for breastfeeding rates to increase and for mothers to get the appropriate care, education, and awareness needed for breastfeeding.

223 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Access to Lactation Care and Support Insurance companies need to cover the services of paid lactation assistance.Breastfeeding is worth protecting and supporting. Artificial feeding of infants is linked to poor health outcomes in the short and long term.Good health care begins with breastfeeding.

224 Concerned Citizen
Paid Maternity Leave In Europe, there is 3 to 6 months maternity leave, and one may opt for an additional 6 months. As you know, this time is vitally important in an infant's development; and as a clinical psychologist, I believe that all women, including nursing mothers, should be able to choose a time to go back to work without fearing job loss and discrimination.

225 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care In a sense by providing free formula in the WIC program we are endorsing and promoting artificial milk for human babies. We are communicating that formula is important enough that the government wants to give it to you for your baby's benefit and that therefore it must be as good as or better then human milk (as my own mother believed in the early 50's. Apparently we let the marketplace decide what was best and re-educate a whole culture. How will we ever reverse this, if even among the most educated people will nurse as a lifestyle choice, not because their baby's survival depends on it. We started giving free formula in WIC, we better start rewarding every women who BF exclusively with more then an extra jar of peanut butter and charging women a discounted price for the formula so that they consider at least their pocketbooks.

226 Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The hospital where I delivered my daughter (Jan 2007) still required for the baby to spend extended time in the nursery. It is recommended that newborns be breastfed at least every 2 hours, and they would require that she stay in the nursery for her Dr. check--sometimes this lasted 3 or more hours!

228 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Use of Banked Human Milk The issue of banked milk should be strongly supported .Much research has proven that using banked milk saves thousands of dollare in infant care.Medical schools should be taught this in revised curriculums along with more studies on breastfeeding management and care.

229 Concerned Citizen
Public Health Worker
Researcher
State or Local Government
Other Areas It is critical that we correct our LANGUAGE around breastfeeding.

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

230 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As a breastfeeding mother, I would like to make a suggestion about hospitals. I gave birth to a baby boy in November of 2008 at Sacred Heart Hospital in Effingham, IL. I thought ahead and decided to hire a private lactation consultant to be there to help the baby and me directly after delivery and to be on-call for the remainder of my time in the hospital. The reason I had to hire one is because the hospital did not provide one for me. I had to pay out of pocket, insurance did not cover this. I could only imagine the amount of mothers that give birth at just this one hospital that get frustrated with breastfeeding, since the first few weeks are the hardest, and give up because they didn't know what to do or have the money to hire their own lactation consultant. I had some nurses come in when my consultant was not available and they were of very little use since they did not know much more than myself on the topic of breastfeeding. My suggestion would be that every hospital be required to keep a certified breastfeeding consultant on staff to handle only breastfeeding support and education. I believe there was a nurse that was certified while I was there but I never saw her because she was busy doing her nursing job. It was not her job to help the breastfeeding mothers. Even better would be to have a certified lactation consultant that is affiliated with the Le Leche League. It would also be nice if the hospitals were required to allow new mothers to contact this lactation consultant for the first few weeks after birth to help with any problems. Mothers should also be referred to the nearest Le Leche League to find help for the remainder of their breastfeeding time with their infants. Thank you for the opportunity to voice my concerns.

231 Other Areas: post-natal doula
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Women with in-home post-natal support from an experienced care provider are more likely to identify the presence of post-partum depression and latch problems increasing the likelihood they will establish solid nursing relationships. All women should have 24 hours of in-home post-partum care available to them.

232 Concerned Citizen
Use of Banked Human Milk I had a lot of extra milk, and was going to donate it to a milk bank. The nearest bank was in North Carolina, and they said that they were always happy to accept donations. It turns out that there were so many people in my community that needed or wanted my extra breast milk so I never did donate any to the bank. With this level of demand I think we need more milk banks and more options for parents who do not want to feed their children formula.

236 Concerned Citizen
Other Areas: post-partum doula
Access to Lactation Care and Support In addition to in-home post-partum care, all women need 10 hours of lactation consultation when problems are identified or intensive support is desired.

237 Lactation Professional
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) We could start a volunteer service to help

238 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Health Professional Education, Publications, and Conferences Need good breastfeeding education integrated into curriculum in medical school from basic sciences through clinical sciences. Need adequate training in all medical specialties that provide any care for breastfeeding mothers and infants, especially Ob/Gyn, peds, and family medicine but also as appropriate in surgery, radiology, ER, etc., since these specialists often undermine breastfeeding due to inadequate knowledge.

239 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media PSAs can be developed (see the add ran in Switzerland) that are artfully appealling and increase public awareness regarding the value of breastfeeding.

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

240 Concerned Citizen
Other Areas: post-partum doula
Use of Banked Human Milk When it is not an option for a woman to breastfeed or provide a milk supply herself, milk from a bank should be an option for all of our children regardless of the family's financial resources. Babies in foster-care should have access to human milk through WIC.

241 Other Areas: Breastfeeding Mother and Founder of www.boobiefed.com
Paid Maternity Leave There is nowhere near enough paid maternity leave for mothers compared with other parts of the world (specifically Europe). Once mothers are forced to return to work (becasue of financial pressure) it is difficult to continue breastfeeding as pumping at work is challenging at best and it is better for mother the bring children to their breast to breastfeed instead of giving their children bottles. The American Academy of Pediatrics recommends exclusively breastfeeding for the first six months of a childs life and then breastfeeding for a minimum of a year with complementary foods. I suggest that women get given a minimum of six months fully paid maternity leave to bond and breastfeed their babies (in line with the AAP's recommendations) and to look to increase this to one year. I believe this will support breastfeeding efforts. I also suggest that a woman's job be held for her upon her return to work.

242 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Worksite Lactation Support, Onsite Child Care, and Milk Expression Maternity leave legislation needs to revised and realistic.Not many women feel well enough to work full time after childbirth at 6 weeks postpartum.Those who wish/must work should do what is best for them ,of course. Babies need to be with their mothers ,not just for the breast milk but because of the psychophysiological reasons that promote the health and wellfare of the mother and baby.women have breasts for a good reason.It would be in everyone's best interest if maternity leaves were long enough that a woman didn't need to worry about expressing milk. Those who will be at work need affordable child care ,preferably onsite.Women who work in lower paying jobs need the same lactation considerations as those in higher paying jobs-a place to express milk.The Business Case for Breastfeeding should be widely promoted and programs devised by baby food companies should not be used.

243 Health Care Provider
Health Professional Organization
Lactation Professional
Other Areas There needs to be a mandatory 24/7 lactation consultants in hospital postpartum units & the NICU's, and a follow up visit 2-3 days after D/C from hospital, not the standard 2 wk f/u with the pediatrician.

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

244 Concerned Citizen
Other Areas: post-natal doula
Paid Maternity Leave Women need six months of paid maternity leave at a minimum.

245 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media We need to see women breastfeeding in a variety of realistic scenarios that aren't sexualized or portrayed as a joke.

246 Health Care Provider
Health Professional Organization
Lactation Professional
Access to Lactation Care and Support There needs to be a lactation consultant 24/7 on the postpartum unit & one for the NICU also, dependaing on the size of the hospital/number of births/admissions.

248 Nonprofit Organization
Support for Breastfeeding in Public Settings Public locations like grocery stores should always provide a nursing room akin to a sitting area, for mothers to be able to nurse comfortably, we should never be forced to nurse in toilet stalls!

249 Breastfeeding Coalition Representative
Health Professional Organization
Lactation Professional
Public Health Worker
Other Areas: Volunteer Counselor
Access to Lactation Care and Support We need to be careful that lactation care and support is provided by health care providers and not by those who financially benefit by selling pumps, pillows, equipment, books, etc.

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.

250 Community Organizer
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Public Health Worker
State or Local Government
Paid Maternity Leave Paid maternity is something other civilized countries have had for years. We could help the mothers of tomorrow by starting paid maternity leave now. Motherhood is the highest calling in my opinion. Our nation is only as good as its citizens, and our mental health begins with good mothering in infancy. It's about time we joined the rest of the civilized world in recognizing the importance of motherhood and paying mothers for maternity leave.

251 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Women need a designated area and support of employers to pump during work hours. The fact that I can be dictated to by my employer about my own body and what i wish to do with it is downright disgusting.

252 Concerned Citizen
Employer
Public Health Worker
State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Staff at all levesl should receive basic training in benefits of breastfeeding and key ways to support. Providers should receive sufficient training to be able to provide sound advice to mothers, be able to assist in correcting a latch, and supporting mothers decision

253 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Discharge packs in hospitals, giving formula samples to parents, should be discouraged in all breastfeeding mothers. Newborn nursery nurses need to be more proactive to encourage breastfeeding by not giving supplemental formula

255 Concerned Citizen
Public Health Worker
State or Local Government
Access to Lactation Care and Support Mothers should have access to breastfeeding support Employer should receive training in support

256 Concerned Citizen
Paid Maternity Leave i just came from 12 weeks fmla. how a family is supposed to survice 12 weeks unpaid is unheard of. I work, i should get paid maternity like the rest of the western world. what is wrong with america? there is no value on having a child, i am a hardworking middle class woman and i am penalized for having a child. Let's join the rest of the world and offer paid leave! and for fathers too!

257 Concerned Citizen
Paid Maternity Leave US pays so much emphazis on breastfeeding but only 4 weeks are paid for maternity leave. Working with breastfeeding is not a very convenient option for mother and child. This is the time when mother should bond with the child but to support child financially, mother takes tough decision to do away with the bonding and direct breastfeeding and goes to job. We all know that pumping is not as effective as direct breastfeeding. Even countries like India offer full year paid maternity leave, look at UK. INdia is going to 3 years of paid maternity leave. If we want healthy citizens in this country and children brought up with care and enough of mothers love we should look for options to provide full year maternity leave(paid). This will not only help with increased breastfeeding but child will get enough of mothers love and we will have well balanced children who r future of this country

258 Community Organizer
Concerned Citizen
Employer
Public Health Worker
State or Local Government
Peer Support and Education of Family Members and Friends Key to success: competent information from trusted sources. Fathers and mothers invited to education sessions

259 Concerned Citizen
Employer
Lactation Professional
Public Health Worker
State or Local Government
Paid Maternity Leave MOthers in the US return to work too soon after delivery. Even health care organizations pressure women employees to return to work quickly to keep their job. Low income moms especially return to work very early: difficult to cope with long hours away from baby. While it is difficult as an employer to find replacement workers, it might be easier to do it for 6-12 months than for 6 weeks. The US needs paid family leave

260 Health Care Provider
Lactation Professional
Access to Lactation Care and Support Insurance companies routinely do not reimburse for lactation services and consults. These visits can mean the difference between breastfeeding success and failure. Insurance companies should be required to reimburse at least part of the costs of a lactation consult for new parents.

261 Health Care Provider
Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I do not think that nursing mothers are portrayed enough in the popular media, including TV and movies. We often see babies being bottle fed, but rarely see a nursing mother portrayed. The recent ad campaigns in California were more of what we need to see. The younger generation is too used to the quick fix and sees breastfeeding as old fashioned and too hard.

262 Concerned Citizen
Health Professional Education, Publications, and Conferences My daughter was born with a severe cow's milk protein allergy. It took 6 months for my pediatrician to take me seriously, and she still called it lactose intolerance, which is a very different thing. For babies like mine, breastfeeding is the only real option, and the mother has to avoid milk products. Pediatricians MUST know about this issue, especially since cow's milk is the most common food allergen in children under 5 years old, and is passed through breastmilk.

263 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Researcher
Support for Breastfeeding in Public Settings I have ideas gleaned from working in these areas for 30 years and also as a teacher where we encourage mothers to bring their babies to work and help them in their homes, at the same time. They are rewarded for optimally caring for their babies by the help they get at home with routine tasks so time is freed up for quality time for their children and support for their parenting.....

264 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care health care providers, specifically postpartum nurses and pediatricians need to be better educated on breastfeeding. So often mom's are given info that is either outdated or blatantly inaccurate. This education needs to at a minimum include breastfeeding frequency, duration, weight gain, identifing proper latch. Also, these health care providers need to understand their education is superficial in this area. (I'm sure they have more indepth knowledge in their field of expertise.) So, it is imperative that they know when to refer to a knowledgeable lactation consultant.

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.

265 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care More doctors need to take the time to talk to their pregnant clients about the benefits of breastfeeding before women get to the hospital. In the hospitals doctors and nurses need to ensure immediate skin to skin contact between moms and babies unless special circumstances arise. This needs to be standard protocol instead of the exception as is current practice. APGAR scores etc. can all be preformed while the baby is on mom's chest and still attached to the umbilical cord. We should also encourage more rooming in of mom's and babies, and discourage circumcision, sugar water, bottle feeding, and pacifier usage. All of these things interfere with breastfeeding. We also need to discourage such high rates of c-sections, epidurals, and narcotic drugs during births. This can be greatly facilitated by encouraging more home births in America as most other industrial nations currently do These other countries also happen to have better maternal and infant mortality rates than us, so home birth safety is not an issue.

266 Concerned Citizen
Access to Lactation Care and Support Each pregnant women should be made aware of the nearest lactation consultant and La Leche League Leader. More lactation services need to be provided free of charge. I know that when I needed a lactation consultant's help, I could not afford it. Luckily I persisted and continued to breastfeed, but it should not have been the case that lack of money means you can not get the health care advice you need.

268 Concerned Citizen
Use of Banked Human Milk This option is not even given to so many parents. Many people don't even know it exists. Public commercials and doctors need to inform parents that banked milk is available. Doctors also need to inform mothers with over active milk supplies that they should donate to milk banks. So often they just encourage the mother in ways to reduce her milk supply, but she should know that if she so chooses she can use that milk to help other babies.

269 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Please, please try to reduce the ways the formula companies market to breastfeeding moms by giving them free formula! A newly breastfeeding mom may not know the important fact that it will take 6-12 weeks of on-demand nursing to build an ample supply for her baby. It is not appropriate to try to supplement with formula with a newborn if the mother wants to successfully nurse. Thank you!!!!

270 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Laws should be passed to ensure that all women have the right to time and a clean private space to pump their milk while at work in every state. Onsite child care would be tremendously helpful as well and encouraging employers with tax incentives would be a good first step. Many women that have trouble pumping would be able to breastfeed longer if they had access to breastfeed their child at an onsite child care facility. This also ensures adequate milk supply since no pump is effective as a baby in stimulating milk production. High quality pumps are also very expensive. Mothers that are going back to work should get tax breaks for buying such expensive pumps, or be covered under their insurance policies and given to them in the hospital.

271 Community Organizer
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I would like to see it encouraged that all pregnant women and their support system take a minimum 2 hour infant feeding course that stresses the importance of breastfeeding and breastfeeding community resources.

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

272 Concerned Citizen
Paid Maternity Leave This is an area that our country lags so sorely behind on. Other countries get 6 months to 3 years off to breastfeed and nurture their children. These same parents get government help and tax breaks to put their kids in daycare, but won't give tax breaks or financial aid to parents who are staying home to take care of their own children. It is really silly. The child needs taken care of and it shouldn't matter who is taking care of the child, the parents should be able to get financial help with the costs of taking care of such a small child.

275 Concerned Citizen
Support for Breastfeeding in Public Settings Women in every state need to have legal protection to feed their babies in every public setting which they have a right to be in. Babies need food and it is unacceptable to say that because someone is choosing to feed the baby breast milk instead of formula or solid food that they baby is not allowed to eat and must leave. This is a human rights issue as in all babies have a right to eat. I agree that public rooms women can go to nurse their babies is a nice thought. However, it gives the impression that just feeding the baby is some how incident and needs hidden. Babies should eat where ever they need to whenever they need to. They should not have to wait until their mother can locate a suitable location etc. If it is acceptable to see a bottle at a restaurant, mall, school, etc. then it should be acceptable to see breastfeeding too. This will help shift the public thought of breastfeeding as normal and not something shameful to be hidden.

276 Concerned Citizen
Health Care Provider
Health Professional Organization
Industry Representative
Nonprofit Organization
Health Professional Education, Publications, and Conferences Breastfeeding education needs to become part of the curriculm for physicians, nurses, and any other health care professional. Continuing education needs to stress breastfeeding. Breastfeeding awareness should be promoted so as all babies receive a fair chance to receive breastmilk. I have mothers who go to all of their prenatal appointments and breastfeeding is never mentioned. No mention of community breastfeeding class either. Mothers did receive consistently their formula literature and formula diaper bag. Mothers then deliver at their hospital where they do not get education and support on breastfeeding, but they all get their formula samples and formula diaper bags. Not all nurses are trained in breastfeeding. Not all hospitals have an IBCLC on staff. Texas only has one Baby Friendly Hospital. None of the delivering hospitals in my area in South Texas have an IBCLC (Intenational Board Certified Lactation Consultant) on staff. I just received a brochure on a Pediatric Conference for health care professionals and there are several talks on formula, but not speakers on breastfeeding. There is a place for formula and always will be, but conferences for health care professionals need to put more emphasis on breastfeeding as the norm.

278 Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Use of Banked Human Milk Needs to be a PSA on the use of Bankd Human Milk. We are lucky to have 2 banks in Texas, but in South Texas banked milk is unfamiliar to a lot people. I would love to hear more campaigns on Banked Human Milk: how to donate, how to order, who uses human banked milk, how it benefits the premies, benefits overall of human breastmilk, etc... I have taken several groups just on a field trip to visit our nearest milk bank 4 hours away. Our critically ill babies really do much better on human milk and get an earlier discharge. On another note, I have had several moms donate their milk to the milk bank when their babies die. It is very comforting to the mothers to donate in honor of their baby and gives the loss some meaning and value.

279 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Breastfeeding should be encouraged to all mothers of newborn infants. Hospitals and healthcare practioners should not encourage formula feeding to new mothers. Formula feeding should be a last resort option only.

280 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) The WIC program should more fully support breastfeeding. Every pregnant women on WIC should told of the benefits of breastfeeding, given education prenatally on how to breastfeed, and strongly encourage to breastfeed. The WIC program should only provide food, and not cover formula except for in certain situations, such as with a doctors note, etc. Breastfeeding should be expected as part of the program unless health reasons arise making it difficult/impossible to breastfeed. These children are already at risk of nutritional deficiency, so the government should make sure breastfeeding if at all possible is apart of their diet to ensure the best start for these disadvantaged children. These changes alone would dramatically increase the breastfeeding rates in our country.

281 Concerned Citizen
Access to Lactation Care and Support Access to lactation care and support is extrememly important to newly breastfeeding women. This is especially true of women that experience difficulties with it and need the support to succeed.

282 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Post delivery care is extremely important to a new mother, regarding breastfeeding. So many mothers quit because the support they need just isn't there. It would be wonderful for these mothers to have help from LC's inside the home immediately after they are home from the hospital. Help in the mother's home setting is crucial to the breastfeeding relationship.

283 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Our country needs to follow the WHO guidelines about marketing breast milk substitutes. That would greatly improve breastfeeding success.

284 Concerned Citizen
Paid Maternity Leave It is crucial to the breastfeeding relationship that the mother has as much time as possible to establish breastfeeding. If the APA recommends that the mother breastfeed for 6 months, than it should be recommended that FMLA last that long. It would also be beneficial to the home environment for the leave to be paid. This will help to ensure that the breastfeeding relationship will continue.

285 Concerned Citizen
Use of Banked Human Milk Banking human milk makes a lot of sense if it can be fully screened for any diseases that mother might have. Human milk is preferable to formula as it is what what provides complete nutrition and immunity building properties

287 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression All working mothers should have a place to pump in the work place, that is comfortable.

288 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression This really helps women continue to breastfeed beyond early infancy, which has been shown to be beneficial to both baby and mother.

289 Concerned Citizen
Paid Maternity Leave Ideally mothers should be able to be fully available to their babies for the first year of their lives if they are willing. There should be at least some paid maternity leave and leave of absence with job security at the end of the mother's leave time.

290 Concerned Citizen
Support for Breastfeeding in Public Settings This has to be supported if we are really behind promoting breastfeeding as the best thing for mother and infant. Mothers have to be able to nurse in public as they still come and go in the community and obviously function outside of the home even when nursing their infants.

292 Concerned Citizen
Health Care Provider
Other Areas: LLL member, working towards being a lactation professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Women need to be encouraged to have as natural a childbirth as possible. Techniques such as Calm Birth, a program developed by Robert Newman and being used at forward reaching hospitals such as Overlook Hospital in New Jersey, should be promoted and taught to ALL pregnant women who choose to use Integral methods to prepare for childbirth.

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.

293 Lactation Professional
Access to Lactation Care and Support Currently, it is up to each individual hospital and physicians office whether or not to offer lactation assistance to their patients. I think that getting the insurance companies on board with providing lactation services to patients would really help women succeed with breastfeeding. If private lactation specialist could bill for lactation visits much like chiropractors can bill for services, this would allow women to seek competent help with breastfeeding. A free market must exist in regards to lactation specialist services with IBCLC being the mandatory credential. This way, patients would be able to seek qualified individuals to help them and not have to depend on the help provided by the pediatrician's office or the hospital where they delivered. This service would be very cost effective for the insurance company and the US government in the case of nationalized health care or medicaid since breastfed infants are healthier throughout their lifetime. Many insurance companies offer 10 visitts per year to the Chiropractor; whereas a woman would only need several visits per child for her lifetime.

294 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Allowing the baby to remain with a mother instead of in a nursery with other babies would increase the maternal bond and make it easier for both mother and baby to nurse as needed, rather than on a nurse's schedule.

295 Lactation Professional
Health Professional Education, Publications, and Conferences I am an IBCLC employed at a major inner city hospital. It is so frustrating to me when I work very hard with a mom and her baby to get them off to a good start with breastfeeding only to have breastfeeding sabatoged in a few days by their doctor. Please mandate breastfeeding education as part of a physician's continuing education. They need to be updated in particular about jaundice, medications and mother's milk, and normal newborn nursing patterns.

296 Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Please allow for more public advertising of the risks of formula feeding as was initially intended to be communicated by the AD council during the Bush Administration. These ADs were deemed to harsh and controversial after the Bush Administration received tremendous pressure from the formula companies. Formula needs to be remarketed as an emergency food when breastmilk is not available not as routine infant feeding.

297 Concerned Citizen
Health Care Provider
Other Areas: LLL member, working towards being a lactation professional
Paid Maternity Leave I had been living and working in this country for 3 years and was 3 months pregnant when I realized I would not be given a paid materinty leave! I was horrified, my family and friends a few hours away and north, were at the time getting a 6 month paid maternity and now are receiving a 1 year paid maternity leave. I was lucky enough to be able to quit my full time job, 10 years ago and have work on a part time basis. I have never returned to full time work as I consider my children a full time effort. How can we posssibly expect women to nurse when so many have to return to work at 6 weeks post partum, and the lowest paid workers are generally the women who have to return the earliest and have no way to pump, or take breaks to assist the continuation of nursing.

298 Breastfeeding Coalition Representative
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Need support for baby friendly pratices. Some of the Pediatricans on staff are not supportive of breastfeeding and are outdated on how to work with mothers and babies to have safe care and support breastfeeding

299 Breastfeeding Coalition Representative
Health Care Provider
Access to Lactation Care and Support Our positions are capped by congress so I could only hire a lactation consultant if I gave up a RN position.

300 Health Care Provider
Paid Maternity Leave I believe this is one of the most cost effective ways to decrease health care costs in this country. Six months would be a minimum

301 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care With each of my childrens' deliveries I was given formula samples, which made it way too easy to want to give up on breastfeeding when it got challenging. I thankfully breastfed each of my children, increasing the amount of time successively. I have to say that if formula were not pushed so much and given away at hospitals that would help beginning parents. Having good lactation specialists and support during the stay in the hospital, but also to visit the home to assist in that crucial time once a new parent arrives at home. Being all on your own can make it seem much harder. I went out to La Leche League meetings and found lactation specialists on my own, but I think that if the hospital would make some kind of an effort to extend the care into the home it would greatly benefit. The first few days and weeks can make or break that breastfeeding relationship. Having a really good start can mean all the difference.

302 Health Care Provider
Health Professional Education, Publications, and Conferences The benefits of breastfeeding and how to support breastfeeding families needs to be part of the basic curriculum in every medical and nursing school. Further competency in breastfeeding must be part of every pediatric residency program and part of training for nurses in OB, public health, pediatrics, and midwifery.

303 Concerned Citizen
Paid Maternity Leave Many women need to return to work after 6 weeks, which is not long enough to establish breastfeeding. They have to choose between breastfeeding and putting a roof over the baby's head. Women should have at least 12 weeks paid leave to focus on the breastfeeding relationship.

304 Concerned Citizen
Other Areas: Mom who breastfed in spite of obstacles
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media We need more public education and legislation to protect breastfeeding moms and babies, uphold their rights to feed in whatever location they may find themselves. Moms should not be subject to risk of ejection from public spaces and even arrest for feeding the baby, nor should breastfeeding pairs be sent off to dirty restrooms and closets. Public breast exposure for purposes of breastfeeding should be legal everywhere at any time, and public education programs to help the public understand the importance of breastfeeding and that breastfeeding is not a sexual act, should be widely disseminated.

305 Concerned Citizen
Support for Breastfeeding in Public Settings In my state there are laws to protect breastfeeding in public, and yet the policy alone cannot change people's perception that breastfeeding should be done in a bathroom stall. It is very frustrating and I don't see how to change it.

307 Concerned Citizen
Paid Maternity Leave All full-time employees, employed for at least one year, should be able to receive 3 months leave with full pay, 3 additional months with half pay, and 6 additional months with quarter pay, or however much of that leave the employee wishes to take. The employee's position should be held for one year.

309 State or Local Government
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I have not seen a promotional campaign targeting the benefits of breasfeeding in the last 3 to 5 years. With all of the advances in technology, we should focus on developing appropriate culturally specific media campaigns.

310 State or Local Government
Peer Support and Education of Family Members and Friends Breastfeeding moms need the support of their partners, peers and family members. Training peer educators in churches, barbershops, beauty salons and other places would be a great way to get the information out to the community about the benefits of breastfeeding.

312 Concerned Citizen
Health Care Provider
Lactation Professional
Paid Maternity Leave The US remains the ONLY industrialized country without paid leave. FMLA does not pay the bills, only holds a job. Three months away from work after a new baby comes home is a bare MINIMUM. Six or twelve months would be optimal.

313 Concerned Citizen
Health Care Provider
Lactation Professional
Other Areas We need a sea change in public policy and opinion that values children AFTER they are out of the womb. Right now, extreme groups seem to value life more inside the uterus than outside. Once the babies are born, they are on their own. This has to stop. We need public policies that show we are committed to our children as a priority, not an afterthought. SCHIP expansion was a good start, but no where near enough.

314 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Co-sleeping options in hospital rooms.

No separation after C-section.

315 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Access to Lactation Care and Support Hospital lactation specialist should provide follow-up calls/visits to all patients after discharge.

In-hospital visits from lactation specialist prior to discharge.

316 Health Care Provider
Lactation Professional
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Incentives for hospitals to participate in the Baby Friendly Hospital Initiative will help support breastfeeding. Particularly important are not offering anything to a breastfed baby unless medically indicated. This needs to be clarified as many babies on day of life 2 are needlessly supplemented with bottles of formula because their weight has dropped 7% which is considered acceptable. Hand expressed colostrum can be spoon-fed to the baby instead of formula in a bottle which can cause difficulties in latching on to the breast. Formula introduction is also harmful as it permanently changes the infant's gut flora.

317 Health Care Provider
Lactation Professional
Nonprofit Organization
Access to Lactation Care and Support Low income women have difficulty accessing lactation consultant services. WIC should have lactation consultants available for office and in-home visits. Lactation consultants can also be available in public health clinics where mothers and babies are seen for well-baby care.

318 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care We need to prevent the artificial baby milk ( formula ) companies from having such a hold on physicians and managers; for example, free goods, lunches, etc.

319 Health Care Provider
Lactation Professional
Nonprofit Organization
Use of Banked Human Milk There is still a lot of misinformation about the safety and benefits of using banked donor milk. A campaign to promote the use of donor milk as well as a campaign to encourage mothers to donate will help raise awareness. Insurance companies should reimburse for use of donor milk so more babies can benefit from its use.

320 Lactation Professional
Access to Lactation Care and Support Home lactation support or free lactation follow-up should be available to everyone. At the moment only women who can afford to pay for private visits are getting the assistance that they need. We need to provide more help for under served populations.

321 Health Care Provider
Lactation Professional
Nonprofit Organization
Paid Maternity Leave It cannot be emphasized enough how important this is. We are one of the few nations left in the world who do not provide paid maternity leave. Returning to work and being separated from your baby is a serious obstacle for many mothers. Breastfeeding exclusivity and duration are seriously affected by mothers returning to work.

322 Lactation Professional
Health Professional Education, Publications, and Conferences Pyisicians OB/GYN,Family Practice, and Pediatricians should be encouraged to update their breastfeeding knowledge and give evidence based information to their patients.

323 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression We need some incentives to be given to companies that actively encourage their employees to continue to breastfeed. We need to increase the number of businesses offering lactation support, and access to pumping facilities.

324 Lactation Professional
Paid Maternity Leave Other countries like Sweden do it, why can't we?

325 Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media The media needs to portray breastfeding as a normal process, but be realistic that for some women it is more challenging than others. Information about getting help is essential.

326 Lactation Professional
Support for Breastfeeding in Public Settings I think that it is interesting that people focus more on concerns about women nuturing their infants in public, and less on explicit signs and advertisements for x-rated movies.

327 Lactation Professional
Peer Support and Education of Family Members and Friends We need to help to educate family members who feel left out or unsure of how to help the breastfeeding mother.

328 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Our country's breastfeeding success rate is severely impacted by the climbing cesarean section rate - now at 32%. By encouraging healthy, low-risk women to seek primary maternity care from a nurse-midwife (CNM) or certified professional midwife (CPM), we will come a long ways toward increasing breastfeeding success rates simply by decreasing surgical births. Birth by surgery is an independent risk factor for breastfeeding failure for several reasons: 1) the delicate hormonal/physiological design of birth has been disturbed, 2) mother's body is exhausted and recovering from surgery which hampers her ability to establish a full milk supply, and 3) baby is often separated from mother in the first hours of life. If breastfeeding is not accomplished in that first hour of life, it is statistically very unlikely that the mother/baby will ever be able to exclusively breastfeed.

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.

329 Lactation Professional
Researcher
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care It is my fervent belief that a majority of women giving birth in America today have no reference for breastfeeding as an integral part of the maternal-infant relationship. The baby as an active participant in the breastfeeding relationship is too often forgotten. Mothers dedicated to the notion of providing their babies with the best nutrition are missing perhaps the most important aspect of breastfeeding—when mother provides her “self” to her baby and begins the natural process of forming secure attachment. This oftentimes missing element causes great struggle for the new mother who faithfully attempts to follow a rigid schedule or some arbitrary set of rules provided by someone who has never met her baby and who has no idea whether the baby's behavior indicates he wants to feed, to be held, or simply to sleep. Moreover, while we have been very successful in alerting the public to the importance of breast milk and breastfeeding, we often create an impossible situation for the new mother who has just experienced a medicated hospital birth, rife with interventions, and expect her to manage breastfeeding as if she or her baby was not impacted by the birth setting. We unintentionally set mothers up for failure because the baby is not able to follow the “rules” and breastfeed on schedule. Nor is he able to latch like the 2-month-old baby in the breastfeeding video. I believe that the generic breastfeeding instruction provided by videos, books, and prenatal classes fall short of the individualized instruction mothers and babies require in the immediate postnatal period. Nurses, pediatricians, and even lactation consultants are typically not trained to provide individualized systematic observations of babies to give parents their very own personalized “tutorial” of their baby. It is my belief that empowering mothers with the lost art of recognizing and interpreting their babies’ signals rather than applying cookie cutter rules will have a much greater impact on breastfeeding success rates. This effort should be made in the immediate postpartum period (i.e., in hospital) before irreparable damage to the breastfeeding relationship (and milk suppy) occurs.

330 Concerned Citizen
Support for Breastfeeding in Public Settings It will do much to promote the social acceptability of breast feeding (which brings with it all of the physical and emotional benefits for children) if we created prominent breast feeding signage in our country. There should be a symbol (as there is in Europe) for breast feeding

331 Lactation Professional
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Lactation consultants need to be able to refer mothers to other resources without having to put them in the awkward situation of having to worry about the cost of the referal service.

332 Lactation Professional
Research and Surveillance We need funding for research to promote breastfeeding and provide evidence based practice.

334 Lactation Professional
Use of Banked Human Milk The public needs more information, and access to human milk banks. There is a lot of misinformation and concern about safety of breastmilk because it is a bodily fluid.

335 Breastfeeding Coalition Representative
Lactation Professional
State or Local Government
Access to Lactation Care and Support I would like to see support at all economic levels. Lactation support is for everyone not only the rich or WIC participants

336 Breastfeeding Coalition Representative
Lactation Professional
State or Local Government
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Having lactation support within complementary programs will encourage breastfeeding mothers get the immediate assistance needed after hospital discharge that is needed.

337 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Expectant mothers need to be given thorough information on the benefits of breastfeeding and - even more importantly - the drawbacks of formula. That is to say, rather than explain that breastfeeding can decrease childhood diabetes, the public needs to know that feeding formula actually increases childhood diabetes. The way we word things now (breastfeeding benefits) actually makes formula feeding the 'norm.'

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.

338 Concerned Citizen
Access to Lactation Care and Support Easy and affordable lactation care and support should be available through hospitals and birthing centers, for all mothers, regardless of whether she gave birth at that institution or not.

339 Concerned Citizen
Use of Banked Human Milk Raw human milk shared from another is perfectly appropriate as long as the mother is free from any disease that may be spread through her milk.

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

340 Concerned Citizen
Other Areas: Breastfeeding mom of 2
Paid Maternity Leave I think this is BY FAR the most important hurdle to the breastfeeding epidemic in this country. If all mothers were given at least 6 months of paid maternity leave, breastfeeding would be easier to establish and maintain, there would be no stress about pumping and supply, nipple confusion, mothers would be less stressed. All mothers should have at least 6 months of time to devote exclusively to their newborn, making breastfeeding and bonding with your baby a priority. Motherhood is not valued in this country - it is THE most important job and should be valued and treated as such.

341 Health Care Provider
Lactation Professional
Access to Lactation Care and Support pediatricians and obstetricians should be referring patients with lactation problems to LC's if they are unable to assist them. Many of the breastfeeding problems that arise early on can be helped easily with a consult and can prevent early weaning. Also, women that do make the connection with the LC often decline the service due to the cost. If health insurance companies would reimburse for this important service, many more women would be able to get the assistance they need. In the long run this would save the insurance companies money by avoiding steep medical costs attributed to early weaning and a diet consisting of artificial milk.

342 Concerned Citizen
Support for Breastfeeding in Public Settings In most states breastfeeding is explicitly allowed by law. This needs to become a standard for the whole country. Educational materials for businesses and their employees need to be provided, so that nursing in public wherever a woman is allowed to become becomes accepted.

344 Concerned Citizen
Health Care Provider
Other Areas: Postpartum care Doula
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) If medical insurance, including that provided to low-income families through the state and federal government, would cover home visitation and support of professional doulas who are trained in breastfeedng support, more women would be able to initiate correct breastfeeding technique. In that way, more women would continue breastfeeding beyond the 3rd month and hopefully into the 2nd year, at least.

345 Concerned Citizen
Health Care Provider
Lactation Professional
Access to Lactation Care and Support The WIC Program needs to be reevaluated, especially considering that it provides free formula to over 50% of American families. I have worked within WIC, at different sites, and it is painfully obvious that formula is given greater value than breastfeeding. Does the government realize that new mothers are given formula packages, even before a lactation consultation takes place; even before the mother is referred to a peer counselor, (if this even happens)? When the American public is so intensely aware that they can get free formula, without even considering BF, and WIC staff supports and encourages this notion, the message is clearly sent that BF is not important. There should be a medical reason for giving formula, right from the start, or mothers should be willing to pay out of their own pocket for formula, if they make the choice to forgoe BF for a convenience reason. Why is the government funding the formula feeding habits which lead to increasing health problems affecting American babies? At the very least, there should be allocations for IBCLCs on staff at every WIC office, in proportion to the amount of clients. Peer counselors must have experts to refer to and this is not the case at the majority of WIC offices across the nation. Peer counselors have a different set of skills than IBCLCs and can not take the place of lactation professionals. At the same time, the government must insist on IBCLCs as the recognized lactation professional; not CLCs or nutritionists, or other WIC staff who can be briefly cross trained but must perform other duties. If the government is serious about increasing BF rates, especially in the WIC population, then they must provide early access to IBCLCs and they must stop giving free formula to such a vast percentage of infants, based primarily on the mother's choice to receive free formula. WIC does not go far enough to point out the fact that BF is normal and formula is inferior. As long as the public 'hears' that formula is the norm, they will continue to formula feed, and babies will continue to pay the price in terms of their health.

346 Concerned Citizen
Other Areas: breastfeeding mother
Paid Maternity Leave We need to support mothers and babies better by allowing mothers to care for their children without penalty. The United States has inadequate standards for maternity leave, shameful, in fact, when compared to many other countries. Breast is best for all babies, and through the beauty of biology is available to all babies. So why do we, through inadequate maternity leave policies, make breastfeeding so difficult for working mothers? The current maternity leave policies suggest raising healthy children is a low priority in the United States.

347 Concerned Citizen
Health Care Provider
Lactation Professional
Health Professional Education, Publications, and Conferences We need to put emphasis on the WHO code and the AAP needs to cut its financial dependence on the formula industry. Formula bags, coupons and other items should not be distributed by any hospital or health care provider.

348 Health Care Provider
Lactation Professional
Access to Lactation Care and Support Why doesn't Medicaid pay for lactation consultations by IBCLCs who are not nurses? There are numerous studies to point out that mothers are not receiving lacation care after they leave the hospital and the fact that private practice lactation consultants are in extremely short supply. There are very few BF clinics across the nation, unless one happens to be in a metropolitan area, and even then, most are staffed by nurses. One does not need to be a nurse to be an IBCLC and there are clearly discriminatory practices at work whereby non-nurse IBCLCs can not secure employment in the community. This is a travesty when the need for the services and educational expertise of IBCLCs is so obvious. Let's see the government fund a BF clinic in each community. Isn't it time we stop depending on our maternity clinics to provide this service, especially when these same clinics receive a great amount of government funding, but fail to allocate for the services of IBCLCs? Let's take BF completely out of the WIC clinic, too, for when state governments receive rebates from purchasing formula, it only fuels the budget for more formula. Isn't this an inherent conflict of interest, depending on organizations who receive the lion's share of their funding from NOT breastfeeding, but formula?

349 Concerned Citizen
Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Employers should be required to have a designated private room for pumping and allow pumping breaks for the working mothers. I remember going back to work when my daughter was 2 months. i had all of 10 minutes to pump while in a bathroom. I quit that day... no job was worth my milk supply!

350 Breastfeeding Coalition Representative
Community Organizer
Lactation Professional
Access to Lactation Care and Support As an IBCLC in private practice it would be ideal for the client to be able to have lactation be covered under health plans. The health plans are always supporting preventative health care but then will not cover any breastfeeding education or consultation.

351 Breastfeeding Coalition Representative
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression The employer needs to support the women that is returning to work. Many moms are having a hard time returning to work and not receiving support at their workplace to express milk for their baby. It is imperative that employers be compensated for establishing Lactation support programs for their employees.

353 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I am pregnant with my 3rd child. My older two were breastfeed for 12+ months each, and this child will be too. On my first prenatal visit with this baby, I was given a jug of formula by the receptionist. I end up donating all formula I receive to homeless shelters, but it only discourages breastfeeding when women are handed formula at their initial pregnancy office visit.

354 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Paid Maternity Leave Moms I work with are returning to work at 4-6 weeks pp and to not receive support to express their milk. But most importantly the mom needs to be able to stay home with her infant. Nothing can replace the mother.

356 Concerned Citizen
State or Local Government
Worksite Lactation Support, Onsite Child Care, and Milk Expression Encourage businesses to support nursing mothers by the provision of breaks for mothers to pump breast milk, provide mother's room for mothers to breastfeed with comfortable table and chairs, an electrical outlet, as a refrigerator for storing milk and preferably lactation support. I am also a federal employee, I would love this to be required for all federal agencies and offices.

357 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Other Areas WASHINGTON. What is being done in the US government to make breastfeeding normal and supported. Are there representatives from the breastfeeding community at thesemeetings that are taking place in the new administration? It has to start in Washington when talking about preventative health care and cutting health care cost that breastfeeding is not mentioned.

358 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) The WIC program needs some major policy changes. Currently, the program promotes use of formula, infant cereals, and processed and baby and toddler foods high in refined white sugar. This program should be a center of breastfeeding education and promotion of good nutrition for mother and child. It is an uphill battle for a mother in the WIC program to continue breastfeeding in the current environment. Formula and infant cereals should not be pressed on a mother who wishes to nurse her child and wait the recommended six months to introduce wholesome first foods, especially after she ays she does not want it. Women on WIC should not have to battle with grocery clerks when using vouchers for vegetables or other whole foodss that are accepted under the program rules but evidently not promoted. All federal programs for new mothers should make meeting space available for La Leche League meetings and other mother-to-mother support organizations, and have qualified lactation consultants available for appointments for free or a sliding scale, especially bilingual consultants.

359 Health Care Provider
Lactation Professional
Health Professional Education, Publications, and Conferences I am a Pediatric Nurse Practitioner and Lactation Consultant in Texas. Before that, I was a hospital nursery nurse and Neonatal Intensive Care Nurse. I perform lactation consults in my pediatric practice. The two biggest frustrations new mothers face related to breastfeeding is incorrect information, and lack of a healthcare professional who is knowledgeable in breastfeeding. I would like to suggest that all RN's and MD's currently being trained have breastfeeding management included in thier educational programs; and that currently practicing MD's and RN's (including Nurse Practitioners)be required to complete an educational program about breastfeeding in order to renew their practicing license in 2010 and thereafter. That way, all health care providers a mother is exposed to during pregnancy and after birth will be able to provide appropriate information to her to facilitate lactation and breastfeeding.

360 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Here in LA my mainly Latina prenatal patients all state that they will breastfeed. We use CenteringPregnancy as our model and focus a lot of time on breastfeeding. Invariably, they return at 6 weeks postpartum and are supplementing with formula. They tell me their babies are stared on formula in the hospital setting and they then feel encouraged to use formula as it is supplied through WIC. The message they get is that if they hospital and WIC give you formula than it must be healthier for their babies. We need baby friendly hospitals that do not routinely supplement and we need WIC to change the message it gives by paying for formula.

361 Health Care Provider
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media When teaching nursing school, I was shocked to find how many young women (nursing students at that) felt that breastfeeding was somehow indecent or even gross. I can only imagine changing the image of breastfeeding in popular media would go along way towards normalizing breastfeeding for younger adults.

363 Concerned Citizen
Paid Maternity Leave We should all be doing more to educate women and families of the importance of breastfeeding. Providing federal or state maternity leave for a minimum of 6 months can help mothers establish a healthy breastfeeding relationship that can be long term.

364 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care It is most important to provide support across the disciplines, that all people involved with the mother is providng the same information. Especially important is early interventionfor any problems, and education of all support persons.

365 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Peer Support and Education of Family Members and Friends As a counselor with Nursing Mothers Counsel, I know how important breastfeeding education and one-on-one support are. The first few weeks are critical for moms to receive support. Through breastfeeding education classes, moms learn what to expect the first few weeks, how to avoid problems, and resources for help.

366 Concerned Citizen
Employer
Health Care Provider
Health Professional Organization
Other Areas: Pediatrician, mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Prenatal -- There needs to be more emphasis on breastfeeding by OBs. Pediatricians often don't see mothers until after the baby arrives, and if a mother hasn't already decided to breastfeed by the time the baby's born, she's probably not going to decide to at that point. OBs need more education about the benefits of breastfeeding, and they need to be actively encouraging mothers to pursue it.

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.

367 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I was kept away from my second child for FIVE hours after coming out of intensive care (post c-section) because of a shortage of available rooms. It wasn't until I was hysterical that the hospital staff took note of this unnatural situation. I had to tell them repeatedly that I wanted to breastfeed, and even then it didn't seem to register that I needed to be with my baby for the most human of reasons.

368 Health Care Provider
Worksite Lactation Support, Onsite Child Care, and Milk Expression Thank you for this opportunity to comment on a new Call to Action. I'm a nurse-midwife who has worked for a number of years with women from communities of recent immigrants. These new Americans often have jobs in the service sector that carry few if any benefits. Some examples are fast-food restaurant workers, and hotel or office building cleaners.

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.

369 Concerned Citizen
Employer
Health Care Provider
Health Professional Organization
Other Areas: Pediatrician, mother
Support for Breastfeeding in Public Settings This is so important. It is extremely difficult to maintain breastfeeding if you feel you always have to be covered up or someplace private. Breastfeeding a baby is natural, healthy thing, and women need to feel free to breastfeed in public without fear of harassment or embarrassment.

370 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care 1) Discontinue hospital practice of giving away diaper bag with infant formula in it. 2) Don't offfer/give infant formula to newborn not unless medically indicated. 3)Referral to WIC program for continuum of breastfeeding/lactation support.

371 Concerned Citizen
Employer
Health Care Provider
Health Professional Organization
Other Areas: Pediatrician, mother
Paid Maternity Leave This is huge. The truth is it is extremely difficult to work full-time and maintain a 100% breastfeeding relationship with your baby. I've done it, and being a pediatrician, I was extremely motivated, but I can attest that it was very hard. Biologically, women were not intended to be physically separated from their babies for longer than a couple of hours. The 8-10-12-hour separations we require in our society for a working mother simply are NOT conducive to breastfeeding. Even pumping every 3hrs with a high-quality breastpump does not maintain a milk supply the way direct breastfeeding does. Biologically, it is EXTREMELY difficult. We talk a lot about family values in this country, but if we really believe in family values, then the truth is that women should stay at home with their babies for at least a year, preferably 18-24mo. This sounds radical, I know, but other developed societies do it. Babies deserve to have their mothers at home giving them the best care possible for much longer than the 6-8wks we allow them. This would undoubtedly result in healthier, happier children and families for our society.

372 Concerned Citizen
Employer
Health Care Provider
Health Professional Organization
Other Areas: Pediatrician, mother
Worksite Lactation Support, Onsite Child Care, and Milk Expression Employers should be required by law to provide breastfeeding mothers with breaks and facilities/space for milk expression -- at least 20min break-time every 3hrs while at work.

374 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Onsite childcare would have an incredibly positive impact on increasing length of time nursing and all the associated benefits to mother, child, and employer too - I would value this far above many other aspects of my job, including compensation.

375 Concerned Citizen
Support for Breastfeeding in Public Settings I feel that national chain, big box stores should be required to have a pristine, spacious, and comfortable nursing mother's room located in their store for public use. Hopefully local stores/businesses would follow suit. When traveling, I've found myself driving around locating a Babies R Us, just so I didn't have to nurse my son in the car.

376 Concerned Citizen
Support for Breastfeeding in Public Settings A designated nursing area in areas where possible/economic/appropriate would be a great seal of approval legitimizing nursing. Additionally, posting the relevant breastfeeding laws in public places - coffee shops, parks, etc. would be significant. Finally, educating police, security guards and even lifeguards at the beach would help diffuse difficult situations where a woman's right to nurse in public is questioned.

377 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Early access during prenatal care to breastfeeding information presented in a non-threatening and enlightening manner with health care provider or lactation professional. Easy access of breastfeeding help (i.e. one on one, accurate, useful, supportive, affordable and timely) during the first 2 weeks post partum. All hospital nursing staff properly trained to help women with latching and positioning. Limited access to formula products in hospital. Pumps available from hospitals with proper and adequate training.

378 Employer
Paid Maternity Leave Unpaid leave is also a critical option - may women choose to sacrifice financially to stay home already, but having the option to return to a job after up to one year out would be incredibly supportive of increasing nursing rates. Unpaid leave may be MORE productive on that front even that increasing paid leave availability or length (since at this point 1 yr paid seems like a non-starter). Getting paid leave increased by a few weeks does not address the difficulty of continuing to work out of the home and continue to nurse (supply challenges, difficulty getting to pump, etc) beyond a few months whereas the option to take an extended leave albeit unpaid would likely allow many many women to nurse much longer.

379 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media CRITICAL, CRITICAL, CRITICAL ISSUE!!! We need positive role models being seen - subtly - nursing. For example, not a targeted pro-breastfeeding ad, but more seeing it weaved into a sit-com where you just happen to be aware that a mom is nursing, but it is not necessarily a plot line. Art depicting the beauty of nursing, showing nursing moms in children's books, etc. to have it be a normally observed behavior. Also, leveraging positive role models that are recognizable - Salma Hayek for example!! More studies about benefits psychologically for the mother and child from bonding associated with breastfeeding. Again, indirect messages though since many women who were unsucessful breastfeeding are vocal critics as they may feel a sense of failure or guilt and have negatively biased views against breastfeeding that they feel compelled to defend their choice/situation. Finally, images of toddler nursing so that people can understand the normalcy and beauty of this. More toddler nursing books, too.

380 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression We need better laws in place for mothers to breastfeed or express breastmilk at work. This should be a right that a mother has not a priviledge. Employers should be mandated to acommodate a breastfeeding mother. Unless it is a paid break, the time should be unpaid for the employee.

382 Concerned Citizen
Researcher
Worksite Lactation Support, Onsite Child Care, and Milk Expression I worked for 9 months at Northeastern University in Boston. When I started, I had a 6-months old baby and was breastfeeding. I could not believe when the HR department informed me on my first day that there were no provisions whatsoever for breastfeeding mothers in the whole university (undergrad students, grad students, faculty and staff all together). I was sent to my supervisor to ask for help and that made me start off-balance. Any company and even more a big institution such as Northeastern University should be required to provide assistance to nursing mothers they employ.

383 Health Care Provider
Health Professional Organization
Researcher
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care A pilot program entitled, Mother's Own Milk (MOM), has been implemented at a women's hospital in Tampa, Florida to improve breastfeeding compliance of mother's who birth premature infants. The targeted population is geared towards high risk obstetric patients with diagnosis that may warrant premature delivery. Participants are assigned to a breastfeeding resource nurse who then performs an antenatal lactation assessment, schedules one-on-one learning sessions and delivers hands on training with breast pumping equipment. After delivery, breastfeeding behaviors are further supported up to 60 days after delivery to assist with transitioning to the breast and promote long term compliance through peer counseling. Areas of weakness include lack of lactation support from the institution and pediatricians, lack of knowledge regarding current breastfeeding methods, and lack of equipment or breast pumping capability primarily among low income families. In addition, many insurance companies do not reimburse health care providers or IBCLC's for lactation services.Which limits availability of lactation resources.

384 Concerned Citizen
Employer
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care In the hospital, free bottles of formula should be marked in case of emergency.

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

385 Concerned Citizen
Peer Support and Education of Family Members and Friends I wish it was mandatory for stores (such as grocery stores and whatnot) to have breastfeeding rooms for nursing moms, instead of making us feel obligated to nurse our babies in the filthy restrooms.

386 Health Professional Organization
Lactation Professional
Industry Representative
Nonprofit Organization
Public Health Worker
Use of Banked Human Milk Sharing of human milk should be more commonly accepted. Many more banks need to be established!

387 Concerned Citizen
Support for Breastfeeding in Public Settings I wish it was mandatory for public places to have breastfeeding rooms for nursing mothers.

388 Concerned Citizen
Peer Support and Education of Family Members and Friends I wish the doctors offices and hospitals and health clinics would not push infant formula use on expecting mothers. There should be more information given to expecting mothers about the benefits of breastfeeding for both her and her baby (or babies) and also references to be given to her family so that they will be more educated about breastfeeding and will be able to support her better instead of bashing her for deciding on breastfeeding. A mother needs a support system when she is breastfeeding, especially in the beginning.

389 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Employer
Health Care Provider
Health Professional Organization
Lactation Professional
Industry Representative
Nonprofit Organization
Public Health Worker
Researcher
State or Local Government
Worksite Lactation Support, Onsite Child Care, and Milk Expression Employers should be be offered incentives to provide mothers with pumping stations. This is especially important in blue collar/hourly jobs - white collar moms have options such as telecommuting, paid disability, etc. to facilitate breastfeeding and pumping. Working class moms face far more challenges - breastfeeding is becoming a privilege - limited to the middle/upper-middle class.

390 Lactation Professional
Paid Maternity Leave The needs of a newborn are fairly minimal when put in the whole scheme of things: they need to be fed, changed and loved. They need their mothers home with them for a minimum of three months following birth. It is a justice that our babies deserve.

391 Breastfeeding Coalition Representative
Concerned Citizen
Nonprofit Organization
Other Areas: Student and Employee
Peer Support and Education of Family Members and Friends We need to make breastfeeding part of everyday life. I am a public nurser and encourage other mothers to do the same. If we cover up nursing it makes it look shameful and its not! Also we need to get mothers to understand the formula isnt just as good a breastmilk and that it can be accomplished with some work. Also I am a student at a public college and I cant get a place to pump when I am at school. That needs to change any public school should provide a room or office where a student/teacher/employee can pump that should be the law. And it should have a big sign on it that says LACATATION ROOM with information on the door explaning the importance of breastfeeding.

394 Breastfeeding Coalition Representative
Concerned Citizen
Employer
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care More post delivery breastfeeding support needed in areas of the country with a less educated population. Once these women leave the hospital or pediatrician's office there is no breastfeeding support or pump rental unless they have the $100 per/hour fee for the IBCLC.

395 Other Areas: education
Other Areas I would like to see breastfeeding included in health class! We teach on pregnancy and birth but not the basics of lactation. I think this should be included in 9th grade health class at the very least.

396 Concerned Citizen
Employer
Paid Maternity Leave Many countries is Europe have much longer paid maternity leaves, they last up to a year and are subsidized by the government. Breastfeeding rates are much higher and longer in those countries. I think maternity leave should be extended up to at least 6 months.

399 Concerned Citizen
Health Care Provider
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Television is the single most influential media in the world today. Breastfeeding is never protrayed in advertisements or public service announcements on television. This should be done 4-5 times a day 7 days a week. It would also be paid advertising on the internet. Thank you,

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

400 Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Implement the BABY FRIENDLY HOSPITAL INITIATIVE

401 Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Access to Lactation Care and Support Pay IBCLC certified lactation specialists well for their essential support

402 Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Health Professional Education, Publications, and Conferences We must include lactation education in the required basic education of ALL physicians, i.e. in medical schools.

403 Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Health Professional Education, Publications, and Conferences We must include lactation education in the required basic education of ALL physicians, i.e. in medical schools.

404 Lactation Professional
Support for Breastfeeding in Public Settings I lead a nursing mother's group twice a month from the fitness center at the hospital where I work. I believe this moms networking is one of the most important support avenues we can offer to mothers. It is free, the moms know it is always the 2nd and 4th Monday of every month at 12:00. Moms who have little ones in preschool or school are typically able to still attend the group and still get to school to pick up an older child. Mothers who come into the group who do have issues find many warm arms around them to help them make it through a difficult time and see the light at the end of the tunnel. I hear over and over again how that group helped a mom continue with breastfeeding and helped her realize how important continuing to nurse really is to her child, herself, etc.

405 Lactation Professional
Access to Lactation Care and Support Our hospital has one full time IBCLC, me, 2 recently IBCLC RNs who work NICU as staff nurses but fill in for me from time to time. One other newly certified IBCLC who teaches our Spanish classes and also covers for me. We have 2 mother baby nurses who are CLCs, one nights, one day, one newborn nursery nurse (who is great! She puts babies on the breast in the OR while mom is being sutured!, she is a CLC. Our patient call back/PT educator RN also was required to become a CLC to help triage calls while following up with patients. She typically is not on the floor unless needed. Many times these nurses do not cover for me if the floor is too busy. I am the only RN, IBCLC who is not staffed for patient care (I do help out in times of insanity). In times of crisis budgets I believe our hospital is doing a decent job.

406 Community Organizer
Concerned Citizen
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe that if labor and delivery and post-partum nurses were given compensation/bonuses based on how many of their patients breastfed, we would see a jump in participation and encouragement from nurses. Moms need that extra support in those first days, and some who may not have planned to breastfeed might possibly change their minds.

407 Community Organizer
Concerned Citizen
Nonprofit Organization
Public Health Worker
Access to Lactation Care and Support Many women who do not qualify for public health assistance do not have funds to pay for lactation consultations outside of the hospital. We need walk-in lactation clinics where all can receive lactation counseling paid for by either their insurance or on an income-based fee scale.

408 Concerned Citizen
Other Areas: Mother
Support for Breastfeeding in Public Settings Our attitude towards breastfeeding needs to radically change in this country. Many people still think women should breastfeed their babies in toilets. Who wants to eat in a toilet? I don't. And neither do babies. If a strong signal is sent that breastfeeding in public is legal, perhaps more people would see it and accept that it is natural. Woman should be able to breastfeed wherever they can comfortably and to it. It would also help (until we as a nation get more comfortable with ourselves and our humanness) to have designated places where more self-conscious woman can breastfeed. These should by no means be the ONLY places women can feed their children, but rather a place to encourage woman who might otherwise feel self-conscious. Or when a quiet place is needed. If women see more of these places and hear more signals that support breastfeeding, it will go a long way in encouraging more woman to choose this healthier form of nutrition for their children.

409 Concerned Citizen
Other Areas: Parent
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I would love to see more open breastfeeding in Popular and Electronic media. The more we see this normal natural and beautiful process, the more people will become comfortable with it. The more people are comfortable with it, the more women will choose this healthiest way to feed their babies. I know it's hard to compete with all the images of breasts as sex objects, but breastfeeding is feeding your baby and we've got to get those images and ideas out there.

410 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Designate one hour four times a day for no visitors in order that mom and baby may breastfeed uninterrupted.

411 Concerned Citizen
Other Areas: Woman
Research and Surveillance I'd like to know more about the link between breastfeeding and the reduction in breast cancer. The only studies I've read or heard about involved breastfeeding where breastfeeding was not clearly defined (time-wise). What about longer breastfeeding? In the US women breastfeed for an extremely short amount of time compared with other countries. When US women breastfeed more along the lines of women worldwide (3-4 years) is there a larger reduction in breast cancer? Could our changing to formula be linked to the increase in breast cancer? Who is looking at this?

413 Concerned Citizen
Other Areas: Parent
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Women need all the support and information they can get about breastfeeding. I'm shocked to talk to many people with PhDs who still think breastfeeding doesn't really have any real benefits over not breastfeeding. And many uneducated people think that breastfeeding is actually BAD for babies. My God, where do people get this idea (I know the answer to this but it's still shocking)! Please do all you can to let women know about the benefits of breastfeeding. And the more children who see their mothers breastfeed their younger siblings, the more this will bring breastfeeding back into the mainstream.

414 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Encourage safe out-of-hospital births for low-risk mothers, in birth centers or at home

415 Concerned Citizen
Access to Lactation Care and Support Birth provider (doctor, midwife, etc.) and pediatrician should provide reference for on-call help during first year of breastfeeding, through La Leche League, lactation consultant,etc.

416 Concerned Citizen
Access to Lactation Care and Support All women deserve access to lactation care and support. This should be part of the birth process and included in the care (whether it's hospital or birthing center etc.). It's outrageous that hospitals send new parents home with Pamper and formula, but don't have a lactation consultant visit them. Ideally, women would have access to this information long before they give birth, so that when their new baby arrives they can begin breastfeeding immediately. There's nothing quite as powerful as seeing this tiny newborn infant KNOW how to go for the breast. Amazing. But we're wired for it and that's what babies need and mothers need to know. There should also be follow-up support for women, especially for those first few weeks. Breastfeeding can be difficult and women need to know that and to have help. Please help our children have access to this most healthy form of nutrition (and bonding).

417 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression All working mothers should have a place to nurse and/or pump; teachers in schools have to pump in bathrooms and most give up. Many jobs could accomodate an infant in arms or in a bassinet if employers were open to it; some women quit entirely since they cannot bring their babies to work.

418 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media As long as we over-sexualize women's breast, instead of seeing their biological function, many people will somehow view breastfeeding as pathological. We need more positive, healthy portrayals of breastfeeding in the media.

419 Concerned Citizen
Use of Banked Human Milk There should be a free human milk bank for qualified applicants. I understand it is very expensive to buy human milk which restricts purchase to a small margin of families.

420 Concerned Citizen
Paid Maternity Leave We should follow the European model and all women should receive a paid maternity leave for a min. of 3 months. It is absolutely horrible that this country states the importance of family and then leaves women little choice but abandon their newly born infants. A young baby needs to be with their mother during the early months and likewise the mother should be focused on maternal bonding.

421 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I think there should be a Public Service Announcement that outlines the benefits of breastfeeding and shows women nursing in public. There should be a campaign of acceptance/support for BF in general and in public.

422 Concerned Citizen
Other Areas: Anthropologist & Architect BF Mother
Support for Breastfeeding in Public Settings In order to encourage breastfeeding on a larger scale, it clearly needs to be publicly accepted. A mother, in a simple act of love and health, should not feel ostracized, ridiculed, wrong and out of place, and uncomfortable just because that crucial, unpredictable moment of need by the child has presented itself.

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.

423 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Nonprofit Organization
Public Health Worker
State or Local Government
Access to Lactation Care and Support It would encourage higher breastfeeding initiation and continuation rates for all population groups if IBCLC services were covered by indurance and Medicaid. Also federal programs such as WIC that targets young mothers and infants should have wider access to breastfeeding peer counselors and advanced lactation practioners. Lactation clinics that staff IBCLCs, peer counselors and medical doctors with expertise in the lactation field should be funded. Rural areas are underserved with lactation services. Grant funding should be made available to encourage lactation training and promotion programs in rural areas. Some hospitals in rural areas do not even have access to a single breast pump.

424 Breastfeeding Coalition Representative
Lactation Professional
Public Health Worker
Peer Support and Education of Family Members and Friends I am concerned about follow up care after the mother and baby are discharged. Some community programs are being phased out to help mothers once they leave the hospital. These programs are beneficial. Also, many of these programs are available to low-income families. There are those who need help but don't qualify for these services. More help is needed for the middle income bracket.

425 Breastfeeding Coalition Representative
Public Health Worker
Health Professional Education, Publications, and Conferences Health Care Providers are too quick to dismiss breastfeeding in cases such as jaundice and weight loss. These problems can be assessed and solved many times before formula even needs to be considered. I believe more lactation support is needed and should be promoted in and out of the hospitals. There seems to be too much of a focus on numbers (ounces of formula, ounces of weight gain, etc.) rather than what is best for mother and infant. For some women, preserving breastfeeding is what is most important to them.

426 Concerned Citizen
Paid Maternity Leave I believe that a longer or paid maternity leave would allow many more new moms the opportunity to breastfeed. We get such limited time off with our new child, and then have to return to work when they are so young, it's very difficult to continue breastfeeding. Breastfeeding requires a very dedicated and time committed mother. It's easy to get discouraged and want to stop. Paid maternity leave, or more time off (like most other countries in the world) would allow for more mothers to breastfeed.

427 Concerned Citizen
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care In the Pittsburgh area, no hospital places a baby in direct skin to skin contact with the mother immediately after birth. This simple intervention makes the baby more neurologically more competent so that breastfeeding is easier to initiate. Immediate skin to skin should be the norm for all babies regardless of intended method of feeding.

428 Concerned Citizen
Employer
Support for Breastfeeding in Public Settings It would be nice for the pulic to be educated on breastfeeding that is not dirty and wrong. I am a breastfeeding mother and won't in public becuase of all the dirty looks and comments from people. I didn't know until I chose to breastfeed my daughter that even my sister was unedcauted about it and thought it was dirty and gross.I would love to see the public accepting of it and for once give women a dirty look for feeding thier baby a bottle instead of breastfeeding. I would love to see public education about it, not just educating new moms or moms to be about it.

429 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care After a woman gives birth, the facility should offer goodie bags with information and/ or items that will encourage and promote breastfeeding instead of automatically offering a diaper bag with samples of formula. Additionally, immediately after giving birth, new moms should be encouraged to nurse by immediately placing the baby on the mom's chest. There should be a lactation consultant working at EVERY hospital in this country. I don't mention birth centers because those are breastfeeding- friendly by design.

430 Concerned Citizen
Access to Lactation Care and Support The employees that work with Women, Infants, and Children (WIC) program should be educated about the benefits of breastfeeding and required to encourage breastfeeding FIRST to poor women seeking assistance during their pregnancy and for the 1st 6 months of their babies' lives. These employees often only have a breast pump to loan, but have no idea (nor believe) that breastfeeding is best. Moreover, I think the policy allowing formula to be given as a WIC benefit should be revisited, because poor women should NOT be seeking to feed their babies with formula first when breastfeeding is the most economical way to feed a child.

431 Concerned Citizen
Peer Support and Education of Family Members and Friends Too often a woman thinks that her milk is insufficient for meeting her baby's needs. This must change in order for women to continue breastfeeding. The current ideology that leads to a woman's belief in her insufficiency is based around the idea that a baby must be scheduled and must follow an average timetable for sleeping, fussing, etc., when in truth, the baby's personality is as varied as our personalities as adults and the contributing factor to a baby's timetable.

432 Health Care Provider
Other Areas: Health insurance
Worksite Lactation Support, Onsite Child Care, and Milk Expression I think that insurance companies should be required to provide some type of discount or coverage of a breast pump. I was lucky that my insurance company covered the full cost of my pump, which enabled me to express milk and build up a supply while I was on maternity leave and then continue to exclusively give my daughter breast milk when I returned to work. Having the pump during work has been critical in keeping up my milk supply and is helping me reach my goal of breastfeeding my daughter for a full year. The cost of a pump is a huge financial burden for many women (myself included) and I think if health insurance companies were on board with seeing the value of breastfeeding they would help women by providing them with a pump and giving working moms the tools they need to breastfeed.

434 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Natural births without medication are beneficial to promoting bonding and breastfeeding. Hormonal production and distribution in the body by both the baby and the mother can be altered via medical interventions, e.g., c-sections, thus interfering with natural, i.e. evolved, processes for birth, bonding and breastfeeding.

435 Concerned Citizen
Health Professional Education, Publications, and Conferences Natural births without medication are beneficial to promoting bonding and breastfeeding. Hormonal production and distribution in the body by both the baby and the mother can be altered via medical interventions, e.g., induction, c-sections, thus interfering with natural, i.e. evolved, processes for birth, bonding and breastfeeding.

436 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Increased prevalence of natural birthing processes and breastfeeding in media, i.e. advertisements, movies, sitcoms, etc., would be powerful in promoting these important issues.

438 Concerned Citizen
Support for Breastfeeding in Public Settings More government organizations as well as private companies that display the international breastfeeding symbol would go a long way to showing united support for breastfeeding: http://www.mothering.com/sections/action_alerts/iconcontest/icon-winner.html

439 Concerned Citizen
Other Areas: Mother
Worksite Lactation Support, Onsite Child Care, and Milk Expression Official policy must be made encouraging companies to provide workplace pumping policy and a designated pumping only area in the company premises. Perhaps the government can give incentives to companies that provide these services.

440 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I'm a woman who managed to breastfeed my daughter while working full-time. It was a lot of extra work, but it was worth it to keep her healthy and happy.

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.

441 Concerned Citizen
Access to Lactation Care and Support I think it's very important to have qualified Lactation consultants in every hospital that delivers babies. With my first child he had a tight frenulum and without the aid of a lactation consultant I would have given up on breastfeeding. This would have been difficult because my child was allergic to all formula. Having someone with knowledge and experience (especially when you have your first baby) is important.

442 Health Care Provider
Lactation Professional
Other Areas As long as our government continues to purchase formula for give away, the encouragement for feeding at the breast will be undermined and fail in the groups who need it the most. Breastfeeding is not only a feeding method, the best in my opinion, but it is also the glue for mother/baby bonding and father/baby bonding. But it takes education, encouragement, and no other back up plans. If you think you can do something another way, or have a way out, then the other way ends up winning. Education is the start but free anything is worth the taking, and why not, IT IS FREE. Mom's don't have to do anything to get free stuff for their new baby except put their hand out. Feeding at the breast is a stigma to some cultures, negative and positive. We need to focus on the positives of breastfeeding and stop giving away the free formula and raise our expectations of new moms, dads, grandmas, sisters as supporters of the natural way to nourish our young. All other animals do it without question and so should we.

443 Concerned Citizen
Lactation Professional
Access to Lactation Care and Support Hospitals providing labor & deliver services should be required by law to provide inpatient lactation services by board certified lactation consultants (IBCLCs). Mother-Baby nurses are often too busy to help with intital breastfeeding in those first critical days. Additionally, Mother-Baby nurses are often inadequately trained in these topics as well.

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

444 Concerned Citizen
Support for Breastfeeding in Public Settings Nurturing of our young is the responsibility of the entire community. Support for mothers being able to feed their babies in public, must include feeding them from the breast. That is only natural

446 Concerned Citizen
Health Care Provider
Lactation Professional
Other Areas: eventual author
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I've been following this process since T.Thompson dropped the ball. Eliminate all input from formula and insurance idustries for a starter - their goals are at cross-purposes to this intended action.

#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

447 Concerned Citizen
Other Areas: breastfeeding mother
Health Professional Education, Publications, and Conferences In my experience, if have found the routine advice given by my daughter's pediatrician and nurses is contradictory to the advice of International Board Certified Lactation Consultants, IBCLCs. Some examples of this advice include start rice cereal and solid foods prior to 6 months, feed solids first, then nurse, offer 6 and 7 oz bottles per feeding. The research provided by IBCLCs is very clear that these practices are damaging to both mother's supply and health of the baby. We so often look to our pediatricians as experts in all things baby. However, they lack solid breastfeeding education. Educate our doctors and you'll help educate our mothers.

448 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe more focus on breastfeeding should be given during pre-natal care. Those who plan to nurse or even conside it, should come up with an action plan for pumping, milk storage, etc. It is a lot to think about when you are already home with your newborn. Plus, I heard several people in my hospital tour say they had already decided to bottle feed and I found that very interesting.

449 Nonprofit Organization
Access to Lactation Care and Support Ideally, if we could get each pregant mother to read a book or reprint on breastfeeding and if she could attend a support Group before the baby is born, that would not only plant educational seeds but give her a support network.

451 Concerned Citizen
Paid Maternity Leave As a father of two young children, I have recently experienced life with newborn children. My wife has been lucky enough to receive paid maternity leave from her employer, but I had to use vacation days for time off. I can't imagine being in the situation of many families of having to juggle work responsibilities around the stress of caring for a newborn, with round the clock feedings, diaper changes, and crying. It is ridiculous that so few new mothers and virtually no new fathers receive paid leave. Nearly every other nation in the OECD grants paid leave automatically to at least new mothers, if not new fathers. If this nation truly cares about families, we need a law mandating paid maternity and paternity leave for at least three months.

452 Nonprofit Organization
Paid Maternity Leave Sweden speaks for itself. 98% breastfeeding rate, they have a full year maternity leave, the lowest sickness and death rate of infants in an industrialized nation. USA has the highest sickness rate and the 2nd highest death rate for an industrialized nation.

453 Concerned Citizen
Support for Breastfeeding in Public Settings A woman's right to breastfeed her baby in any setting needs to be protected by law, as it is in most other countries, and the fact that breastfeeding in all setting is protected by law needs to be publicized, both by healthcare providers and by publically-sponsored advertisements. A federal law should be passed that would make public breastfeeding a protected activity in all states (I understand that some state do not protect the activity at present).

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.

454 Nonprofit Organization
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media We need to put ADs on TV speaking of the benefits of breastfeeding! The public should be made more aware of the choice that they are making.

455 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care More emphasis needs to be put on breastfeeding instead of on formula. Nobody asked me if I was breastfeeding they just assumed that I would formula feed. It was very distressing for me as a new mom who needed support with breastfeeding.

456 Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care We need to get the OB/Pediatric on board with the baby friendly practices that promote breastfeeding and especially nursing the baby the first hour of life when he/she is most alert.

457 Concerned Citizen
Use of Banked Human Milk This is not advertised enough. I didn't know that there were milk banks until I researched it. There also needs to be more places to donate milk instead of sending it off because it is inconvinent when you have a newborn or infant and have to go with frozen milk to send it off.

458 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I have a degree in elementary education and I decided to work as a substitute teacher after my daughter was born. I had very little time to pump and had to do so in bathrooms. More needs to be done for teachers who are pumping because they can't take scheduled breaks to pump. Teachers should be offered additional support while pumping at work.

459 Employer
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media There have been a lot of instances on the internet considering pictures of women nursing their children to be obscene and that makes me as a nursing mother disgusted. There needs to be more commercials promoting breastfeeding and pictures of it in the media so people understand that breastfeeding is natural and NOT obscene.

460 Concerned Citizen
Health Care Provider
Lactation Professional
Paid Maternity Leave Too often mothers have to come back to work early because they can't afford to take time off without pay. Many women are force to choose between working outside the home and breastfeeding/provide their own milk. Their milk supply and the baby nursing is not well estblished by 6 weeks much less at 2-3 weeks Mothers need a longer time to

461 Employer
Support for Breastfeeding in Public Settings I always get glares when I nurse my daughter in public. I usually cover up with a blanket but sometimes I forget. Either way I still get rude stares. There should be signs that are put up that says something to the effect that breastfeeding mothers are welcome so other patrons will know that mothers are going to be feeding their children.

462 Concerned Citizen
Paid Maternity Leave It should be fairly obvious to any thinking person that the lack of paid maternity leave in the US has a hugely negative impact on breastfeeding. As you know, the US is the only dveloped country that does not guarantee paid parental leave, and I think one of only 3 or 4 countries in the world with this situation. As you also know, the standard paid maternity leave even for upper middle class women is six weeks. I was lucky to have 16 weeks and the ability to take another three months unpaid.

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,.

463 Concerned Citizen
Support for Breastfeeding in Public Settings Make sure there are laws in every state that protect a mothers right to breastfeed anywhere.

464 Community Organizer
Lactation Professional
Public Health Worker
Researcher
Paid Maternity Leave It is time that our goverment takes a long hard look at the monumental role that motherhood plays in the development of strong, healthy, well-adjusted, intelligent, future leaders of this country. Staying home to nourish and nurture their babies should be a fundamental right for both mothers and babies. Give mothers the opportunity to do what they were designed to do . . . parent their children. When one looks at other countries and the way in which they honor mothers and promote the family by providing extended paid time off, it is is easy to see why we have so many problems in thsi nation.

465 Concerned Citizen
Researcher
Paid Maternity Leave I think we need to catch up with Europe and have at least 16 to 24 weeks of full pay for mothers after they have a child. As a new mother, 6 weeks at 60% of my pay is not something that would encourage me to breastfeed for 6 months! If this country is really committed to the best health care practices, this one is obvious.

466 Concerned Citizen
Other Areas: Breastfeeding mother
Paid Maternity Leave The US has the worst maternity leave in the WORLD. 12 weeks for a parent to stay home with their newborn? And I have to pay for my benefits! Luckily, I received short-term disability but still only received 60% of my pay. How about mirroring Canada's maternity leave policy? One year paid maternity leave with a guaranteed position when the mother returns. I could only afford to take six weeks off when both of my children were born. I wasn't even completely healed from having c-secitons both times. Mothers and/or fathers need to be home with their infants during the first year.

467 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care * Staff hospital maternity wards with nurses and aids who are mothers. During most of my hospital stays, the most of the nurses were very young and did not have children themselves. Therefore, they were not very helpful when it came to helping with breastfeeding. I would also suggest that every maternity room be supplied with a breastpump and if the mother is interested, the staff should train her on how to use it. * Quash the idea that c-section births interfere with breastfeeding. I've had 3 c-sections, including twins, and have been able to nurse my children. The real problem is that 1st time moms just don't know what they are doing. Let people know that even if they do not nurse in the first few minutes or hours, that they can still breastfeed and bond with their baby. * Quit the campaign

468 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Mothers should be encouraged to have baby room in with them after birth and nurse on demand with a minimum of 8-12 times in 24 hours. Formula should not be offered or free samples given without the request of the mother. I would like to see lactation consultatants in OB's offices. This way there can be more education for the mother during the prenatal phase and beyond.

469 Breastfeeding Coalition Representative
Health Professional Organization
Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media people unfortunately beleive what they see on TV and read in the print media. Advertisers are very savy when promoting their products. All healthcare organiztions, i.e., the AAP, Public Health Association, HHS, etc., should be giving equal time to breastfeeding promotion with the same verocity as the formula companies!

470 Concerned Citizen
Researcher
Worksite Lactation Support, Onsite Child Care, and Milk Expression If we had more on site quality day care, this would also encourage mothers to keep breast feeding their child not just for 6 months but longer, as their child would be with them at work. We also need better lactation support t work as wel.. the current laws allow for only 15 minute break, which is hardly enough time to pump. The break times for mothers without on site day care needs to be longer as does the time women would have to breast feed their kids at work.

471 Lactation Professional
Access to Lactation Care and Support Too often you get what you pay for - and in the case of Professional Lactation Support - that is nothing. If you can't afford the cost of a L/C mothers struggle or give up. How can we say that human milk is a health goal and not pay for the experts to help mothers/babies having problems. Not every mother needs professional consultation. but every mother deserves access to support, information, education and encouragment. Then when things are not going well - payment for professional services. I understand - what provider (physician, NP, PA) is going to give up their piece of the shrinking reimbursement to share with L/C but it is time to discuss the issue in earnest.

472 Concerned Citizen
Access to Lactation Care and Support Get lactation consultants out in public, close to where women live. Set up weekly clinics at grocery stores, not doctors offices or hospitals. You need to meet women in places that are convenient for them and are in their comfort zone.

473 Health Care Provider
Health Professional Education, Publications, and Conferences Mandate increases in education to healthcare providers, especially physicians.

474 Concerned Citizen
Other Areas: Breastfeeding mother
Support for Breastfeeding in Public Settings I breastfeed my son in public restrooms because of the stigma associated with breastfeeding in public. I am too modest to openly breastfeed. I wish there were public 'mother's rooms' where breastfeeding women could go to nurse their infants. They wouldn't have to be elaborate, just a quiet, dimly lit room with some decent chairs. I just hate balancing one foot on a toilet in a tiny stall so I can support my baby while he nurses. Some places are filthy and disgusting.

475 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Realize that most people in this country are employed by small companies who have limited resources. Come up with ways were small companies can band together to provide these services -- i.e., all the residents of an office building.

476 Community Organizer
Concerned Citizen
Health Care Provider
Nonprofit Organization
Paid Maternity Leave I think that all the better-informed health care professionals, public service announcements, and community support will only go so far to increase breastfeeding rates. Until there is paid maternity leave and better government regulation to protect a nursing mothers' right to pump, breastfeeding rates will continue to stagnate while mothers have to work outside the home to support their families. If our government truly supports breastfeeding for at least a year and the preventive health benefits that arise from a child receiving breastmilk, then it needs to support a comprehensive paid maternity leave. The countries around the world with the highest and longest breastfeeding rates are those that enact policy to protect the right to breastfeed and offer paid maternity leave.

477 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Quit making women feel like they need to be super mom. Realize that mothers are human and we need to look after their needs as well as the babies. Find ways to help women balance their needs while also providing for their children. Don't make them feel like failures if the need to supplement.

478 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Encourage insurance companies to pay for nurse/doula/lactation consultant to visit mom and baby one to two days after leaving the hospital.

479 Concerned Citizen
Paid Maternity Leave It is extremely difficult, emotionally and physically, for a mother to leave a new baby and return to work. In so many cases, there is no choice. Breastfeeding is almost certainly interrupted when this happens. Pumping at work presents so many challenges, from finding a private place to pump, to having enough breaks in the day to do so, to maintaining your milk supply. I returned to work when my son was 3 months old, and it was the most difficult thing I had to do. I was fortunate to have a supportive workplace, but even so I had to make some difficult arrangements involving a coworker giving me her office (in exchange for my cubicle). I had been told by the building manager I could no longer lock the bathroom door and pump there. Others are not so fortunate, and give up on breastfeeding because it becomes so difficult. Teachers (my sister included) have very difficult times finding break times to pump milk.

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.

480 Community Organizer
Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals should not even offer formula. If a mom asks, they can get it, but they should be waaaay more pro breastfeeding. I have only had homebirths, but many moms that I work with (I am a wic breastfeeding peer counselor)- tell me that the hospital did not help at all with breastfeeding. Also, people need to be informed just how important breastfeeding is, it isn't just breast or formula. its a life long decision, and they need to know its not just like colby cheese or monterry jack cheese. this is a SERIOUS decision!

481 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I've never had a baby in a US hospital (thank god) but from what I have heard the situation is absolutely terrible in many, many ways, but especially in terms of establishing breastfeeding.

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.

482 Concerned Citizen
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I have worked in postpartum settings, and also have worked in community health with both prenatal and postnatal clients plus I have many children and have breastfed them all. I was recently able to be at the birth of one of my grandchildren and it was my daughter's first child. Because of my experiences both professionally and personally, I was able to greatly enhance her beginning breastfeeding with her baby. Seeing how much better it was for her to have someone to show her and work with her through each feeding (at least through the day!), I really think most new mothers (to breastfeeding, at least) would be able to have success more often than the little bit they receive in hospital and from community health. This is not to say that nurses or other lactation professionals are not doing their best; rather, it is just not possible to give such one-on-one help to each mother. But, I do think this would make breastfeeding be the experience we all want for these moms.

483 Concerned Citizen
Nonprofit Organization
Worksite Lactation Support, Onsite Child Care, and Milk Expression A supportive workplace, where managers and coworkers understand the importance of breastfeeding and make space for milk expression, is so critical to working mothers to continue breastfeeding. I returned to work after 3 months of maternity leave, and there was not a set place where I could express milk. After being told I could no longer lock the bathroom door to express milk privately, I managed to get a female co-worker to give me her office so I could have some privacy. It is tramautizing and embarrassing to have to figure all of this out with managers who do not value or understand why it is important. I have talked to women who have designated milk expression rooms in their workplaces, and it increases morale and makes continued breastfeeding so much easier.

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.

484 Lactation Professional
Other Areas I would like to see school nurses or guest speakers such as RN's or lactation consultants go into high schools and start educating young women and men alike on the benefits of breast feeding vs bottle feeding. I think many would decide before they even get pregnant that breast is best! Also, we hand out free formula for WIC. Is there incentive to breastfeed for those who are struggling financially? How about giving them breast pumps instead of formula. It's actually much more cost effective than formula for even a few months.

485 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Public Health Worker
State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care We need to reduce the number of c-secttions, inductions and epidurals because of the negative impact they have on mother baby togetherness and breastfeeding. All maternity hospitals should be baby friendly. Follow up breastfeeding care in the pediatricians office by a lactation consultant should be standard.

486 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care All mothers choosing to breastfeed should be given all necessary materials prior to leaving the hospital or prior to a homebirth, taking into account each individual circumstance and depending upon the mothers level of prior breastfeeding experience. These supplies should be considered as necessary take home supplies, just as a sitz bath is considered a necessary take home supply. These supplies should be covered by insurance, included in the bill for self-pay patients or given to those that fall below a certain income. These services should include continuous support while in the hospital, apporved book(s), 24 hour breastfeeding support hotline, phone numbers and locations of local LLL meetings, membership to local breastfeeding organization, breastpump rentals, help with use of breastpump and home care visits to mothers that are tempted to stop breastfeeding because of pain, complications or a lack of understanding/knowledge.

487 Concerned Citizen
Health Care Provider
Worksite Lactation Support, Onsite Child Care, and Milk Expression Employers should be educated that breastfeeding is the NORM and plan accordingly. It should be viewed as a common mainstream event of society.

488 Concerned Citizen
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals should insist on rooming-in and have lactation support available 24 hours to address all women. Staff nurses should be properly educated about lactation support and special needs.

489 Concerned Citizen
Health Care Provider
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Breastfeeding should be portrayed as the common, everyday event that it is. Let it return to being a comfortable cultural norm.

490 Concerned Citizen
Access to Lactation Care and Support These services should be coverd by insurance, self-pay patience should pay based on a sliding-fee scale and these services should be offered freely to all by the Health Department.

491 Concerned Citizen
Access to Lactation Care and Support I gave birth at Niagara Falls Memorial Hospital and was unprepared for the need for coaching to help me successfully breastfeed my baby. She had an inverted suck and luckily for me there was a lactation specialist, Linda Grace, who not only visited me in the hospital, called that night to see if I was ok, and when I wasn't, returned to the hospital at 10:00 at night to help me, she then followed up with me after I went home. For any program that supports breastfeeding, I applaud. Breastfeeding my daughter has been such a rich experience and I wouldn't trade it for anything. Had I not had such phenomenal support, that relationship might have perished as I have heard of many women abandoning breastfeeding for not knowing how to succeed. I count myself blessed.

492 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Public Health Worker
Access to Lactation Care and Support The standard of care should be for obstetricians and pediatricians to be able to write an order for lactation consultant services prenatally and postnatally for all lactation care as the first response to lactation needs. lactation care providers should be avalable in pediatricians and obstetricians offices. Breastfeeding classes should be available during prenatal care.

493 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression All employers should be required by law to provide a clean, safe, comfortable place for breastfeedig mothers to pump. An employed breastfeeding mother should never have to use a restroom where it is all to easy to contaminate the milk with filthy waste and germs.

494 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Use of Banked Human Milk banked human milk should be available in all special care nurseries for use by premature babies whose mothers are unable to provide mothers own milk.

495 Researcher
Research and Surveillance I am a Professor at the University of Nebraska- Kearney and have published numerous scientific articles relating to the benefits of breastfeeding and the lack of physician knowledge in the area of human lactation. I am most interested in working with you in order to increase breastfeeding initiation and duration rates across diverse populations. Please let me know how I can be of service. Thank you for your time- Dr. Jeanne M. Stolzer

496 Concerned Citizen
Lactation Professional
Nonprofit Organization
Worksite Lactation Support, Onsite Child Care, and Milk Expression There needs to be support (laws?) that protect women at work - ensure that they have the time to pump milk for baby and/or a site to feed infants at work. So many mothers are planning their

497 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Yes, yes, yes! This is a great way to tame those who are so offended by a breast and a nipple that is feeding a baby!!

498 Concerned Citizen
Researcher
State or Local Government
Paid Maternity Leave When pregnant women begin a breastfeeding discussion, there is a huge disparity in response related to the support that woman will have following the birth of her child. I work with low income women. As a group, these women are less likely to initiate breastfeeding and half as likely to continue breastfeeding for 6 months because they will be returning to work shortly (often within two weeks of giving birth) and have zero support to help breastfeeding happen. Paid maternity leave would allow mothers to breastfeed and provide the optimal nutrition and nurturing babies need. Why is the US so backward on this????

499 Concerned Citizen
Nonprofit Organization
Access to Lactation Care and Support I believe breastfeeding rates and breastfeeding success would skyrocket if women's insurance policies covered one home visit or outpatient visit with a lactation professional (IBCLC) after mother and baby are home from the hospital. The costs for covering one postnatal consultation would easily be justified by much lower costs for breastfed infant health care. Although more and more hospitals have lactation consultants on staff for mothers immediately after birth, so many breastfeeding problems do not occur until after the mother-baby pair is alone at home, lacking good information and support.

500 Other Areas: Doula
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospital - the good news is that breastfeeding is recognized as important by RNs. The sometimes bad news is that some RNs now rush the baby to the breast and force it on before the baby has shown readiness to breast feed. Also, mothers report to me that within 24 hours some RNs have mothers using breast pumps instead of the baby to help bring the milk in. They also get mothers into the mindset of feeding baby every three hours. Finally, RNs and Pediatricians get the parents focused on baby's weight and especially the dreaded 10% weight loss as a signal that baby needs formula supplementation without regard for the baby's condition, accuracy of the scale and/or the fact that mother (and baby) has received IV fluids that women (and baby) take on in their tissues and that take time to release (so the baby's weight is artificially higher than it would have been otherwise).

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.

501 Concerned Citizen
Other Areas: mom
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Lactation professionals should be available to mothers imediatly after birth to assist with breastfeeding. I had to wait to feed my son and he was so hungry and upset I was unable to breastfeed him and had to give formula for the first feeding. I did get help later and he is a happy breastfeeder at 2.5 yrs.

502 Concerned Citizen
Nonprofit Organization
Paid Maternity Leave Any improvement in paid maternity leave would help breastfeeding rates and success. The United States needs to look at others countries (Western Europe, Australia, Canada, and Scandinavia in particular) to see how their excellent breaastfeeding rates are supported by their national policies.

503 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Public Health Worker
Research and Surveillance The research is too often interfered with or influenced by the formula companies. Research needs to be totally unbiased and not supported by any organization that is merely a front for a formula or drug company. The co-sleeping issue needs some totally unbiased research. I would like to see unbiased research on human milk fortifiers and I would like to see more research on lactoengineering so that no premature baby would get any formula or fortifier so that the horrendous monetary and painful consequences of necrotizing enterocolitis would disappear!!!!!

504 Concerned Citizen
Other Areas: mom
Access to Lactation Care and Support There should be free support after mom's leave the hospital or they should be told about La Leche League. Sometime everything is OK in the hospital while the lactation consultant is there, but you have problems when you go home and don't know where to turn. Most new mom's can't afford hundreds of dollars an hour to hire a private consultant. Health Insurance plans should cover this, because if more babies were breastfead it would save them money down the road.

505 Lactation Professional
Use of Banked Human Milk A Human Milk Bank is essential. Every state should have one. It has been proven that when babies who are born prematurely and supplied with Human Milk the outcome is better. Each stateshould have their own. It would save millions of dollars. The Human Milk Bank should be a non profit and established outside of a hospital to avoid the politics of being part of a hospital.

506 Concerned Citizen
Other Areas: mom
Worksite Lactation Support, Onsite Child Care, and Milk Expression One reason I waited to have my son is that I was comitted to breastfeeding & felt it would not work if I was a working mom. Maybe if mom's knew ahead of time that they would have support they would try.

507 Concerned Citizen
Nonprofit Organization
Health Professional Education, Publications, and Conferences Doctors desperately need good lactation education in medical school. Hospitals and/or nursing schools need to train all nurses. Women receive so much erroneous, unhelpful breastfeeding information from HCPs.

508 Concerned Citizen
Other Areas: mom
Paid Maternity Leave This is a no brainer, it would be a huge help for breastfeeding & just bonding in general.

509 Other Areas: Doula
Health Professional Education, Publications, and Conferences Many mothers report to me that during their hospital stay each new RN at shift change tells them different things about what is the correct way to breastfeed. Having RNs and other health professionals (Peds) have consistent eductation and training in terms of how to present the info to families would be extremely helpful in breastfeeding success.

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.

510 Concerned Citizen
Other Areas: mom
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Breastfeeding needs to be portrayed in a positive light in mainstream media, not just parenting magazines. If people saw it more it wouldn't be such a shock to those unfamiliar. Maybe if non parents understood the value they would not upose it in public.

511 Concerned Citizen
Nonprofit Organization
Peer Support and Education of Family Members and Friends Breastfeeding is a win-win opportunity for most. We know it is best for both Mom and Baby's health. It is an opportunity for bonding. Easy, convenient and affordable. I breasfed my babies, and encourage other Moms to do the same. I do hope Moms are discreet in public if they nurse, so others won't even notice, thus no negative comments or issues.

512 Other Areas: Doula
Paid Maternity Leave The lack of support for sufficient maternity/paternity leave for new families is a terrible thing in the US. We need to look at other industrialized countries (all the information is available) to see what works and apply it in the US. Families are under tremendous financial pressure to get the mother back to work within 3 months or less at a time that mother and baby should be able to spend uninterrupted time together. If we are truly committed to children's health, we will make maternity leave reasonable and available to all women after their children's births.

513 Concerned Citizen
Other Areas: mom
Support for Breastfeeding in Public Settings Large stores & shopping centers should have a comfortable place to feed/comfort a baby weather you breastfeed or not.

514 Concerned Citizen
Other Areas: mom
Peer Support and Education of Family Members and Friends I think if there was more public awareness this wouldn't be a problem. I shouldn't have to explain to my grandma why I'm still breastfeeding my son at 2.5 yrs old. Maybe if she read about it in print media & saw it on TV or in the news more she would be more accepting. Sometime people are more receptive to information from the outside.

515 Concerned Citizen
Other Areas: mom
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) This is very important, but it should start with the OB's when you are pregnant. If more OB's spent a few minutes telling their patients about the benefits of breastfeeding & gave them information on how to get help later and where to take a class pre-birth it would make a big difference. I attended 2 or 3 La Leche League meetings while pregnant & our childbirth class had a 3 hour class on the subject. I know a lot of mom's who's OB told them it wasn't a big deal & breastfeeding didn't make that much of a difference.

516 Concerned Citizen
Other Areas: mom
Research and Surveillance More research would definitly help especially if it was publicised.

517 Breastfeeding Coalition Representative
Health Care Provider
Health Professional Organization
Lactation Professional
Use of Banked Human Milk As a pediatric dietitian for over 30 years, I encourage all mothers to provide their babies with optimal nutrition...breastmilk. Breastfeeding according to the AAP's recommendations is the gold standard, but when a baby is sick or hospitalized, this is not always possible. I have assisted many breastfeeding mothers when their infants/children were admitted to the hospital and worked with them so even if the baby couldn't actually nurse at the breast, the baby was assured of receiving mother's milk as the source of nutrition. Many mothers find it difficult to maintain their milk supply and are unable to provide enough milk for 100% of their child's feedings. Other mothers, for whatever reason, do not provide ANY breastmilk for their babies. I have seen a marked difference in the overall progress of babies who do receive human milk for their feedings in the hospital. Donor human milk is an option that is recommended by professional organizations when baby's own mother's milk is not available, but it is rarely ever used in clinical settings. More needs to be done to educate healthcare professionals in the use of donor milk, especially neonatologists, pediatricians, and pediatric dietitians. Academic curriculums should incorporate information on HMBANA and how donor milk can and should be used. Currently, there is a huge gap in knowledge in this area for these professionals. The establishment of more regulated milk banks should be encouraged in this country to make donor human milk accessible and easily utilized.

519 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care In my experience through three pregancies and hospital deliveries, the vast majority of medical professionals who are not International Board Certified Lactation Consultants have consistently given me poor and in some cases, damaging advice about breastfeeding. They seemed unaware of some of the basic facts about lactation, unaware of some of the normal occurrences & variances that can take place, and unaware of current research concerning effective breastfeeding management.

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

520 Concerned Citizen
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe that it all starts at the OB/GYN prenatal visit. When women see and are given bags of formula, the assumption is to formula feed. The first form of feeding should be breastfeeding and Dr's should provide support if a woman can't breastfeed. That is where it should all begin.

521 Breastfeeding Coalition Representative
Health Care Provider
Health Professional Organization
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I see many women who plan to breastfeed, but the medical model used in maternity hospitals practically sabatoges successful breastfeeding before it even starts. The use of long duration epidurals, and extensive drugs for c-sections cause sluggish moms and babies for many days after delivery---the crucial time that breastfeeding is established. Mothers are exhausted, in pain, and find it hard to get their infants latched well to the breast for initiating breastfeeding. After a few days of misery, they end their effort to breastfeed because

522 Concerned Citizen
Other Areas: mom
Other Areas More Education & support & being more Proactive. Mom's need to be educated & have all the information before they give birth & the support after to be successfull. I had a hard time with my son & if I hadn't been determined to breastfeed I would have given up like a lot of mom's I know. My son is a very happy breastfead baby and at 2.5 yrs old it doesn't look like he will be giving it up anytime soon. It's the only thing that sooths him when he's sick, teething or upset, I don't have to worry about him getting dehydrated when he's ill. When he's not feeling well & doesn't eat much I know he's getting his nurishment. He's rarely ever sick & is very healthy. It's so important and it makes me sad that so many mom's quit because of lack of information or lack of support especially from medical professionals, family members or husbands. At the first sign of any problem many Doctors are too quick to switch to formula and abandon breasfeeding & for everyone I know it only made the problem worse.

523 Health Care Provider
Health Professional Organization
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As a breastfeeding mother of a one year old, I would like to comment on how I had to fight all sorts of obstacles from the health care industry to get to this point. They say that they support breastfeeding, but I find them highly uneducated. In the beginning, I had a lactation consultant that was clueless and overworked in the hospital, nursing staff that encouraged me to use formula for supplementation, and a OB that didn't understand nipple confusion and thought I was a

524 Concerned Citizen
Support for Breastfeeding in Public Settings Breastfeeding in public should not even be an issue. Any one who is offended at the sight of a breast that is nurturing a baby/child needs psychological therapy. We as a society have let this go on far to long. It is outrageous that breastfeeding mothers can be thrown out of resturants and public places for breast exposure!! A mother should have the right by law to do whatever she has to do for a pain-free nursing experience, and a child should not be forced to cover their head to eat their meal; even if this means complete breast exposure. How talented are we expected to be and how many arms/hands do people think we have? With one hand/arm carressing and positioning baby/child and one hand positioning breast for correct latch-on for pain-free nursing there are no hands left to fidget with clothing or blankets all while needing to be able to see. Are we to be expected to put a cover over our heads and our bodies to save some immature person the embarrasment of blushing when they see a breast? No, a woman should be free to nurse her child when ever, how ever and where ever she sees fit. And people who have a problem with that should be expected to get over it or seek psychological therapy for help getting over it. And any person, people, business or organization who makes a woman feel uncomfortable in any way because of breastfeeding should be charged with harrassment and should be faced with fines, or for multiple offences, imprisionment.

525 Breastfeeding Coalition Representative
Health Care Provider
Health Professional Organization
Lactation Professional
Other Areas: Pediatric Dietitian
Access to Lactation Care and Support The U.S. is close to reaching the initiation goal for breastfeeding; however, reaching the goal for 3, 6, and 12 months is nowhere near the goal. I feel this is because the mother loses touch with the LC at the birth hospital, and may be asking her pediatrician for lactation assistance. Unless the pediatrician has obtained specialized education in the management of breastfeeding, or employs someone who does, mothers are likely to get wrong or no advice except to formula feed. No wonder we are not reaching our long term breastfeeding goals! The promotion of lactation consultants, and reimbursement for their services must be encouraged and promoted so that more women can be assisted and breastfeeding goals can be met. If every pediatrician utilized an IBCLC (or even employed one!), breastfeeding could be preserved in many of the mothers who decide to stop breastfeeding.

526 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Breastfeeding education should start while a woman is still pregnant. In general, there is a lack of information for women and their partners about breastfeeding unless the woman seeks it out on her own. Breastfeeding benefits the baby and the mother in numerous ways that women should know about before they give birth. Without support, it is hard for a mother to continue breastfeeding through any problems or difficult circumstances she might encounter.

527 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Consider JAACHO criteria with BF rates, BF initiation and BF support post partum as part of every delivery hospitals' evaluation for renewal with them.

528 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The Southeastern US is documented as having some of the lowest rates for continued breastfeeding. Factors that we see contribute to this problem are advertising through the OB offices where mothers's names are given to formula companies, limited support by OB offices prenatally in encouraging breastfeeding for at least 6mons., weak labor and delivery practices about early and sustained contact between mother and baby skin to skin (documented as of high importance to extended breastfeeding), and no insurance coverage for lactation consultants who can help after the mother leaves the hospital. Thank you for this opportunity. We wish you the best in seeing these types of things through. Greensboro Childrens' Doctor, Greensboro, North Carolina

529 Health Care Provider
Health Professional Education, Publications, and Conferences All physicians who care for women or children should be trained re lactation. In my formal medical training I recieved little to information re breastfeeding or how to help women be successful. Physicians should also be trained on hospital and practice barriers that make it difficult for women to successfully breastfeed.

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

530 Health Care Provider
Worksite Lactation Support, Onsite Child Care, and Milk Expression Working with active duty AF women who would like to breastfeed but do not have enough support, i.e., not encouraged to pump, given a private place to pump. Most young women are having babies, they do not have a lot of money to spend on a good ($250-350) breast pump. Having 2-4 pumping stations around base (number depending on size of base and population breastfeeding) with a professional breast pump available. There is no consistency among supervisors on how breastfeeding mothers are treated. Very frustrating.

532 Lactation Professional
Access to Lactation Care and Support Lactation servies should be reimbersed from insurance companies, and a required service for insurances covering maternity care.

533 Lactation Professional
Health Professional Education, Publications, and Conferences All physcians providing care to women of child bearing ages should be required to take a course in lactation.

535 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I teach nutrition education and cooking & shopping skills to limited resource families. Virtually none of my clients have breastfed. A recent client told me she had wanted to breastfeed, but after her C-section they gave her morphine and then she could not breastfeed her baby(her fourth child). Ideally, someone should have provided her a breastpump and taught her to use it to discard her milk while on morphine so that she could then breastfeed her son after she was done with the morphine. Alternatively, other pain medication could have been provided that would not have affected her milk.

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.

536 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care First neither medical center in our town have professional breast pumps for rent, no supplementing equipment to purchase, or a dedicated lactation consultant. The one facility that has a lactation consultant does not use her for 100% breastfeeding assistance; she is given other duties to preform. Plus she is not the most enthusiastic LC I have encountered. Neither hospital has a policy of encouraging and assisting breastfeeding mothers. There is no offer of follow-up assistance for breastfeeding. Healthy Start nurses try to assist, but they see a small percentage of the ladies delivering and trying to breastfeed. I've been told it comes down to money at the hospital...and assisting breastfeeding mothers is not a priority.

537 Concerned Citizen
Support for Breastfeeding in Public Settings as a mother, i TRY to bf in public so that it becomes something we are accustomed to seeing. it is normal and natural and should become part of our natural habitat. why can we see someone half naked, strung out, wearing tattoos all over their body, smoking a cigarette, and walking down the street and think this is ok, but we see a mom feeding her baby and go crazy????

538 Community Organizer
Concerned Citizen
Lactation Professional
Access to Lactation Care and Support Follow up lactation consults should be covered by insurance and included as part of the overall postpartum care to be expected by parents, just as you would go see your OB/GYN for a follow up visit after you have a baby.

539 Concerned Citizen
Peer Support and Education of Family Members and Friends i think my mother didn't really want me to bf bc she hadn't. she felt that if i did, it was a comment on how she had parented. i didn't care as i have a healthy separation from her, but for some who may have a lot of issues this could be bad.

540 Lactation Professional
Nonprofit Organization
Public Health Worker
Researcher
Research and Surveillance I would like to introduce myself as German IBCLC, LLL leader and doctoral student of public health with a dissertation on breastfeeding.

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,

541 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Our hospital (St. Rose De Lima) in Henderson, Nevada, was great in offering lactation consultants after birth. Even though they were available, I didn't feel they gave enough time, and being a new mom, I wasn't sure how much time I could have. I would've liked more time with them, at least an hour a day.

542 Concerned Citizen
Lactation Professional
Other Areas: postpartum doula, early childhood specialist
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I am in full support of the activity of breastfeeding, and of nurturing the mother-infant relationship that begins with breastfeeding (or absence thereof). And in support of the baby having only breastmilk in its stomach for at least 6 months.

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

543 Concerned Citizen
Lactation Professional
Other Areas: postpartum doula, early childhood specialist
Access to Lactation Care and Support I am in full support of the activity of breastfeeding, and of nurturing the mother-infant relationship that begins with breastfeeding (or absence thereof). And in support of the baby having only breastmilk in its stomach for at least 6 months.

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

544 Concerned Citizen
Research and Surveillance To better help the public, I think it would be useful to study women who tried to breastfeed, but felt that they failed or gave up too soon. Ask them what they think contributed to their problems and what could have helped them.

545 Breastfeeding Coalition Representative
Health Care Provider
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The three phases of maternal-newborn care need immediate attention if we expect to improve BF rates. Physicians and their office staff do very little to promote BF. The usual practice is to ask,

546 Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Eliminate free formula bags in hospitals at discharge.

547 Concerned Citizen
Paid Maternity Leave I have a lot of friends that live in Canada or Europe and comparatively speaking, we have no maternity paid time. They get a year off! That's how it should be!

548 Concerned Citizen
Support for Breastfeeding in Public Settings At public malls and parks, there should be nursing rooms with a chair and stool where we can privately nurse.

549 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Be honest an upfront about how hard breastfeeding is. Most women feel it should be completely natural, when in truth both the mother and the baby need to learn how to nurse. Be honest that it can be quite painful and exhausting. But also let mothers-to-be and new mothers know that if you are able to stick with it, nursing usually becomes an enjoyable time with your baby.

550 Health Care Provider
Health Professional Organization
Access to Lactation Care and Support So many of my moms can not pay to have an LC do a home visit. This should be covered by all insurances, as a routine visit after mom and baby returns home from the hospital. All OB should be telling moms to get educated about breastfeeding while pregnant, so they know what to expect when the baby comes!!! Also need to educate moms about the side effects of formula.

551 Breastfeeding Coalition Representative
Health Care Provider
Other Areas: state perinatal director
Worksite Lactation Support, Onsite Child Care, and Milk Expression Providing support for working-mothers must be addressed to improve BF rates, expecially exclusive BF for the first 6 months. Longer, paid maternity leave will remove most barriers, along with support for milk expression at work. Onsite childcare may be the ideal remedy but an idea to begin supporting.

552 Concerned Citizen
Other Areas As a nursing mother of a 7 month old, I find it fairly comfortable nursing in public and at home. There are times that I wish I had some privacy, but overall I feel that no matter what others say, I think its important to nurse my baby and nothing can stop me. I just don't feel that others are like that. I have several friends that had a baby at the same time as me and I'm the only one nursing. I wish I had a little more support. But in the end, the baby is all that matters.

553 Other Areas: Health Insurance Company
Other Areas Health Insurance companies should encourage breastfeeding – not just to employees, but to all of the covered lives that they insure. The trend is shifting towards Health & Wellness promotions. We send mailings and brochures to covered members encouraging them to get their annual screenings (breast, cervical, colorectal, etc). Any breastfeeding handouts are included in maternity mailings, but they are very generic and in my opinion, don’t really stress that “Breast is best”. Also, check out NCQA.org and HEDIS. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. For example, HEDIS rates will tell a plan how well their female members are doing in regard to receiving mammograms and pap tests. If rates are poor, Quality Improvement initiatives can be put in place to increase compliance. The same thing could be developed for breastfeeding rates with incentives to increase those rates.

554 Breastfeeding Coalition Representative
Health Care Provider
Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media BF needs to be portrayed as the norm. Perceptiions that female breasts are for sexual poeasure only must be corrected. Not being able to share a picture of a happy BF mother-baby dyad on a public website is intolerable.

555 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Many- perhaps most- hospitals are not breastfeeding friendly. I suggest that hospitals be required to report out their breastfeeding vs. formula feeding numbers. These numbers should be publicly posted to provide an incentive for L&D nurses, OB Gyns, and other HCPs to really change their approaches to newborn care.

556 Concerned Citizen
Other Areas Most women in the US are woefully uneducated about breastfeeding. I find that many new moms know nothing about engorgement (they think that when engorgement ends, their supply has disappeared) or growth spurts (again, when baby starts cluster feeding, they think they have no milk.)

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?

557 Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The routine use of medical interventions and medical pain relief has a profound effect on newborn's readiness to feed at birth. The breastfeeding community needs to get active promoting normal, un-medicated, un-induced, un-augmented birth. The C-section rate is now over 30%, and many mothers are delivered of their babies before the baby is ready. These practices are interfering with breastfeeding. We have done a great job in getting lactation professionals into the hospital to help mothers breastfeed soon after birth. Now we have to listen to what these professionals are saying about the impact of routine interventions during labor and birth on the initiation of breastfeeding. We have great answers to these problems. Doulas attending births help reduce the need for medical interventions and help mothers start breastfeeding right away. In addition, home births with Certified Professional Midwives has been shown to be safe and to reduce the use of medical interventions and to improve breastfeeding success. It's time to use evidence based practice in labor and delivery, just as Lactation Consultants have been doing for breastfeeding.

558 Lactation Professional
Public Health Worker
Paid Maternity Leave Staying home with a newborn baby is worth money. It's time we showed mother's that they are important as primary care givers for their babies by paying them for their time. Sending mothers back into the work force just to get them to work gives the message that it is more important to work at a minimum wage job flipping burgers than to nurture and breastfeed a newborn. This devalues both mothers and their children. We say our country is family centered and value based, but we value low wage jobs that any person can do over the personal devotion of a parent to their own newborn child.

559 Concerned Citizen
Other Areas: nursing mom
Support for Breastfeeding in Public Settings The right to breastfeed should be legally protected in all 50 states. Additionally that right should be protected by civil penalties against individuals/companies that would impugn it similar to other civil rights legislation.

560 Lactation Professional
Other Areas I believe that it would be prudent to change the Women, Infant's and Children food program to the jurisdiction of the Department of Health Services rather than the Department of Agriculture. The latter agency supports formula distribution - this was one of the initial reasons that the WIC program was started, was to support the distribution of formula. Now that the benefits of breastfeeding has been researched over the many years since the inception of WIC, it's time to step up and provide the education and money needed to promote better health through breastfeeding.

561 Concerned Citizen
Other Areas: nursing mom
Access to Lactation Care and Support With the president's promises for improvements in health care we should be moving towards a more care based, less profit driven model. With this in mind, more hospitals should provide breastfeeding classes and support groups as part of their public education opportunities.

562 Concerned Citizen
Other Areas: Nursing Mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care In my dream world:

- 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.

563 Concerned Citizen
Other Areas: nursing mother
Worksite Lactation Support, Onsite Child Care, and Milk Expression Low income women need access to breast pumps because many must re-enter the workplace early and cannot afford expensive pumps ($300 or more for quality ones.)

564 Concerned Citizen
Other Areas: nursing mother of 2
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) I find it appalling that if a mother does not want her child to be given cow's milk while enrolled in a federally subsidized program, she must obtain a doctor's letter or the child will be given cow's milk. Even if a mother brings her own pumped milk, the child must have a doctor's waiver. That seems to me to be an unneccessary governmental intrusion into the parent/child relationship and makes women who nurse their children into the toddler years (as supported by the WHO) seem odd and unusual.

565 Concerned Citizen
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Postpartum nurses need to be trained yearly on breastfeeding. AT the hospital I gave birth to my son, the lactation nurses were not there every day all day. I had to wait until day 2 of my stay to see one. All the nurses should be educated enough that they can help more. It would also be helpful to have a nurse come to your house and check that you are breastfeeding correctly.

566 Concerned Citizen
Health Care Provider
Worksite Lactation Support, Onsite Child Care, and Milk Expression As a person who breastfed for 16 months and worked full-time the entire time, I know the difficulty in finding a place to pump and the time. It needs to be made a law that employers give you time to pump. I am a pharmacist, so I was able to basically tell my employer I would be pumping, but there are a lot of mom's who do not get to do this because they don't have a good job with a degree to back it up. Breastfeeding decreases the time off a mom needs because it is better for mom and baby, and employers need to be made aware of this. All mothers should be allowed to breastfeed and work full-time if needed. Unless it is made a law that mom's be allowed to pump without negative effects, then only mom's who are in professional level jobs and stay at home mom's will be able to do this. The country is so unhealthy, and we need to increase breastfeeding rates.

567 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Nonprofit Organization
State or Local Government
Other Areas: WIC
Peer Support and Education of Family Members and Friends Peer COunselors are a valuable resource for the WIC program. The program should be expanded, some full time jobs should be available and peer counselor access should be made a core service of WIC in every area where the WIC program exists. The expected increase in breastfeeding rated would decrease costs of formula and health care costs for the taxpayer.

568 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Nonprofit Organization
Paid Maternity Leave Remove maternity leave as a disability and call it maternity leave again. 6 weeks is an unrealistic amount of time for mothers and babies to establish lactation and prepare for separations. The unrealistic deadline to get back to a job or school interrupts the normal pattern of establishing lactation and the mother baby bond. This often results in a belief that a mother might as well not try, beginning introducing other feeding methods and products, and increasing weaning behaviors. There needs to be an honest understanding of the unrushed TIME it takes complete the the pregnancy/birth/breastfeeding cycle...even under normal circumstances. Add an unexpected difficulty and TIME needs protected to establish good health practices in infant feeding. Take some dollars from the HUGE drive for an increase in infant child care and provide a stipend to mothers. There is a driving concern that there are not enough infant slots for child care. Well, there is a mother for every infant. Place the dollars closer to persons in the situation provide support for mother/baby pairs in these early months - 3 minimum - 6 or more ideal. Then the workforce lactation rooms and breaks will take much less perceived time away from the workplace.

569 Concerned Citizen
Health Care Provider
Paid Maternity Leave I think that most people only take the 6 or 8 weeks because that is all they are paid by their employer. Some women are forced to go back earlier than this. For a good breastfeeding relationship, mom's need at least 12 weeks off with their babies. Breastfeeding your child should be considered a reason to continue short term disability/paid maternity leave. You should be able to get paid for the 6 weeks for the mother and the other 6 weeks for the baby. I don't think you should necessarily be paid your full income, but there is no reason not to pay them for the full 12 weeks. I was able to take 12 weeks off because I have a significant income that allowed me to save plenty while pregnant. Lots of women cannot do this. All women should be able to take 12 weeks off if they are breastfeeding full-time.

570 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Nonprofit Organization
Public Health Worker
State or Local Government
Access to Lactation Care and Support Reimbursement of lactation consultant service by Medicaid and private insurance would improve access to lactation support and would reduce health care costs for the taxpayer.

571 Concerned Citizen
Support for Breastfeeding in Public Settings Breastfeeding anywhere a woman has the right to be should be made a federal statute. I believe my State of Florida allows a woman to nurse her child anywhere she is otherwise legally permitted to be, but it should be this way in all 50 states.

572 Concerned Citizen
Paid Maternity Leave I took 12 weeks of unpaid leave to be with my baby when she was born in 2007, this was unbelievably difficult for my family because I was the one who made the most money. To this day we pay for my daughters birth through medical bills, and I continue to pay off credit card debt incured during that time. If paid leave was available, I would have been able to support my family a little while longer and our quality of life would have been better. For my daughter's sake I hope she choses to have her children in Europe where women are allowed to take care of their children for at least their first year w/out having to pay an obscene amount for that.

573 Concerned Citizen
Access to Lactation Care and Support Insurance should pay for a breat pump for women who request it. More hospital staff should be made aware of certain procedure to encourage lactation to establish breastfeeding before a woman leaves the hospital.

574 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The USA needs to become more serious about adopting the WHO Code as practice. The Baby-Friendly Hospital initiative needs to be standard of care. Research must be shared about the negative effects of infant formula, and the FDA lack of supervision of additions to formula. The FDA has been well paid by the formula industry to overlook the melamine, rocket fuel, and other contaminants in infant formula, saying that a little is okay. A little is not okay. These are our youngest citizens. There should be some stricter guidelines on WIC handing out this formula. Mothers should be given formula only if they cannot breastfeed for a physical reason or if they are working and not allowed to pump at work. Babies need their mother's milk. Hospitals should not be allowed to give out formula packets or to accept free formula.

575 Concerned Citizen
Use of Banked Human Milk I am a nursing mom and I would love to donate milk but I am not allowed because I lived in England during the 80s. This is ridiculous rule, and it should be changed. I don't have mad cow disease.

577 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Public Health Worker
State or Local Government
Health Professional Education, Publications, and Conferences Agencies that provide health care should make liberal use of video teleconferencing and other modern technological opportunities to increase training to health care professionals who interract with the perinatal population. Since our culture does not SEE breastfeeding much, more opportunities to show how correct breastfeeding positioning is achieved should be explored.

578 Lactation Professional
Health Professional Education, Publications, and Conferences Lactation information should be a required part of all medical education- in medical school, chiropractic school, nursing school, and in all programs training dietitians. As a lactation professional, I understood ignorance 25 years ago but there is NO excuse for ignorance today. There are too many pediatricians that have no knowledge about breastfeeding, do not want to help mothers when problems arise, and feel that formula is just as good. That is just plain wrong. There are too many infants who do not get help from medical caregivers if they have ankyloglossia because pediatricians rely on old information and refuse to believe that this can destroy breastfeeding sometimes. Because they don't care, and don't care to learn new information, breastfeeding is lost.

579 Lactation Professional
Use of Banked Human Milk Banked human milk is a valuable commodity. It is available, safe, and extremely important for premature and sick infants, as well as adults who have severe health issues. There is too much ignorance from physicians who do not know about providing this medicine for infants, and who choose not to learn. Physicians who take the time to learn about the importance of banked milk would be very impressed with the usefulness and safety of this practice.

580 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Lactation support should be made available to all working mothers. Onsite child care would make breastfeeding available to infants. Businesses who value breastmilk for its health values should be rewarded by the government with special site awards. Businesses who support their breastfeeding employees by providing a safe clean area to nurse or pump should be given awards and advertisement by the government as incentives for continuing this practice.

581 Lactation Professional
Paid Maternity Leave This is common in many European countries. We should make a study of how they are able to do this and still have a viable economy. Mothers' work is valuable. Babies are valuable. We treat working mothers unfairly, and expect them to do two full time jobs and do them both well. We do not support their efforts to provide the very best beginning for infants through breastfeeding. Both full time and part time workers should be compensated with paid maternity leave.

582 Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I understand that in Brazil, the government had women breastfeed on the soap operas, and so many of the women were exposed to breastfeeding, and their breastfeeding rates improved. Perhaps it would be good to ban babies from bottle feeding in the media, just as smoking in the media has been banned. Using bottles for advertising as a symbol of babies should also be discouraged.

583 Lactation Professional
Support for Breastfeeding in Public Settings All states should have laws about the legality of breastfeeding in public. Most do already. But, it is important that the word gets out that moms should not have to stay home or hide to breastfeed their infants. It is a cultural expectation in the US that women will bottle feed, so people are used to seeing bottles. It will be just as culturally acceptable someday to see moms nursing in public, without fear of being ridiculed or ask to move to another place. Women are terrified of offending others, so they would rather stay home or feed their babies by bottle out in public. This needs to change.

584 Concerned Citizen
Other Areas: mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Natural, vaginal births should be encouraged by physicians, hospitals, insurers, and public health organizations. They are safer for the mother and child before and after birth than cesaerean sections, not to mention much less costly. Women should be encouraged to embrace natural birth as the safest option for herself and her infant, with a faster recovery than surgical birth, not to mention natural birth can be embraced as an empowering process for women and their families.

585 Lactation Professional
Peer Support and Education of Family Members and Friends Breastfeeding peer counselors have been shown to improve breastfeeding rates with young people in the community. Peer counselor programs should be supported and funded by the government.

586 Concerned Citizen
Public Health Worker
Access to Lactation Care and Support Women need breast feeding support and education! In the hospital, at home, in the workplace. They need to understand how much better it is for them and their infant to breastfeed for as long as possible, and the financial and insitutional support must be put in place to support this choice. The investment this would require would be so little compared to the returns on imporved infant and maternal health outcomes.

587 Lactation Professional
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Breastfeeding should be part of the curriculum in public schools, beginning with kindergarten. This program is already in place in New York state. Programs can be incorporated in other community support programs. In one country the postal workers were actually taught to support breastfeeding mothers, and as they went from home to home they offered support. In the US we don't have postal workers who would be in that kind of position,but it is important to think outside the box and to look at how women learn, and what programs impact them in the childbearing years.

588 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care It would be great if there were lactation consultants available at all hospitals and birthing centers, including water birthing centers. If I had had one at my disposal when I gave birth and started to nurse my baby, I'd probably still be breast feeding him. I didn't have that, so I didn't know what I was doing and during the time that I did nurse my baby, we fought every time I tried to nurse him. He would basically bite me constantly and I would have to either bare the pain, try to re-latch him or let him starve. It made us both very angry with each other, and I was ready to hurt him for hurting me, my version of postpartum depression, which was bad. Luckily my mother and husband were there to support me and help me and my baby through it. I have since been pumping daily to keep him fed and he is healthy and happy. We don't fight about feeding at all, which is great and he still gets his nutritional needs taken care of, but the bond that grows between mother and baby during nursing was cut very short in this instance.

589 Concerned Citizen
Public Health Worker
Worksite Lactation Support, Onsite Child Care, and Milk Expression Employers should be required to provide women a clean, private location (not a bathroom) and adequate time to pump breastmilk. This is a small accomodation to make to help ensure the health and future success of our children. Why is it that the needs of infants and young children are given so little priority be the rest of society? They are our future and deserve the best care we can give them, including breast milk and the presence of one or both of their parents during their earliest months/years.

590 Lactation Professional
Research and Surveillance The mPINC survey should continue every other year to survey hospital practices. This will give hospitals a chance to see how they are doing and to make improvements.

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.

591 Lactation Professional
Other Areas The breastfeeding TV public service ads need to come back, without censorship from the formula companies and the American Academy of Pediatrics, who accepts money from formula companies. A lot of good research and work was destroyed by ignorance and by the AAP's reliance on formula funding. The formula companies should not have been allowed to have a say in sharing the truth about their products with American women.

592 Community Organizer
Concerned Citizen
Public Health Worker
Paid Maternity Leave Yes! We are the only developed nation in the world that does not require employers to offer paid maternity leave, and in fact still allow employers to discriminate against mothers (and fathers). Employers are part of social fabric and should have to participate in the social contract...infants need to be with their mothers, especially during the first few months of life. The benefits of this are enormous (breastfeeding is just one part of it). The long term outcomes of a healthy, bonded, breastfed infant are so much better than those who are not, and yet our goverment has to yet to see this as a priority because of the cost to business. If a healthy future generation of workers and citizens is not our goverment's priority, than what is? I am a stay at home mother in the Washington D.C. region and I see a LOT of infants cared for by nannies. These nannies are experienced and caring women for the most part, but the care they provide does not even compare to that offered by an infants parents, especially a nursing mother. In this area, just making the mortgage payment often requires both parents to work, and the absence of paid maternity/paternity leave forces many many parents back to work before they or their infants are ready. My husband and I make a lot of sacrifices so that I can stay home with my son, but at least we have the option. Many families do not, especially those with children who need a mother's care the most.

594 Community Organizer
Concerned Citizen
Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Yeah, like could we see some. I don't think I have ever seen a nursing mother in an American film/ tv show. Lots of breasts, but none providing milk to an infant. What a disgrace! I think that HHS should run tv ads that show a diversity of mothers nursing with supportive partners at their sides. Think of all the happy, happy babies! My 2 year old son loves watching babies nurse (and still nurses himself!).

595 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Formula should be discouraged and not made out to be equal to breastmilk. Hospitals should stop giving out free formula to new mothers. It makes it seem like medical professionals are encouraging the use of formula.

596 Concerned Citizen
Access to Lactation Care and Support Free lactation care and support should be available before and immediately after birth, and ongoing.

597 Community Organizer
Concerned Citizen
Public Health Worker
Support for Breastfeeding in Public Settings Please support a federal law that allows women to openly breastfeed anywhere. It is a shame that we even need this law, that there are people and institutions who would view this natural, nourishing process as offensive in any way. I was ordered to cover up as a breastfed by a security guard at an outdoor fountain which serves as a play area for children. I refused, and fortunately I was in a public place and my rights are protected here in Maryland. But what if they were not? Or if I was inside a private store? This happens all the time, and most women are too ashamed to refuse these unreasonable demands. I also feel that the lack of women nursing openly in public is part of the reason that more women don't breastfeed. It's not seen as a part of everyday life. It's embarrassing, it's a pain to cover up every time...just one more incentive to switch baby over to that synthetic nipple and chemcially formula. Good heavens, it makes me angry! Can't we get the women of Congress on this one?

598 Concerned Citizen
Health Professional Education, Publications, and Conferences Health professionals, especially OB/GYN's and nurses, need to have more training in lactation, or else refer their clients to a lactation professional.

599 Concerned Citizen
Use of Banked Human Milk Use of banked human milk should be cheaper and more accesssible. We need more human milk banks, and it should be easier to donate.

600 Concerned Citizen
Support for Breastfeeding in Public Settings Women need to be able to feed their babies wherever the need arises, and should not have to resort to dirty bathrooms.

601 Community Organizer
Concerned Citizen
Public Health Worker
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) I think many programs and physicians are not emphatic enough about the importance of breastfeeding. I don't know if this is for lack of knowledge, fear of offending mothers who choose not to breastfeed, or pressure from the formula companies (they give a lot of free stuff to pediatricians and then young mothers get lots of flashy formula ads...it is totally uncool). Every new mother should be offered at least one free visit in the home from a certified lactation consultant, and then unlimited free consultation via phone or internet. The benefits of this would be enormous compared to the costs. Early breastfeeding presents many women with a lot of questions and challenges, and this support could help so many make it through that difficult neonatal period and onto the road of long term breastfeeding. Yeah!

602 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Women need to be able to express their milk in a private, clean environment, without being rushed or feeling guilty while at work. Onsite child care and lactation support at work would be ideal.

603 Public Health Worker
Other Areas: L&D Nurse
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Encouragement and promotion of breastfeeding during prenatal care is critical to a mother's committment prior to delivering her baby in the hospital. If the mother does not have a committment or the knowledge base behind her infant-feeding decision, she will not be as committed to continuing breastfeeding if she encounters a barrier (no matter how big or small). Peer mentors who can assist adolescents in breastfeeding decisions may encourage younger mothers-to-be to breastfeed initially and longer. Keeping mothers with their babies after the baby is delivered will also ensure the proper bonding and breastfeeding initiation while in the hospital. Too often, pacifiers and formula are given as a supplement when babies are in the nursery during

604 Community Organizer
Concerned Citizen
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Get formula companies out of neonatal units now! No free samples, no coupons, no ads, no reps. They need to get out! They are not there in the interest of public health, maternal health, or infant health, they are there in the interest of profit. WHO declared long ago that formula should get out of hospitals but in the USA these practices continue. It needs to stop now.

605 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media It's pretty amazing that babies are so typically portrayed as all being bottle-fed in traditional popular media. It's unusual to see a baby being breastfed. It should be the other way around if we are to change society's view of breastfeeding as the norm.

607 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe it is very important for everyone in the hospital to express to new moms that the breast should be offered any and all times that an infant (under 3mos) seems to be fussy and/or hungry. This is vital to ensure that you will be producing an adequate supply of milk. Eventually an infant will be on a more definitive schedule for eating, but I have found from my own experience that by offering the breast often in the early months, your milk supply will be plentiful.

608 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe it would be helpful for all who work with pregnant women to assume that the new mothers will breastfeed. This would mean not asking right off whether they plan to breastfeed or bottle-feed. I do not mean that women should not have the choice, but rather breastfeeding should be the default assumption until a mother makes it clear she does not want to.

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.

609 Concerned Citizen
Paid Maternity Leave It is ridiculous to recommend six months of exclusive breastfeeding for newborns and not to provide EVERY mother six months of paid maternity leave.

610 Breastfeeding Coalition Representative
Employer
Health Care Provider
Health Professional Organization
Worksite Lactation Support, Onsite Child Care, and Milk Expression Employers need incentives to provide workplaces that are breastfeeding mother friendly.

612 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Access to Lactation Care and Support In today's society, many moms are uninterested in or too busy for a support group, and don't want to bother their health care professional with their concerns. I see more moms looking online for help, or possibly phoning a support line or person who is dedicated to breastfeeding. I think that there needs to be more follow-up care in person from all types of organizations in those first few days and weeks postpartum. Having a collaboration of services to ensure the timing of visits is also crucial. If there could be one group that all organizations point to for reference, specifically La Leche Leauge, I feel more mothers would utilize that in the interim when they are not sure who to contact and when (from the other organizations). La Leche League is available for online help, phone calls (at any hour), and in-home visits. There are no strings attached to contacting them and I think many mothers would appreciate a non-governmental agency who is soley dedicated to breastfeeding success in today's mothers. And to have their services free of charge is also critical for many, too.

614 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Use of Banked Human Milk Without a doubt there needs to be more milk banks. I am not a fan of pasteurization of human milk, but for mothers in need, I think there should be more readily accessible in every area of the country.

615 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care It felt i was pushed into an induced birth which to me seemed to add more stress and complications to the beginning the breastfeeding process, plus at the hospital it seemed the where very eager to feed my son infant formula even after i stated my intention to breastfeed.

616 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Worksite Lactation Support, Onsite Child Care, and Milk Expression Making workplaces more breastfeeding friendly is critical to the health of mothers and nursing babies. I believe a national campaign informing mothers of their rights and getting more workplaces to change policy is a step in the right direction. Lactation support in all areas of life will make it easier for moms who have to work to continue to nurse their babies. I feel many moms already plan to quit nursing when going back to work, and this way they don't have unneeded worry placed on them from the beginning. Onsite childcare would be a huge advantage to all involved -- moms, babies, and employers. Making more jobs baby-friendly is a good balance for today's working moms. Milk expression in regards to working should be held in such a regard as being able to breastfeed. Too many moms are pumping in bathrooms stalls or in utility closets. This can't be good for milk production or the pysche of a nursing mom who has to express milk at work.

617 Health Professional Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care i have 2 boys. one breastfeed, the other not. both times in hospital the LC was unavailable, it was the weekend or she was out sick. my insurance would not cover another LC. i had no support real with #1 and had to give up BFeeding after 2 weeks. I battled on with #2 and we have been breastfeeding for 7 months. I worked hard to prepare myself with literature, purchased pumps but really needed the help of a professional LC to make things work. I din't get it with either baby.

618 Employer
Health Care Provider
Paid Maternity Leave 6 weeks in not enough time to establish breast feeding and pumping. Breastfeeding takes time to establish and pumping is should be the icing on the cake. You can't imagine pumping in the car park at the library after leaving your 8 week old baby at day care. Heartbreaking and humiliating.

619 Concerned Citizen
Peer Support and Education of Family Members and Friends From my family im the UK I have heard only positive supportive things about BFing From my husband's American family it is all negative; about why bother and it's too much work. There is obviously a huge gap in public education about the benefits and value of breastfeeding in the USA. I am lucky that as a teacher my co-workers are all supportive and knowledgeable

621 Breastfeeding Coalition Representative
Health Professional Organization
Nonprofit Organization
Paid Maternity Leave Of course I feel Maternity Leave should be longer, as well as a leave for fathers, too. Many companies still only give/allow 6 weeks of leave, which is totally incompatible for getting breastfeeding off to a good start. There should be incentives for companies to give longer leaves for mothers, even extending beyond the traditional three months.

622 Breastfeeding Coalition Representative
Lactation Professional
Public Health Worker
Access to Lactation Care and Support This is SO important. I work both in the public and private sector in a city that has many low income people and a good number of middle class. Because I work for WIC, right now my low income population has more affordable access to lactation care than do the rest of the families. But this is the exception, not the rule, for WIC. We are scrambling to find money to keep us afloat.

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

625 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care What went wrong at the hospital: --I had a c-section and the drugs made me and the baby drowsy (need to lower the c-section rate) --A nurse gave 4 oz of formula to the baby at one point (too much for an infant and then wouldn't nurse) --Told me I needed to nurse every four hours (should have been continually to every 2 hours) --Didn't know how critical the second day was to successful breastfeeding --Sent me home with formula --Didn't know that with a c-section, I needed my husband to stay overnight so the baby would be nearby--encouraged me to sleep instead of nurse the baby

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.

626 Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression lets explore longer paid leave for breastfeeding mothers? how about work site support as well- business who are breastfeeding friendly for both staff and customers-- BEST PRACTICES and support small businesses

627 Health Care Provider
Lactation Professional
Support for Breastfeeding in Public Settings what intiatives can be marketed to state and local government to help support breastfeeding friendly parks; beaches;malls etc?

628 Community Organizer
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care obstreticians are not involved in prenatal education for breastfeeding or for breastfeeding breast exam BUT do allow artifical infant formula promotional materials in their offices

629 Community Organizer
Concerned Citizen
Lactation Professional
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) WIC offices SHOULD NOT BE ALLOWED TO PAY for artificial infant formula without an assessment of the infant and the mother for reasons why the mother cannot breastfeed. The system is backwards, paying mothers to avoid breastfeeding and thereby increasing healthcare costs for the infant as well as the approximately $1200.00 per year retail cost for artificial formulas

630 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I would like to see 'in home' nurses come to private homes to provide lacation advice and infant care instruction to those that request it. There is already a program in place similar to this in the UK, and I believe it could be an excellent blueprint. Not only would public funds increase the rate of breastfeeding, but compassionate and professional in home support would decrease the likelihood of child abuse. In addition, such a program would provide increasingly isolated nuclear families a trustworthy support network in the first crucial months.

631 Concerned Citizen
Paid Maternity Leave The first 6 weeks of breastfeeding are the most challenging and crucial to a succuesful long term breastfeeding relationship. Sadly, many mothers are forced to go back to work just as they finally 'get' breastfeeding and, through grueling workplace hours and the demands of infant care, either lose their milk supply and/or their interest in breastfeeding. A longer postpartum period would allow for stronger breastfeeding relationships.

632 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Right now, the Media portrays graphic and glamorized births in TV and movies (i.e. Knocked Up, Friends, Baby Story). However, for all the sensationalism of showing a crowning baby, there is never a portrayal of the mother contentedly breastfeeding her child. Until we see more public breastfeeding, it will never truly be considered normal.

633 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals need to be held to a higher standard when it comes to breastfeeding support. They should have comfortable, private areas for mothers to feed their newborns when they are in the nursery and/or NICU. As a breastfeeding mother who was discharged before my newborn I was forced to sit in a hard chair in the middle of the nursery where anyone could see in order to attempt to nurse my son. Hospitals should also implement other procedures for feeding babies besides with bottles. I understand that my son had to be fed formula in order to help flush out the bad things, but I didn't want him to have a bottle and that was my only option.

634 Concerned Citizen
Nonprofit Organization
Other Areas: La Leche League volunteer Leader
Support for Breastfeeding in Public Settings We need a cultural acceptance and encouragement of breastfeeding. Hospitals and medical providers need to discontinue promotions of formula including free gifts and sponsorships. These relationships are a marketing tool for the formula companies and adversely affect breastfeeding rates.

635 Community Organizer
Concerned Citizen
Researcher
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Please help all hospitals discontinue giving formula samples and coupons in gift bags to go home with new parents. Please help hospitals encourage skin-to-skin contact with babies and rooming-in sleeping arrangements. Please support birth in birth centers and at home. Please ensure that all women receive home visits during the first few weeks at home, when they can ask questions about nursing and get help if needed.

636 Community Organizer
Concerned Citizen
Researcher
Paid Maternity Leave Please work to extend paid maternity leave-- it's essential for healthy children, sane mothers, and financially secure families.

637 Health Care Provider
Other Areas Hospitals that receive any federal money ie, Meicare payments or other federal funding should be prohibited from giving any formula samples to new or expectant mothers. Formula should be used only when medically necessary and banked milk isn't available. Formula companies should be banned from sponsoring educational programs in hospitals and should not be providing samples and gifts to gynecologists and pediatricians.

638 Community Organizer
Concerned Citizen
Researcher
Support for Breastfeeding in Public Settings Please work with businesses and the public sector to express support for nursing in public, including the showing the international breastfeeding icon, ensuring that employees are trained about the legal rights of mothers to nurse in public, and ensuring that all applicable local, state and federal laws are upheld and increased.

639 Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The thought of breastfeeding needs to be started at that very first Prenatal visit and the topic brought up at every visit there after. Most MD's in my area DO NOT have any current knowlege of lactation and these are the professionals that are giving the orders to nurses and LC's in the hospital to give the formula. Doctors do not like to be questioned when it comes to their knowledge, so make it more of a curriculum for these medical students/residents, even if it will not be their specialty.

641 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Despite many initial struggles with breastfeeding my daughter, I persisted and was able to feed her exclusively with my milk. However, once my maternity leave was complete and I returned to work, I faced a whole new set of issues.

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.

642 Concerned Citizen
Research and Surveillance More research needs to be done on weight gain in breastfed infants. Very frequently, doctors hinder breastfeeding by suggesting the baby is not gaining enough weight and should be fed with formula. Once a new Mom starts using formula, she most likely will not successfully breastfeed. Supplementation can be responsible for a plummenting milk supply and a feeling of inadequecy in the new Mom. These factors (especially when combined with other outside stessors) are often responsible for the Mom believing that she 'just couldn't breastfeed'. If she encounters a stressful introduction to breastfeeding, she will likely continue to formula feed all of her children.

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

643 Lactation Professional
Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media It would be wonderful to have some of the more popular TV shows having a mother breastfeed, or at least pretend to breastfeed. Our young people are not exposed to a mom nursing her baby, so they may think it is normal to give a baby a bottle of formula. We need to help our future generation know that breastfeeding is the norm,not the bottle.

644 Community Organizer
Concerned Citizen
Nonprofit Organization
Other Areas: La Leche League
Access to Lactation Care and Support This should always be covered by insurance. The insurance companies will benefit in the long run from always covering the cost of a certified Lactation consultant

645 Community Organizer
Concerned Citizen
Nonprofit Organization
Other Areas: La Leche League
Paid Maternity Leave Moms and babies need time together (sometime lots of time) to get breastfeeding going well. This time should be covered with paid leave. Sometimes breastfeeding moms are still struggling at 4 - 6 months.

646 Community Organizer
Concerned Citizen
Nonprofit Organization
Other Areas: La Leche League
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media All childrens book should have breastfeeding. That is a good way for it to start being the norm. As it stands you have to search the natural catalogs to find a book that portrays a breastfeeding family.

647 Lactation Professional
Public Health Worker
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Not all communities can have a Le Lache League where they live, but 1 person can start a support group for mom's to come together with other mom's that are breastfeeding. I started a support group for several mom's in my community 5 years ago and we are still going strong. The orginal mom's are now in another phase of their lives, but new mom's are always coming to find that additional support they are needing for their breastfeeding. I personally provide home visits for Healthy Start and I would love for every new Lactating mom to have a home visit during the first 2 weeks post partum. So many moms I talk to quit before they have really given herself and the baby a chance to learn how to breastfeed. WIC is a wonderful program, but most moms know they can always get free formula, so why should they make breastfeeding work. Prenatal Breastfeeding Education is paramount for all pregnant women,but most women do not read or watch anything on breastfeeding.

649 Community Organizer
Concerned Citizen
Nonprofit Organization
Other Areas: LLL
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) It should be taught to all high school students including males so they will support the mother of there child in it.

650 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I know that when I had my two children, I was given formula samples and coupons many times by mail, the hospital and my children's pediatrician. If we want to truly support women breastfeeding, I believe this practice has to stop. I'm not saying the free samples shouldn't be made available to those who do choose to formula feed their babies, but to just send/give formula samples by the doctors and hospitals it sends a message that formula is normal. I also believe that every woman should have extended access to lactaction consultants after childbirth. This should be something covered under all health plans as well as being available to women who don't have health coverage. Thank you, Michelle Finseth

651 Health Care Provider
Other Areas One the two reservations I have worked at (Rosebud in SD, and Ft. Peck in MT, I see almost NO breastfeeding. The women need Role models, community pride, and a financial incentive thru WIC! If women were paid to breastfeed here, they would all do it. The monies would be recouped in less diabetes, less dental disease etc... I am serious! Maureen Sullivan CNM, WHNP, MS

652 Lactation Professional
Public Health Worker
Paid Maternity Leave Most of my lower socioeconomic pregnant women know they will have to work to provide for their family, so they do not even start breastfeeding. If the government really wants to help and encorage these to moms breastfeed, offer additional $ to let them do that. Give families the option of decreasing WIC $ for money to live on for a set amount of time,say 6 months. Is this not how long our AAP recommends to exclusivly breastfeed.

653 Concerned Citizen
Support for Breastfeeding in Public Settings Many moms are very timid and nervous about breastfeeding in public because they are scared someone will complain or make negative comments and rude remarks to them. There also has been a lot of news of brestfeeding moms being kicked out or banned from certain places of business for breastfeeding in public. This sort of behavior is what creates a negative effect on breastfeeding mothers; many of whom want to avoid as much conflict as possible. It is stressful enough to have a hungry baby, and to stop what you are doing and find a place to nurse while maybe even taking care of other children at the same time. Added stress is not necessary! I think society needs to come to terms that breastfeeding is the most natural and beneficial act and leave us breastfeeding mothers alone to feed our children in peace.

656 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Support for Breastfeeding in Public Settings I believe that through visible designations that breastfeeding in public will become more accepted. Our societal predispositions of the human body lead many to choose not to breastfeed in public, choosing rather to give a bottle instead. Overcoming those mindsets takes education and perseverance, and over time this will become easier.

657 Concerned Citizen
Health Professional Education, Publications, and Conferences Doctors need to be better educated on the benefits of breastfeeding, especially past age one. They also need to have ready referrals to breastfeeding support systems (Lactation Consultants, Peer Counselors, La Leche League, etc.) to give to moms who are struggling.

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

658 Concerned Citizen
Other Areas Considering how inferior infant formula is, and that it was originally intended as a substitute for a wet-nurse if a mother was incapable of breastfeeding her child herself, it would be a huge step in the right direction to make formula less accessible. Make it be available by prescription only.

659 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Peer Support and Education of Family Members and Friends Education of family members would be ideal for many new moms.

660 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Implement breastfeeding education in the prenatal clinics and give private physicians a tax credit if they can show good evidence of breastfeeding education in their clinics. Push hospitals to adopt mother/infant bonding skin-to-skin int he first hour of life. Use evidence based guidelines to promote no infant bath until after the first breastfeed and to delay vitamin K injections and prophylactic eye ointment until 1 hour of age. Eliminate all procedures that separate mother and infant for prolonged periods of time. Give tax credit to those hospitals that practice family-centered care.

661 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Other Areas I would like to see funding for training and educating lactation professionals in other languages to effectively reach other ethnic groups. Overcoming the traditions of some groups and replacing them with new more breastfeeding-friendly ones takes an empathy and understanding that should be learned in order not to offend any culture. For these people, they should know that you are there to help them succeed in breastfeeding and that it is the best option for them and their babies.

662 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Access to Lactation Care and Support Find a means to well publicize the value of breastfeeding professional (IBCLC) or support group. Push insurance companies to recognize the cost savings and provide coverage for consultations and increase existing coverage.

663 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Health Professional Education, Publications, and Conferences The State of Texas actually has a very good education program, but needs more instructors available to teach the curriculum.

664 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Research and Surveillance I would like to see more research by baby-friendly organizations promoted within the medical community. In the surveillance of breastfeeding mothers, I think that collaboration within various agencies would be the best way to go about it.

665 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Use of Banked Human Milk More public awareness of the importance of human milk and use of banked human milk when breastfeeding is impossible. Campaign to educate the public. I have alway thought that television drama programs should make breastfeeding the norm in storylines since it is as important as some of the other current events they weave into the story.

666 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Tax credit for those employers who truly provide onsite child care for breastfeeding mothers, breaks for milk expression and even a pumping station with hospital grade pump included.

667 Concerned Citizen
Paid Maternity Leave I think paid maternity leave is very important. Those first few weeks and months is when babies need their parents the most. It's a very big and important adjustment period that the baby must be home with their mothers. Without it babies are sent to daycares way too early when parents are forced to return to work. A 6-8 weekold in daycare is way too young.

668 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Paid Maternity Leave Private employers have difficulty giving more maternity leave, but tax credit might make it more appealing. Additionally there are those places of employment where an infant less than 6 months could appropriately be kept near the mother so that she could feed on demand. Give them a tax credit. Give credit for something worthwhile.

669 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I have already made this comment. Storylines of Television programs could include breastfeeding and information regarding why it is important. Human milk banking would be a great drama and worked into a story. Much of the truthful information about human milk would blow people away. They would think it is science fiction and then the screen credits could give the resource bibliography. A whole movie about an infant born to a family could include breastfeeding. This does not even have to be a main focus, just show people breastfeeding in the story. For instance, a movie about a family trapped in a blizzard or flood could save the baby and toddler because the mother was lactating. Or a movie about a dad who is a coach of some notariety could just happen to have a wife that breastfeeds.

670 Lactation Professional
Paid Maternity Leave IT HAS BEEN MY EXPERIENCE AS A LACTATION CONSULTANT THAT WOMAN WITH AT LEAST 3 MONTHS MATERNITY LEAVE ARE MUCH LESS ANXIOUS AND MORE EAGER TO RELAX AND ENJOY BREASTFEEDING THAN MOTHERS THAT HAVE TO RETURN TO WORK IN 6 WEEKS.

671 Lactation Professional
Health Professional Education, Publications, and Conferences There needs to be more breastfeeding education in medical schools, residency programs and in nursing schools. I have found that nurses and doctors have a poor understanding of breastfeeding and rarely consider it the normal way to feed an infant.

672 Lactation Professional
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) The WIC program needs to have better informed employees. So much formula is given out and so little time is spent on breastfeeding counseling.

673 Concerned Citizen
Other Areas: mother
Health Professional Education, Publications, and Conferences I beleive all doctors needs additional training on the importantance of breastfeeding. I continually hear horror stories of moms who are forced to wean because of bad medical advice or a health care provider prescribing a medicine and not researching if it is really harmful or looking for a more suitable choice. Babies are also being fed formula as newborns due to jaudice which sets moms up to fail at breastfeeding. Neonantologists also do not have sufficent training in lactation. As the mom of a preemie I had gotten really bad advice about fortifiers and supplements. Health care providers need to understand how important the breastfeeding realtionship is and take care when they prescribe any intervention that can interfer.

674 Concerned Citizen
Other Areas: mother
Use of Banked Human Milk Banked human milk should be provided to all premature babies in the NICU. It should be a first choice instead of formula. Moms who want to donate should be screened before they leave the hospital and their milk allowed to be donated to the sick babies who need it the most. I had a baby on bowel rest and would have gladly donated a large quantity of milk to my NICU if they had a program set up to accept this life saving gift.

675 Concerned Citizen
Other Areas: mother
Paid Maternity Leave Mothers are undervalued in our society. If we had maternity leave for up to a year as most other industrial countries in the world, breastfeeding rates would improve dramatically.

676 Concerned Citizen
Use of Banked Human Milk I donated to Mother's Milk bank and I think every mother should do this. I wasn't able to provide much but every ounce counts!!! Formula should have to have a doctor's prescription.

677 Health Care Provider
Lactation Professional
Health Professional Education, Publications, and Conferences Breastfeeding education must be a required part of medical schools' and residency programs' curriculum. Journals such as American Family Physician, AAP and OB/GYN should contain at least one article in each issue starting with breast feeding basics and going into more detail about breast feeding issues. E-mails from the Dept of Health, cdc, etc should be written quarterly and sent to all FP, Peds and OB/GYN providers in the US. Maybe some on line CME opportunities.

678 Other Areas: a breast feeding mother
Support for Breastfeeding in Public Settings I would love it when I would happen upon a place of business that would happend to have an arm chair in the restroom, a family room in the changing area or even a nursing area. I wish that more places had such areas so that I did not feel anxious whenever I went out in public. Also it would be nice if rest areas on the highways had nursing areas.

679 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Immediately after birth, moms should be given written information showing the feeding and elimination pattern for the first 5 days of life so that she will not think her baby is hungry and give formula.

680 Concerned Citizen
Paid Maternity Leave As a working mom, it was incredibly difficult for me to continue breastfeeding after my daughter went into full-time day care at 6 months old. My day care center was a drive from my workplace, which made it impossible for me to go to my daughter in person to breastfeed her. I had a supportive workplace in which to pump, but my daughter did prefer to breastfeed at the breast. If I had had the luxury (like they do in many Western countries - France, Canada) to have an extended, paid maternity leave of at least 1 year, my breastfeeding experience could have been so much more positive for both me and my daughter. As it was, we had to supplement with formula. In all it turned out fine, but I wonder why we, of all nations, treasure motherhood less than other societies. I realize that now, in the midst of an economic crisis, that providing for extended paid maternity leave may be a pipe dream, but it could do wonders to help this generation of moms who struggle for that delicate balance the first year of a child's life, as well as the children they are nurturing.

Thank you.

681 Concerned Citizen
Support for Breastfeeding in Public Settings If obesity is such a health issue, why not encourage more moms to breastfeed? Some people say the strangest things about it: the stares of breastfeeding in public are daunting. Education and awareness is the key. (Maybe by making sure people know that this choice will be healthier for our entire society in the long run.)

682 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care In my experience with maternal and infant care in through ob-gyn's as it relates to breastfeeding there is not enough support or encouragement through the ob-gyn's for mothers to breastfeed even when they are determined to do so. The doctors/nurses send the baby's off to NICU so many times and do not promote the mother baby nursing bond that is essential in the first hour after birth to make nursing a learned practice for the baby so that it is not so difficult for the mother. The nurses should not be putting pacifiers and bottles in baby's mouth and instead giving baby to mom so she can breastfeed. Doctors need to stop giving out formula and act as though it is the norm to bottle feed. A plan to breastfeed for fifteen to twenty minutes after the birth should be enacted so that the baby has nursing down pat and then mom and baby can get cleaned up and baby returned to mom for more nursing. If the first hour goes by and the baby does not nurse, he sleeps through the most important learning time and from then on it is much more difficult for both baby and mom. Doctors/nurses need to have this on the front of their minds after baby is out of mom's belly. Lansinoh is a huge help. It should be on hand and given to mom to put in her nipples so it does not hurt. Nursing also helps mom's uterus contract so it stops the bleeding and she does not need pitocin etc..... so if she nurses right after birth the benefits are: baby learns to nurse and this makes long term nursing possible and likely and easier, mom's uterus contracts and she stops bleeding and begins to recover from birth immediately which eliminates hemmorhaging possibilites etc......

683 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care When my twins were born four years ago I was offered breastfeeding support at the hospital. However, I was also given many roadblocks while there. Not only were my twins given pacifiers after I specifically requested them not receive them but I was pushed to supplement them even though they were healthy full term twins and one was almost six pounds, the other over seven. I believe that hospitals should present mothers who want to nurse with some basic information right away. For example, nurse on demand, supplementing can wreck havoc with milk supply, there are many ways to increase supply, don't hesitate to call a lactation consultant.

684 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Health Professional Organization
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I was a Neonatal ICU nurse for a number of years before I had my own children. I realize that breastfeeding in our society is sometimes not the most convenient. But I think 80-90% of our moms pumped in the Nicu, they may have not continued to nurse at home or they just pumped milk in a bottle. But they saw the importance of the milk . We as nurses and the medical community see a difference in outcomes from BM to formula. In my own experience when both my children were sick they would only take BM and could only digest that when vomiting, diarrhea, or bad colds...and at least they were getting nutrition. Not just pedialyte. But we live in this society where we do not want to make others feel guilty , rather than eduacting them on the seriousness of breastfeeding and also what baby needs most is their mothers. Any amount of time a mom nurses is better than no nursing.

I went to a children's museum the other day with my boys and I only saw one mom nurse, in a nursing dungeon corner. Every mom or caregiver was bottle feeding. We frown upon a mom nursing in public, standing in a line, etc....what would mom then com to. Do what everyone else is doing. Anyway, we need more prenatal and hospital support. thank you. Christina Falco

685 Concerned Citizen
Paid Maternity Leave As a graduate student on a federal fellowship, I needed a way to take maternity leave but there was no mechanism included in the fellowship to do so. Many women in science face this dilemma at all levels of academia. If you work hard enough to win a grant or fellowship, you are basically 'not allowed' to take leave to establish good breastfeeding practices because of the time sensitive nature of the funds. This needs to be changed so that there can be flexibility in the granting of funds and a federal maternity slush fund not associated with the particular grant or agency for maternity leave pay for women earning their salary from grants or fellowships.

686 Concerned Citizen
Support for Breastfeeding in Public Settings There is very little support for breastfeeding in public. I have been asked to leave public businesses after being told that breastfeeding is disgusting and

687 Concerned Citizen
Other Areas I'm interested in working from home so that I can breastfeed. I need a caregiver to help me do so, but can't afford one. Some type of childcare/breastfeeding support fund/low-cost loan would be extremely helpful!

688 Concerned Citizen
Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care there are many things that set a motherbaby up to have breastfeeding issues such as lack of education and information about how birth affects breastfeeding. also, the use of drugs during labor and the lack of immediate skin to skin contact with the mother has been shown in research to harm the brestfeeding relationship initially.

689 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Better educate the maternity & newborn wards of hospitals to be more supportive of breastfeedimg mothers. I have 4 children that were all breastfed and I encounterted attitudes and advice in the hospital that were counter productive to establishing the breastfeeding relationship and almost sabotaged it entirely. More education is needed.

690 Concerned Citizen
Other Areas: nursing mother
Access to Lactation Care and Support The lactation consultant is readily available while in the hospital. However, once you step out the door, you then have to pay for the advice and help of a consultant. Even when health insurance covers the visit, you are still responsible for a large portion of the cost. Lack of support leaves women with no choice but to give up entirely.

692 Concerned Citizen
Other Areas: nursing mother
Use of Banked Human Milk Health insurance should make the use of banked milk more available and more widely covered cost wise.

693 Concerned Citizen
Other Areas: nursing mother
Paid Maternity Leave I cannot even begin to say enough about this!!!!!!!!! How can a new mother establish a breastfeeding relationship with her child when she has to return to work within weeks of giving birth? Just when they establish it, at 5-6 weeks, a majority have to return to work because they are not receiving paid maternity. With the prospect of breastfeeding or returning to work to keep their house, most moms will choose to return to work, stop breastfeeding and switch to formula. That is, if they even breastfeed at all. Why start something when you have almost immediately stop? Take care of the mother by paying her so that she can take care of her baby!!!!!!

694 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals must be truely pro breastfeeding; examples would be to not even offer formula when you know that a family only wants to breastfeed. Provide lactation consultants 24/7 in the hospital. I gave birth in a hospital on a Saturday and no lactation consultants were available until Monday. This made the whole situation difficult. My son was born 5 weeks early and could not breast feed or bottle feed. We basically had a nurse scare us into formula feeding through a tube--even though the nurse instead should have had me pump and provide colostrum instead. When we finally had a lactation consultant to help us on Monday; they were outraged (as when they had me start pumping I produced ample amounts of colostrum)that the nurses chose formula rather than have me pump. As a first time mom I had absolutely no clue. Over the next month I worked very closely with the lactation consultants as I had a intensely strong desire to breastfeed my child. I pumped and tube fed for almost a month. He will turn 2 years next week and we are still breastfeeding. I plan to breastfeed as long as he needs. I totally believe in extended breastfeeding.

695 Concerned Citizen
Health Care Provider
Use of Banked Human Milk There need to be more centers collecting human milk, or better ways of delivering it to the centers. I live in Wisconsin and was not able to donate >200 oz I had saved because I couldn't transport it frozen to Iowa (the nearest milk bank). All major cities should have some form of a milk bank for their youngest, most vulnerable citizens. Could blood centers or the Red Cross take up this task?

696 Concerned Citizen
Paid Maternity Leave Maternity leave should not be deemed an illness/disability. It should just be maternity leave and be 100% pay (not 60%). Paid maternity leave should be 6 months. Babies need their moms! Six months rather than 6 weeks would allow the mother/baby team to sucessfully establish breastfeeding.

697 Concerned Citizen
Support for Breastfeeding in Public Settings Women need to see other women breastfeeding. As a nation of mothers we need to understand and feel comfortable that breastfeeding is natural and encourage extended breastfeeding for at least two years if not more! I hope(as a breastfeeding mother of an almost two year old little boy) that when I breastfeed my son in public that I help to pave the way for others to feel ok and strong enough to also breastfeed when their time comes to making that decision. Moms need support to become comfortable with breastfeeding in public settings.

698 Concerned Citizen
Other Areas: medical student, breastfeeding mom
Health Professional Education, Publications, and Conferences My medical school provides almost zero instruction on the act of breastfeeding: if the breast is discussed, it is usually in connection to breast cancer, gynecomastia, or prolactinoma. It would be great if the NBME would make breastfeeding a focus of the boards--it would force breastfeeding to be a more prominent topic in medical education. Medical students should learn medications and substances that are safe or contraindicated for breastfeeding, infectious diseases that are compatible/non-compatible with breastfeeding, common breastfeeding problems and their management, the composition and immunology of human milk, and current recommendations for breastfeeding.

Also, many woman physicians find it very difficult to breastfeed and pump milk during their medical training. This leads to less personal experience with breastfeeding and less comfort counseling women on breastfeeding. Medical colleges and residency training programs should provide sanitary places (not bathrooms) for mothers to pump, and publish guidelines for instructors and administrators on how to support nursing mothers during their medical training (the AAP has already done so).

699 Concerned Citizen
Access to Lactation Care and Support 1) Lactation consulting should be covered 100% on all plans from all insurance companies.

2) Formula should be taxed at a high rate and the taxes should be used to supplement support for lactation services (just like cigarette taxes are used for health programs).

700 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Nonprofit Organization
Peer Support and Education of Family Members and Friends Peer support is the most effective means of increasing breastfeeding initiation, exclusivity and duration, look at the history of La Leche League. I would like to see more funding go towards the training and employment of breastfeeding peer counselors in a wide variety of settings, not just WIC offices.

701 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I have been working in the hospital postpartum setting. The use of medications during labor has harmed the initiation of breastfeeding. If the medications were not funded by public groups it would reduce the amount used, thereby reducing the harms fro the initiation of breastfeeding.

702 Concerned Citizen
Health Professional Organization
Paid Maternity Leave I would love to see the USA institute paid maternity leave, many women do not breastfeed or do so for only a short time because of needing to return to work so early.

703 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I feel that breastfeeding information should be given starting at 6 months prenatal as part of routine prenatal care. Practioners should be sharing the benefits especially to first time mothers.

704 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Before a woman gives birth they should be assisted in making a plan for how to continue successfully nursing after a return to work. This should include offering suggestions beyond a private place to pump. Since this is not always available perhaps suggesting pumping in the car if available. Also the state guidelines on workplace lactation should be made available to both women and employers.

705 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The Everyday Miracles program of doula care for low-income women in Minnesota has an 88% breastfeeding rate; other doula programs around the country have similar high rates of breastfeeding if doulas meet prenatally and postpartum with mothers. Doula care increases the rate and duration of breastfeeding. Mary Kroeger with Linda Smith have written the definitive summary of the Impact of Birthing Practices on Breastfeeding in their book of that title. To increase breastfeeding we need to demedicalize and normalize childbirth for most women.

706 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I am a Family Physician who regularly sees women who start out planning to breast feed, but are already formula feeding when they return to my office for an infant check up at 3 days of age. This is due to the lack of time for skilled nursing support of breast feeding skills, the ready provision of formula in the hospital & in go-home kits, availability of pacifiers in the hospital, and absence of creative problem-solving among hospital staff, and coverage of the costs of pumps, supplemental feeding systems, and comfort measures like nipple shields and gel pads.

708 Concerned Citizen
Other Areas: OB RN
Paid Maternity Leave I still am amazed that the USA would allow itself to be 4th worst in the WORLD at anything, but materity leave in the USA is just that. I think that this is really one of the biggest deterents to long term nursing. I have heard so many mothers say that they breastfed their children 2-6 weeks untill they were forced to go back to work because they couldn't afford not to. At 2 weeks post delivery a womans body is still recovering, and breastfeeding is still at it's most difficult stage, with both mother and baby learning how to make it work. Protecting a woman's job is not enough, what difference does it make if she can't afford to take the time off. We need paid maternity leave!!!! Beyond that our jobs need to be protected for longer than three months, I think in Canada they are protected for a year! Also men need paid paternity leave, women need their support and children and fathers need to bond, which would have the added benefit of lowering abuse rates. We need to get with the program and stop being the 4th worst country in the world where it comes to maternity leave. It's simply ridiculous not to.

709 Community Organizer
Other Areas: OB RN
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media When I was a child breastfeeding was all over children's tv, MR Rogers included. Now my niece who is 6 doesn't know what breastfeeding is, and videos from my 70's and 80's childhood tv shows are being deleted from youtube. When I was a kid the Cosby show was on in the evenings, now I can't think of any tv shows that don't constantly talk about sex. When sex is all we see, then of course people will think of breastfeeding in public as indecent.

710 Concerned Citizen
Health Care Provider
Other Areas: Lactating Mother
Paid Maternity Leave While breastfeeding is the 'natural' way to feed your child, it is a definate learning process for both mother and child. A mother milk is not fully established to a babies feeding needs until they are at least 3 months old. Going back to work prior to this time could impact a mothers milk supply and make it difficult to continue breastfeeding her child. Yet I don't know of any company that offers 3 months of 'vacation' time. In this economy no mother can afford to take that amount of time unpaid. If we want to save money in the longterm mother should be paid for at least 3 months while establishing a milk supply. This will have long reaching benefits including lowering health care costs in the future.

711 Concerned Citizen
Health Care Provider
Other Areas: Lactating Mother
Support for Breastfeeding in Public Settings There needs to be lactation rooms provided in large malls, and there needs to be more education so that a mother who is nursing in public is not made to feel uncomfortable.

712 Concerned Citizen
Health Care Provider
Other Areas: Lactating Mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals should not be giving out free samples of formula to mothers. Maternity nurses need to be better educated about breastfeeding and not try to push formula on an already overwhelemed new mothers. Pediatricians need to round into the mothers room instead of taking the baby to the nursery so that the baby can feed if it needs to do so.

713 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Desperately need education to OB's and Pediatricians. Sadly, there is little support and too often misinformation from our medical community- sometimes even outright resistance to encouraging and supporting breastfeeding

714 Health Care Provider
Lactation Professional
Support for Breastfeeding in Public Settings We need to do more to unapologetically promote the benefits of breastfeeding. So few parents realize that breastfeeding can protect their children from common problems like otitis media and from devastating diseases like childhood leukemia and diabetes.

715 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Must begin to encourage hopsitals to become Baby Friendly. Early breastfeeding support in hopsitals and birth centers has been shown to increase rates and duration of breastfeeding. The US lags behind the rest of the world in promoting the Baby Friendly Hospital Initiative. Make it a national goal!

716 Concerned Citizen
Health Care Provider
Other Areas Why was one of your topics NOT the marketing of breastmilk substitutes? I looked for this topic and was surprised not to see it because it alone is responsible for the difference between the breastfeeding rates of this country and others.

Why is the government asking for information on what will improve breastfeeding rates, when it knows perfectly well what will be effective, but chooses not to utilize those methods?

The Breastfeeding Awareness Campaign, an HHS initiative, has been criticized for its ineffective ads. The ineffectiveness of these ads was deliberate—their content had been watered down by interference from the formula industry. According to an August 31, 2007 article in the Washington Post, the Committee on Oversight and Government Reform, then chaired by Rep. Henry Waxman (D-CA), investigated allegations that

717 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Get formula discharge bags out of hospitals!!

718 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I think more companies should provide an area for mother to express their breastmilk without fear of workplace problems like taking too many breaks or break too long, no area beside restroom to express, etc...

719 Concerned Citizen
Paid Maternity Leave State or companies should provide a longer pd maternity, In RI where I reside it is 6 weeks for vaginal delivery or 8 weeks surgical. Well that is just not long enough. With the daycare that is provided they just are not as well equiped to take care of such a young baby. I think three months would be better for mother and child. plus breat feeding is well estabished by then. Daycare center also should have more training on providing breastmild to infants. The center in which I choose hd no knowledge of how to heat or how long breastmild could be stored before my daughter arrived. All the other children her age were formula feed.

720 Health Care Provider
Health Professional Education, Publications, and Conferences Comments/warnings on package inserts and PDR info on various drugs are often needlessly restrictive and ignore existing research on breastfeeding and the drug. If the AAP includes information about a drug in their listing of medications' compatability with breastfeeding, then inclusion of that information should be required in any manufacturer's statements on that topic. Perhaps there is a way of including information from Hale's Medications and Mother's Milk as well. Bernice Keutzer APN CNM

721 Concerned Citizen
Health Care Provider
Paid Maternity Leave The U.S. ranks in the bottom of industrialized nations for maternity leave benefits. If women had paid maternity leave benefits, breastfeeding would be much easier because moms could take the time to stay home with their infants and establish this feeding option. Breastfeeding takes time and patience, and many new mothers feel the pressure of returning to work keeps them from having breastfeeding as an option. In addition, if fathers had some paternity leave benefits, this would further encourage and support mothers who are breastfeeding (especially in homes with more than one child).

722 Concerned Citizen
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Encouraging for breastfeeding should start at the first prenatal visit. Breastfeeding education should be mandatory. In the hospital after baby's birth, every effort should be made for mother and infant to have time as soon as possible after delivery for breastfeeding to start. Lactation specialists should be available for every mother in the post-delivery period, so that breastfeeding can begin successfully before mother and infant are discharged home.

723 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Other Areas: mom whose child uses donor milk for inflammatory bowel condition
Use of Banked Human Milk Make routine use of donor human banked milk preferable to using formula in NICU's. Education for physicians on cost savings and health benefits.

724 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Access to Lactation Care and Support Make outpatient lactation services available free through hospitals, for moms still struggling with breastfeeding after discharge (probably about 40-50% still need followup).

725 Concerned Citizen
Health Care Provider
Access to Lactation Care and Support Insurance companies should offer coverage for new mothers to have access to lactation specialists. Also, hospitals could offer free lactation specialist services to breastfeeding mothers. Mothers need to be educated about organizations, such as La Leche League, who can support them in breastfeeding.

727 Concerned Citizen
Other Areas: nursing mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care When I was in the hospital with my newborn last year, I had a nurse actually tell me I would be starving my baby if I didn't feed him formula until my milk came in. Everything I know about breastfeedings says that colostrum is the best food for newborns, and this supposedly educated nurse didn't know that. doctors and nurses need to be much better educated about breastfeeding practices.

728 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression The ability to work and breastfeed has become a class issue. Those with white collar jobs have the ability to pump at work, while those in other occupations have no ability and/or are ridiculed by their employers for doing so. There needs to be federal legislation concerning breastfeeding (it's allowability in public WITHOUT covering up (what baby wants a sheet over their head? Mine sure doesn't) and a mother's right to pump at work in order to feed her infant).

730 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Teen mothers need to be educated about breastfeeding, and school systems need to provide ways for those mothers to pump. If any baby needs the benefits of breastmilk, it is the babies of young mothers.

731 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Even in the most advanced cities in this country, so many people are very unaware of the true benefits of breastfeeding. It has been demoralized and sexualized by many so that when a mom is out with a baby and needs to breastfeed, she is made to feel ashamed and asked to cover up or go to a private place. Though mom's have the legal right to breastfeed in public, most of the public is not educated on the legal rights. Whenever the media has a story about breastfeeding in any context, breastfeeding is always described as Hard to do or difficult, or something easily substituted with formula. There is more of a negative light when it comes to breastfeeding that it is truly sad many new mothers and mothers to be will often follow that unsound heresay and go against what is best for mom and baby or following their natural instinct. Popular media continues to only portray the difficulty of breastfeeding while many moms do not have difficulty and find it easy to do. Society is so far away from the day where a mom can breastfeed her child and not get dirty looks, shunned upon or be asked to not do that. Breastfeeding is not an act of bad behavior!!!

732 Concerned Citizen
Health Care Provider
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) WIC and other government programs could save money spent on providing formula to infants if they would instead encourage and support mothers to breastfeed. Each and every government organization should focus on teaching breastfeeding to pregnant moms and their partners, and providing them with support to continue breastfeeding once they start.

734 Breastfeeding Coalition Representative
Concerned Citizen
Health Professional Organization
Nonprofit Organization
Public Health Worker
State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care There is a lack of incentive to promote, protect, and preserve breastfeeding from some health care professionals, nurses, doctors ect; meaning we still haven't reached our goal to educate this as a public health message. The message needs to be clear that not only does breastfeeding need to be supported moreover, it is down right neglect by the medical community not to.

735 Lactation Professional
Paid Maternity Leave Creating a health program like that of Sweden, would improve our Breastfeeding out comes as well as a healthier community. Paid maternity leave would allow parents to breastfeed with confidence. Thank you Raina H. Snyder Nursing Mothers Counsel 4223 Starboard Court Soquel, CA 95073

736 Concerned Citizen
Support for Breastfeeding in Public Settings We need to educate public places such as restaurants and stores that telling a mother to breastfeed in the bathroom is an unsanitary option. We need to protect breastfeeding dyads' rights to feed in public or in private rooms set up for breastfeeding. We also need to educate adults and children that it's acceptable for a woman to breastfeed in public, not just tell the family that breastfeeds. There needs to be acceptance from all, not just the families who do so.

737 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Women need to be provided with materials that point out the obvious and not so obvious health benefits that breastfeeding provides to both the baby and the mother. Hospitals need to stop handing out formula bags (diaper bags with free formula samples given by the formula companies). Studies show that hospitals which do not hand out these bags have a higher rate of breastfeeding mothers when mother and baby are discharged. The mother and baby couple needs to be provided with a positive and encouraging lactation consultant. There should be enough lactation consultants on the floor so that the consultants have plenty of time to assist all mothers. They also need to be made available after the mother and baby leave the hospital in case of any troubles that may arise then, and a lactation consultant MUST be covered by insurance.

739 Concerned Citizen
Access to Lactation Care and Support Lactation consultants are a MUST and need to be provided to all mothers and covered by all insurance companies.

740 Lactation Professional
Access to Lactation Care and Support Insurance reimbursement be assured to all persons requiring profession lactation support based on a preexisting condition or an acquired diagnosis in the infants first year of life.

741 Lactation Professional
Health Professional Education, Publications, and Conferences Each post partum nurse be required to obtain at least 4.0 breastfeeding cerps at least every two years.

742 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media As a parent, I have found it practically impossible to find books, movies, videos, and other media that portray breastfeeding as acceptable and normal. Bottles abound, even in adds for breastfeeding. Breastfeeding, if mentioned, is usually negatively commented on unless the book or movie came out before 1950 or after 2000. Prejudices against breastfeeding are still being emphasized. It's truly frustrating to raise my children without them becoming confused. But I think what's worse is that there have been many places where the topic could have been raised in a respectful manner in the media, and instead they've buried the topic because of controversy and the possibility that people may become uncomfortable or they've sensationalized one area making it into a war, when it shouldn't be.

743 Community Organizer
Health Professional Education, Publications, and Conferences Many health care providers are ignorant of the benefits of breastfeeding. I knew a nurse who tried to convince her daughter-in-law that breastfeeding was going to harm her child because she ate things like pizza and soda and these things would contaminate the milk and thus the baby. Now, we all know that pizza and soda are not the best things to eat, but the value of breast milk by far outweighs the value of formula even if the mother eats an occasional cheese burger. All health care professionals should have to attend mandatory conferences to educate them on the value of breastmilk. Also, it should be in the curriculum for upcoming health care professionals to learn in their training.

744 Lactation Professional
Use of Banked Human Milk NICU's should be strongly encouraged to utilize donor banked milk in the absence of a biological mother's milk for all infants under 28-20 weeks of gestation and health care coverage for it should be provided. Donor banked milk should be offered as a viable option for all parents who request it for their babies if mom is unable to provide it herself.

745 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression It should be made a law that ALL employers must provide lactating women with a nice quiet, sanitary place to express her milk, and they must provide the woman with breaks every three hours to do so, so that her baby can have enough milk while she is away and so she doesn't lose her supply. Also, any onsite childcare would be very helpful, so that when they baby is hungry, the mother may go nurse her/him.

746 Concerned Citizen
Support for Breastfeeding in Public Settings It should be made illegal in EVERY state to tell a mother she cannot breastfeed in any place which she is otherwise welcome to be. This includes private settings as well. And there should be legal consequences for doing so. A mother needs to know she is as welcome to breastfeed her infant as a formula feeding mother is to bottlefeed hers. It is ridiculous to expect that a baby should go without eating because some ignorant adult is uncomfortable with that.

747 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Guidelines similar to FMLA that requires companies over a certain size offer 12 weeks of maternity leave, also need to provide a place for employees to pump and time to do should be considered. No employee should be discriminated for using break and lunch times to express milk for their child.

748 Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Breastfeeding should be portrayed in a completely normal light and if discussions occur regarding difficulties, they also be addressed in a solvable light. Equality of breast milk and formula should not be portrayed. The government and all government agencies should refrain for any advertisment of infant formula and not engage in any promotion thereof.

749 Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Breastfeeding support must start in the hospital. Support means taking time to work with women to be sure they understand what they are doing. Especially first time mothers can feel uncertain about how to manage the care of their baby. Nurses should be trained to use supportive language and must have better knowledge about breastfeeding. Bottles and pacifiers should not be given to breastfeeding babies in the hospital. Nurses also need more updated breastfeeding education.

750 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Many hospitals have no lactation consultant. Bottles at these hospitals are offered to the mothers for their babies, sometimes given without the mother's consent if the baby is in the nursery (even when she has specifically requested that no bottle be given.) Mothers are sent home with packages which contain formula bottles and formula advertisements.

751 Concerned Citizen
Other Areas: Breastfeeding Mom
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Prenatal care: Discuss breastfeeding support options during office visits (LLL meetings, community classes, networking early). Encouraging moms to get connected with local breastfeeding moms before delivering allows for continuity of care.

Hospital: Insurance coverage of doula support. Limit surgical interventions to emergency situations. Limit unnecessary interruptions (like newspaper delivery, testing that can wait a month, etc.) in hospital room. Breastfeeding friendly hospitals should NOT be sending mothers home with formula. Increase lactation consultant's availability.

Post-Delivery Care: Train hospital nurses/staff in listening/nurturing skills.

752 Concerned Citizen
Other Areas: Breastfeeding Mom
Access to Lactation Care and Support Insurance coverage of doula support, lactation consultants, home visits. Provide literature at prenatal visits about benefits of breastfeeding/local support/lactation consultants. Breastfeeding to almost FREE, compared to formula, so any help to breastfeeding moms should be covered by insurance.

753 Concerned Citizen
Other Areas: Breastfeeding Mom
Support for Breastfeeding in Public Settings Use the international symbol for breastfeeding to welcome breastfeeding families.

Sometimes, allocating a lactation room is helpful, but can also make moms feel as though they can only breastfeed behind closed doors.

Encourage legislation to make breastfeeding in public legal.

754 Concerned Citizen
Other Areas: Breastfeeding Mom
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Use PSA's to promote breastfeeding as the best start for babies.

Advertise in baby magazines promoting breastfeeding.

Increase the diversity of breastfeeding mothers and children in advertising.

758 Concerned Citizen
Other Areas: Breastfeeding Mother
Access to Lactation Care and Support The hospital where I gave birth did not have La Leche League even listed in their list of resources, and the lactation consultants only worked a day-shift during the week. I was fortunate to have heard about La Leche League before giving birth, and was well prepared for breastfeeding through their support. I have found the most helpful and accurate breastfeeding information from La Leche League.

759 Concerned Citizen
Other Areas: Breastfeeding Mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Don't give formula samples in the hospital. It make it too easy to give up. Also Hospitals should list La Leche League as a resource for breastfeeding support.

760 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Nonprofit Organization
Researcher
Other Areas: Medical & Nursing School Faculty
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care 1. I strongly support the WHO-Unicef

762 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Researcher
Other Areas: Medical & Nursing School Faculty
Health Professional Education, Publications, and Conferences Education STARTING at the pre-service level is important. More importantly, PRACTICE CHANGES are necessary - how to accomplish??

763 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Health Professional Organization
Lactation Professional
Researcher
Other Areas: Medical & Nursing School Faculty
Paid Maternity Leave ESSENTIAL to improving OVERALL CHILD DEVELOPMENT as well as breastfeeding rates/exclusivity.

764 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Researcher
Other Areas: Medical & Nursing School Faculty
Support for Breastfeeding in Public Settings ESSENTIAL if we are to have more sustained breastfeeding/exclusive breastfeeding in the first months.

765 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Researcher
Other Areas: Medical & Nursing School Faculty
Research and Surveillance More funding, of course!

767 Concerned Citizen
Support for Breastfeeding in Public Settings Being asked to not nurse in public breaks my heart, as I am always discreet. It's sad that giving my baby his best start is frowned upon and that the general public has been brainwashed to think it's 'disgusting' and 'leud'. It's a beautiful thing and I think we are damaging forward progress by having to keep it hidden. I'm proud to nurse my child and I want the world to know.

769 Concerned Citizen
Access to Lactation Care and Support All lactation education and consulting services should be fully covered (100%) by every insurance plan. Inability to pay should not be barrier to getting support.

770 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Training of professionals in all of these areas in regards to breastfeeding is horrible. After only a few months into breastfeeding as a first time mother it became very apparent that all of the people who medically cared for us knew less about breastfeeding (technique, problems and growth of breastfed babies) than I did. I live in an area where it is more accepted, so I shudder at the tales of women who don't. The care industry is supported and coddled too much by formula companies. Formula is too readily available and care providers don't seem to be able so voice their risks to patients. Formula samples are given all the time, but where are the breastfeeding materials? Our care providers should be voicing the true order of infant feeding: 1. At the breast. 2. Expressed milk from mother. 3. Expressed milk from donor. 4. Formula.

771 Concerned Citizen
Access to Lactation Care and Support I think there are two aspects to this: knowledge of the support and when to seek it. I think some women aren't aware that this support is separate from and better than their doctor's. They don't know who to call, how much it will cost and if insurance covers it. They also don't know when to call. It would be nice to get information either at the hospital or in a prenatal visit. It should contain contact information of specific lactation consultants and specific indicators of when to call.

Where possible it should be mandatory that a lactation consultant meet with a patient before discharge.

772 Health Care Provider
Health Professional Education, Publications, and Conferences Health Professionals need to have breastfeeding in their primary education curriculum. Over 90 percent of medical and nursing schools do not teach the basics of breastfeeding. Some pediatric residents may be lucky to get some training and the nurses may get it as continuing education after getting hired, which is very late in the education process to establish the necessary breastfeeding support of the mother-baby dyad and healthy outcomes for the newborn.

773 Concerned Citizen
Health Professional Education, Publications, and Conferences In depth training should be mandatory for pediatricians, obstetricians, and nurses with a pediatric or obstetric focus. Mandatory separate courses!

Publications need to highlight the risks of formula, not just benefits of breastmilk. Framing it properly makes a difference.

774 Concerned Citizen
Access to Lactation Care and Support As a mother of three, I have enjoyed breastfeeding, but it is not without challenges. Fortunately our income allows us to pay for expensive breast pumps and lactation consultants. I believe ALL mothers, regardless of income or social status deserve access to GOOD lactation consultants, and hospital grade breast pumps, and nutrition supplements or herbal supplements to help increase milk supply if necessary. ALL mothers DESERVE this for themself and their babies. The hospitals should STOP giving free formula, and give free lactation visits and free pump rentals until breastfeeding has been successfully established. Here in the US we have WIC to help with food and we have food stamps, formula assistance, free birth control - WHY DO WE NOT HAVE FREE HELP FOR BREASTFEEDING? Breastfeeding in the long run is MUCH CHEAPER than buying formula for 12 months, and gives babies much better immunity - less cost for health care - AND reduces mother's risk for breast cancer...etc. In the long run, the US would save money by investing in breastfeeding.

775 Concerned Citizen
Support for Breastfeeding in Public Settings There are many public places where women are harrassed or even forbidden to breastfeed. Breastfeeding is FEEDING - it is NATURAL, it is BEST - we are mammals!! Women should be able to breastfeed ANYWHERE, ANYTIME without hassle from employees or store managers. Babies need to eat often, and women have to leave home with their babies - especially single moms.

Most stores and restaurants have womens, men's, and family bathrooms, or at least a changing table. Stores and restaurants need to have a nursing room - a rocker in the nice corner of the bathroom at a minimum - or a proper little room with a rocker and a changing table - where a mom can get privacy.

If a store or restaurant does not want to provide a separate nursing area, then they should be required to adopt a policy that a baby can nurse ANYWHERE - even on the best display couch in the store - because it is a baby's right to be fed.

776 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care There are not enough mother - baby friendly hospitals. I am referring to placing a TOP priority on the mother baby bond - starting with support for less medicated birth, and including no separation for baby (unless truly medically necessary). Early bonding for baby immediately after birth has HUGE consequences on breastfeeding success. There are WAY too many PROCEDURES done on a newborn, that could be postponed by an hour or two with no adverse health effects - thus allowing a baby and mom to bond and establish breastfeeding as a FIRST not a last after the baby is upset and has undergone shots and tests and poking and prodding.

Also, prenatal care has a MINIMAL focus on breastfeeding. Breastfeeding classes should be taught and include mothers who come breastfeeding (ask for volunteers from La Leche League - they'll come!) Sitting in a class taking notes will not teach you much - you need the information and the EXPERIENCE of SEEING babies breastfeed to learn how it is done.

All moms to be, should be contacted BEFORE birth by a Lactation specialist who WILL meet with them after birth, unless they are already successful and confident in their feeding.

Too often the lactation consultants employed by hospitals are FAR below the level of knowledge and helpfulness as the private, expensive lacation consultants. This should not be - we pay ENOUGH for our doctors and hospitals, they should have the best lactation consultants!

777 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media All the magazines portray baby bottles, formula and happy babies. Even the magazines the hospital gives moms are FULL of formula feeding photos.

Advertising for formula is appalling - as it always makes it appear that formula is the norm, good and without problems. Babies do MUCH BETTER with HUMAN MILK!!

Breastfeeding should be advertised POSITIVELY and REGULARLY and especially should be advertised in every Mom magazine.

778 Concerned Citizen
Paid Maternity Leave Our country lags FAR behind others when it comes to paid maternity leave. Six weeks is not even enough time for a baby to sleep through the night! How can a mother be expected to return to work so soon, be productive and attempt to pump regularly?

We need at least 12 weeks paid leave, and then a minimum period of another 2 months where the leave is unpaid but all job benefits are held and the position remains open for the women. More women might return to work and be more productive if maternity leave was adequate.

779 Concerned Citizen
Health Care Provider
Lactation Professional
Other Areas: Former breastfeeding mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care State WIC programs provide hospital grade breast pumps to enrolled mothers with babies in a NICU or who have feeding issues making actual breastfeeding impossible or problematic; however, not all insurance companies have this coverage for NonWIC mothers and should.

780 Concerned Citizen
Health Care Provider
Lactation Professional
Other Areas: A mother who breastfed
Worksite Lactation Support, Onsite Child Care, and Milk Expression Over 50% of childbearing women are in the workforce. Not all businesses have protected time or space for employees to breastfeed a child brought to them or for breast pumping. In fact returning to work is a common reason women wean. There should be a national mandate that employers provide time and privacy for breastfeeding mothers.

781 Concerned Citizen
Health Care Provider
Lactation Professional
Other Areas: Former breastfeeding mother
Use of Banked Human Milk Use banked milk in hospital settings is promarily a decision by a baby's physician. I believe it should be an option made available to all breastfeeding mothers whose babies are in a hospital setting and additional supplementation is needed. The costs of using banked milk is expensive and should be covered by all Medicaid and private insurer plans.

782 Community Organizer
Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care *Formula bags should be removed from all hospitals; evidence shows that formula bags reduce breastfeeding success. *All hospitals should achieve Baby Friendly status. *All hospitals should employ enough IBCLCs to provide coverage for babies and moms on nights and weekend in addition to week days. *Home visits by public health nurses with breastfeeding training or by IBCLCs should be provided to all mothers within the first week of discharge, preferably several visits over the first few weeks.

783 Community Organizer
Concerned Citizen
Nonprofit Organization
Access to Lactation Care and Support Healthcare support provided by IBCLCs should be covered by insurance companies.

784 Community Organizer
Concerned Citizen
Nonprofit Organization
Use of Banked Human Milk *Use of banked human milk should be covered by insurance companies. *Creation of more human milk banks should be facilitated. Brazil has close to 200 human milk banks, we should do as well! *Hospital NICU units should offer the range of tests that moms need to undergo in order to donate milk to a human milk bank to all of their pumping moms. This way, a preemie mom who has been pumping can more easily donate any unused milk once their baby is nursing at breast. *A preemie whose mom has not pumped enough milk for her baby should be offered banked human milk before formula.

785 Community Organizer
Concerned Citizen
Nonprofit Organization
Worksite Lactation Support, Onsite Child Care, and Milk Expression *The first line approach to worksite lactation support should be in the form of a six-month paid maternity leave - most developed nations with better infant and maternal mortality rates offer at least six months, if not 12 months. *Worksite child care should be offered after this time has elapsed. *Moms should be taught hand expression techniques while pregnant. *Quality control information on pumps should be easily available.

786 Community Organizer
Concerned Citizen
Nonprofit Organization
Paid Maternity Leave * Is absolutely essential. ** The minimum paid maternity leave should be six months, ideally it would be 12 months. *** Babies need consistent, sensitive parenting. **** Baby needs to be with mom while the baby is awake, i.e. during the day.

787 Community Organizer
Concerned Citizen
Nonprofit Organization
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media There needs to be more images of nursing children with their mothers. Small babies, one year old toddlers, two year olds and three year olds. WHO recommends a minimum of two years of nursing, people need to see what that looks like. No doubt it was shocking at first to see women wearing trousers but with enough consistent exposure it's not considered that unusual now.

788 Community Organizer
Concerned Citizen
Nonprofit Organization
Support for Breastfeeding in Public Settings Anyone giving a nursing child's mother a bad time should receive a consequence. It needs to be clear, legally, that children have the right to nurse where ever they are.

789 Community Organizer
Concerned Citizen
Nonprofit Organization
Peer Support and Education of Family Members and Friends Peer Counselor training should be taking place at all WIC offices across the country. Formula should not be distributed by WIC; doing so adversely impacts this demographic's breastfeeding rates.

790 Community Organizer
Concerned Citizen
Nonprofit Organization
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) All moms should receive several home visits within the first few weeks after their baby's birth. Parents should be taught how to interpret basic newborn behavior, for example, that they need to nurse at night, that they cry to communicate discomfort, that they are easily overstimulated and so on. They should also be taught to nurse as needed for both food and comfort.

791 Concerned Citizen
Other Areas: Breastfeeding mother
Support for Breastfeeding in Public Settings People need to STOP looking at public breastfeeding in a bad way. It's natural, & it's what breasts are there for!! We need more support. I think that we should be able to breastfeed our children where ever & when ever, covered or not! I mean, we shouldn't just sit there with our boobs hanging out, but a little breast or quick glance of a nipple shouldn't matter. When we are nursing in public, we aren't standing there dancing around topless & yelling

792 Concerned Citizen
Other Areas: breastfeeding mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe all doctor's offices and/or hospitals should have Lactation Consultants on staff or within a call's reach, as well as Breastfeeding classes and follow-up. I think a lot of women, especially younger women, may not understand or know about all the benefits of breastfeeding, or at times they may struggle with or have problems breastfeeding and they give up prematurely because they don't have experience or someone they can call about their particular situation.

793 Concerned Citizen
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Encourage health professionals to educate women on the benefits of Kangaroo Mother Care (KMC). My daughter came 1 month early and was jandiced. I practived kangaroo care and breasfed often in those early days. Her condition improved and we were both discharged. I practiced KMC because I knew it was the right thing to do. The doctors and nurses (save the lactation consultant!) NEVER instructed me that I could do this and all I could think of was what if I didn't already know? Why wouldn't they tell all women they can do this, ESPECIALLY the ones in my situation. We rely too heavily on NICU's and incubators, when those hi-tech solutions DO NOT promote mother/infant bonding and breastfeeding!

794 Concerned Citizen
Public Health Worker
Use of Banked Human Milk I had to throw away TONS of pumped milk, because I was not eligible to donate. I was told it was because I had lived in Africa?! I was a Peace Corps volunteer and served in West Africa in the mid-1990's. In order to join and upon completion of service, all peace corps volunteers are tested for HIV. Unless, there are other concerns about this, this rule should be reviewed.

795 Concerned Citizen
Public Health Worker
Paid Maternity Leave WHERE DO I EVEN BEGIN WITH THIS ONE? I will not recount the stats that put the US dead last in terms of supporting our working women. I have taken TWO unpaid maternity leaves during my career and it has seriously strained my family's finances. I am considering a job with the USG and am excited about the opportunity. HOWEVER, the United States government (USAID in particular), DOES NOT provide a paid maternity leave for its employees. THIS IS ABSOLTELY UNACCEPTABLE.

796 Concerned Citizen
Public Health Worker
Access to Lactation Care and Support Provide funding for WONDERFUL AND INDISPENSIBLE organizations like the Breastfeeding Center of greater washington (in DC). It holds free classes and subsized consultations with the on-site lactation consultant. GIVE THEM SOME MONEY,,,THEY ARE DOING WONDERFUL THINGS!!!

797 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I think that the ad campaign was poorly constructed. Negative images of pregnant women taking outrages riska and subtle images invoking breasts with risks of not breastfeeding- did not appeal to the public. A better way to promote breastfeeding would have been that of images of women and children breastfeeding naturally, comfortably and in a way that shows how it can be done in public, with out revealing the womans breasts and with out being a burdon to her- also healthy happy breastfed babies- and maybe contradict with showing formula fed babies with runny noses, eczema, asthma, pneumonia hospitalization obesity etc...

800 Employer
Worksite Lactation Support, Onsite Child Care, and Milk Expression It is still a major problem that most employers do not supply a private, non bathroom setting with a locking door for a woman to express milk. This makes it extremely difficult for a working mother to maintain milk and express milk in any efficient way.

Perhaps some way for a given office building to pool resources across all tenants and get together to offer these types of accomodations?

801 Employer
Paid Maternity Leave Why not find a way for women who will take maternity leave to work extra time and bank hours/leave toward paid leave? The companies would benefit from extra work being performed and would merely be paying for that work later in the form of leave.

802 Other Areas: Nursing Student & Mother
Other Areas In my opinion, the ten most important actions, that must be taken immediately, to promote breastfeeding in the U.S. are:

1. Allow mothers and babies, unless a medical emergency occurs, to spend the first hour after birth together. 2. No infant should be given supplemental sugar water or formula, unless the mother requests it. 3. Preemie babies need breastmilk and human contact as much as, or more than, full-term babies. Hospitals should be required to allow these best-health practices. 4. The c-section rate must be lowered! Mothers who deliver by surgical means, statistically, have a harder time with breastfeeding. 5. Mothers should not be sent home from hospitals with bags of formula samples! 6. Eight weeks of paid leave plus four additional weeks of unpaid leave should be given to all new mothers. 7. Fathers should be given two weeks of paid paternity leave; this would allow for new mothers to have support during the crucial first days of breastfeeding establishment. 8. Every state should have laws protecting mothers' rights breastfeed in any public place they have the right to be in and should be able to take legal action if this right is suppressed. 9. WIC programs should discontinue the practice of giving free formula to women who are capable of breastfeeding. This is a waste of taxpayers' money and is unhealthy for the mothers and babies who receive this

803 Other Areas: Breastfeeding Mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care There seems to be a lot of importance on the prenatal and hospital stay part of these practices for the mother. I noticed that they drop the ball on the post delivery care for the mother and the child. There is no national standard in place to check up on any new mothers right after birth. That is a overwhelming feeling to be a new mom and I think more education and home visits to the new mothers home would be great to put in place. It would answer a lot of questions new moms have and that there would be an increase in breastfeeding.

804 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As an IBCLC, my clients are typically 1-3 weeks postpartum. They see me because of the mistakes that were made in the hospital, starting with a very high cesarean rate to almost universal formula supplementation to receiving inaccurate/outdated information from the staff, including the lactation staff. The clients I see are the ones who chose not to quit from all the frustration and pain they experienced unnecessarily, AND could afford the services of a private consultant; how many others gave up?

805 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Nonprofit Organization
Access to Lactation Care and Support As an IBCLC, my clients report that they had to repeatedly request lactation help during their hospital stays; breast pumps were difficult to obtain and were not properly explained; and the lactation care that they did happen to receive was almost always rushed, poorly timed, and often more confusing to the mom than helpful. The moms are being taught very bad technique that results in painful latch, poor milk transfer, low weight gain, low milk supply, formula supplementation, and high breastfeeding failure. I believe that this is the main reason that our breastfeeding initiation rate is high, but most of those couplets wean in the first few weeks.

806 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Health Professional Education, Publications, and Conferences As an IBCLC, my job is to provide education, information, support and encouragement to breastfeeding mothers and babies. It's so frustrating when I offer accurate, current, evidence-based information to my clients, but they are reluctant to believe my information when their pediatrician or OB provides conflicting information that is outdated, opinion-based, and usually detrimental to the breastfeeding relationship. I am required by my certification to remain current in breastfeeding information, yet doctors are allowed to go around spewing whatever thoughts or ideas they scrounged up. Many health care providers are biased toward formula feeding and push formula when breastfeeding problems arise, rather than urging the mother to get help with her breastfeeding problems. Doctors really need to get on board with the AAP, who urges mothers to exclusively breastfeed for the first six months, etc. Add in the WHO code as it relates to the marketing of breast milk substitutes, and we would have a much healthier USA.

807 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression An area that would help promote breastfeeding for working lactating mothers, is mandatory areas for milk expression and the time needed to do it. Many mothers are not given this opportunity and it makes it much more difficult to pump during working hours if expression needs to take place somewhere inconvenient or less than welcoming. Women who have to resort to restroom stalls, storage closets and cars are much less likely to continue breastfeeding. In addition, lactating mothers have different expression needs. Babies are individuals too and aren't necessarily on feeding schedules that are every 3-4 hours. Therefore, mothers that are only given time during meal hours may be forced to have a lower milk supply because they are unable to express milk as often as necessary to keep up the needs of their baby/babies.

808 Concerned Citizen
Paid Maternity Leave Maternity leave is a vital time for mothers to recuperate from labor and delivery, connect and bond with baby/babies, and adjust to a major life change. From first-time mothers adapting to breastfeeding, to a mother having subsequent children and the challenges of a growing family, time off after birth is imperative. Most mothers and/or families cannot afford to have extended unpaid time off. Employers should realize that paid maternity leave, or even partially paid leave, is not just a financial issue. Employees will have more job satisfaction and the future generation of the working population will be getting the best start possible. Additionally, it would be helpful to have paid leave that coincides with the Family Medical Leave Act. Every woman should be granted the opportunity to be home after the birth of a child for 12 full weeks if desired. When other developed countries offer citizens 6 months and more of leave and paid time off, it seems that the United States should be more than able to provide women with 3 months. Furthermore, paid leave should also be available to mothers that work part-time as well even if it is partially paid.

810 Community Organizer
Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Your only choice for having birth with a birth attendant with Dr. or midwife is in the hospital birth were you have almost 0% chance of walking out with a healthy baby and 30-40% chance of having a major operation. The best way to start breasting feeding right is to have a non medicated natural birth of a healthy baby. CMPs have great stats for helping women to have natural non-medicated births. These baby are born healthy alert and ready to do their part to making breastfeeding a success! Encouraging states to pass legislation when it comes. Almost all states have asked for some sort of licensing, not even half have passed.

811 Community Organizer
Concerned Citizen
Nonprofit Organization
Paid Maternity Leave I see to many women worrying about going back to work and how they will juggle pumping, working, and taking care of new baby not to mention finding quality daycare for a newborn. I think we need to look at how other countries help families take care of there youngest citizen. I am not asking for a nanny, but maybe a longer paid maternity leave. Full pay for 8 weeks. 75 % pay for the next 2 months, 50% pay for the next 4 months 25 % until the baby is a year . One of two things will happen families will learn that they can live on less and parents will be raising there children. We will have older babies going into daycare. (As former daycare provider I can tell you that the older a babies is the easier on everyone) or families will see they really need a job and go back to work before the 6 months. We are spending this money already between daycare assistance and medicaid. Why not let the person best equipped for the job do the job and give her a little money to make it work.

812 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Workplaces should be required to provide clean, private space for mothers who need to pump or breastfeed. Like many women, I found myself in a grimy bathroom with a manual pump - very unpleasant and questionably sanitary.

813 Concerned Citizen
Other Areas My grown daughter is a 3rd generation breast feeder.She and her husband have 3 children,ages 5, 3,and 1.Circumstances have now placed into her life 2 more children, ages 3 and 1.They are her husbands niece and nephew.The one year old has only known formula.My daughter is standing by her convictions to breast feeding, and is now pumping to give this little boy all the benefits of breast milk.Her own one year old has been weaning, so her milk supply has been on the decline.Fortunately her friend has had a baby in the last 5 months, and has a reserve of breast milk in her freezer and is willing to share until her own breast milk increases again. I am incredibly proud of the fact that my daughter refuses to give in to polluting this little boy with what his own mother has thought to be the way to feed a child.I have often wondered about moms who claim to not have enough milk, along with other various excuses as to why they with held breast feeding from their babies. This has not been easy for my daughter and son in law, quite the contrary.They are completely exhausted, and yet refuse to give in to the easy way of feeding this precious little boy.Bottling a new baby should not be an option for parents.My children were raised believing that bottles had no place in the home,even for pretend.Parenting is not an easy endeavor.Breastfeeding can sometimes be a challenge.With all of the new ways of researching parenting and what is best for your baby, no mom needs to pollute her baby with infant formula.I see that as an incredibly selfish and ignorant form of abuse on a helpless human. So new moms and dads, go ahead and do what you must,but know this, when I see you bottling your baby in public, I will be seeing abuse to an infant.I know that this is very harsh, but it is time to take a stand on this issue.

815 Concerned Citizen
Nonprofit Organization
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Too often complementary programs have lukewarm support of breastfeeding. Breastfeeding impacts so many areas--education, health, and even rates of child abuse. I think it would really help for women to get a consistent message about the importance of breastfeeding and to be able to be referred for help when needed.

816 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I am an American citizen who has been living in Copenhagen, Denmark for the past year and a half. I consider myself very fortunate to have given birth in a Danish hospital which has the WHO Baby-Friendly certification. (See http://www.who.int/nutrition/topics/bfhi/en/index.html for complete text on the guidelines.) I wonder why hospitals in the U.S. do not follow these same principles? Thanks to the WHO Baby Friendly guidelines, I believe I had a very good support in becoming a successful breastfeeding mother.

I think the single most important guideline that U.S. hospitals need to adopt immediately and wholeheartedly is compliance with the international code of marketing and breast-milk substitutes. In a nutshell, free samples of baby formula should not be distributed in a hospital or in pediatrician's office. Further, even nipple shields or pacifiers can be a hindrance to developing good breast feeding practices in the crucial hours and weeks after birth; hospitals should not give these out under any circumstances.

Next, I think it is extremely important that a newborn child be given the opportunity to breast feed from its mother immediately following birth. In my case, the hospital staff placed my daughter on my chest, helped me guide her to my breast, and allowed my baby and I to explore breastfeeding in an unpressured setting for the first two hours after birth. Weighing, cleaning, etc. was postponed until after the first feeding, and all procedures were conducted in the same room with mother and father present. The baby was never whisked away to a nursery for or other location for any reason; she was in my immediate care for our entire 48-hour hospital stay and I was encouraged to feed the baby on-demand around the clock so that my milk supply was quickly established.

I know new mothers who unfortunately did not receive the same type of hospital care and guidance. They were given nipple shields, ointments and pacifiers at the hospital, and their babies were not able to establish good suckling wit the breast. In other cases, the baby was not able to have a first feed with its mother immediately after birth. It then became an uphill battle to teach the baby how to suckle in the days after birth.

The birth process should be viewed by hospitals as a natural event, not a sickness needing to be treated, and as such mothers should be given plenty of time and support to develop positive breast-feeding practices with their children. I hope my comments will help the US to develop more baby-friendly practices so that other new mothers can have the same positive experiences with breastfeeding that I have had.

Sincerely, Jane Olson US Citizen Copenhagen, Denmark

817 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care A lactation consultant should be available for EVERY hospital birth. Some hospitals (where I gave birth) use their nurses who have a variety of different opinions and are not specifically trained to help new moms learn to breastfeed.

818 Concerned Citizen
Nonprofit Organization
Peer Support and Education of Family Members and Friends I believe that in populations with low breastfeeding rates, an effective way to change is for women to get support from friends and family, and from their peers. Peer counseling programs are a great way to help women who have successfully breastfed help other women breastfeed also.

819 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Nonprofit Organization
Researcher
Use of Banked Human Milk There is great opportunity to expand human milk banks in this country. I believe the greatest resistance to using banked milk is the lack of understanding of its safety. The government needs to put out a statement supporting its value and safety. Only then will the administrators and neonatologists in our Baby-Friendly certified hospital agree to purchase, store and use banked milk. I believe that in situations where babies need supplementation in the hospital, supplementing with banked human milk would greatly encourage mothers to work thru those early feeding challenges and ultimately provide their own milk. Many women give up when they see the bottles of formula appear for their babies in the hospital. The formula undermines their confidence, especially in hospitals that provide poor lactation support. I did a survey of pregnant women in our community in 2006 regarding interest in banked human milk. The majority of women (62%) replied that they would either prefer banked human milk or use banked human milk if recommended by the physician if their babies needed supplementation in the hospital. Interestingly, more than 70% of all women surveyed answered that they would be willing to donate some of their milk. The greatest concern among the pregnant women surveyed was safety of the milk. This is the same concern that I have heard from physicians and administrators in our hospital. Now is the time to move forward with this relatively untapped resource by providing funds for more research and a government statement about safety

821 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Researcher
Other Areas Pharmacists in most major pharmacies are still using the PDR for drug information on breastfeeding. Unfortunately, women are often told to 'not breastfeed' by pharmacists when this information is absolutely not true. This is unethical medical practice. A recent example is a lactating woman for whom I provided a clindamycin prescription. She was told by the pharmacist that she should not breastfeed while taking the medication! Something needs to be done to teach pharmacists lactation physiology and appropriate resources for drug information during lactation. And, if pharmacists believe that a woman should not breastfeed while taking a certain drug, they should contact the physician who wrote the script. This sort of advice is not appropriate for a pharmacist to give casually to a patient. It should be handled in the same way that an allergy is. If a patient has an allergy to a med that is prescribed, the pharmacist calls the doctor to find an alternative for the patient.

822 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Use of Banked Human Milk With current childbirth practices, it seems that many babies lose at least 10% of their birth weight, and parents are told that they must supplement. If only babies were supplemented with banked human milk instead of formula, the risk of diabetes could be lowered, and babies would be healthier. It would also emphasize, to parents, the importance of human milk and the risk of formula! If supplement were given with spoon, tiny cup, or dropper, it would decrease the risk of nipple confusion.

823 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Health care professionals should be strongly encouraged to put newborn baby on mother's chest and let him/or her self-latch!

824 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Paid Maternity Leave A year's paid leave, with a guaranteed position at the end of that period, would go far to promote breastfeeding and good mother-baby bonds! It would be *so* much better than pumping rooms at work!

825 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Portraying breastfeeding as the norm and any *other* infant 'food' as far inferior is important. Stop selling dolls with bottles attached! They promote the idea, from the beginning, that feeding babies = bottles! Show more breastfeeding mothers/babies on Sesame Street and other children's shows!

826 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Lactation Professional
Other Areas Strongly encourage all hospitals to follow 'Breastfeeding Friendly' guidelines!

827 Public Health Worker
Worksite Lactation Support, Onsite Child Care, and Milk Expression Returning to work has been linked to reduced breastfeeding duration (Fein, Mandal, and Roe, 2008).

Feeding the infant directly at work and pumping at work have been shown to promote increased intensity (number of breast milk feedings versus supplemental artificial baby milk feedings) and duration of breastfeeding, with feeding the infant directly being the most effective practice for both increased intensity and duration (Fein, Mandal, and Roe, 2008). Of the women who stopped breastfeeding when their infant was between three and five months of age, 21.3 percent – or one in five mothers – said they could not or did not want to breastfeed at work (Li, Fein, Chen, and Grummer-Strawn, 2008).

Actions Desired Congress should enact legislation that supports breastfeeding and/or pumping at work. Baby-Friendly Workplace legislation should contain the following points for businesses to follow: 1.Providing unpaid breaks as needed for milk expression, 2.Making accommodations for privacy when pumping, 3.Providing a source of clean water, and 4.Providing a place for milk refrigeration (Wilson-Clay, et al., 2005).

When possible, employers should support direct breastfeeding of children in the workplace. It is acknowledged that having access to the infant at work may be difficult or even dangerous, and not all occupations lend themselves to breastfeeding or pumping in the workplace. In these extreme situations, companies could be exempted from the legislation.

Legal Precedent for Desired Action (National Conference of State Legislatures, 2008) Other states have laws or resolutions that promote, encourage, or protect breastfeeding in the workplace. A summary of those legal actions follows: Twenty-five states, including Arizona, protect breastfeeding from any claims of public indecency. California, Colorado, Connecticut, the District of Columbia, Georgia, Hawaii, Illinois, Indiana, Minnesota, Mississippi, Montana, New Mexico, New York, Oklahoma, Oregon, Puerto Rico, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington and Wyoming all have laws or resolutions that either encourage or require employers to provide breaks, privacy, and/or refrigeration facilities to breastfeeding mothers. Texas, Florida, and Washington allow a “mother-friendly,” “baby-friendly,” or “infant-friendly” designation to be used by businesses that agree to abide by certain provisions that support breastfeeding.

Arguments Against Breastfeeding in the Workplace Many employers might not support mandated support for breastfeeding in the workplace for a variety of reasons: disruption to work and staffing schedules and costs to provide privacy and refrigeration being two of the major concerns. However, for every dollar spent on breastfeeding, companies save three dollars because women return to work earlier and take fewer sick days, while staff turnover is reduced (American Public Health Association, 2007). Unpaid breaks for breastfeeding or pumping can be rolled into already scheduled breaks during the workday, thus minimizing workplace disruption.

Conclusion Nearly half of all states (21 out of 50) support breastfeeding in the workplace, which shows political will, but more should be done. Because of the health, social, and financial benefits, Congress should develop legislation to strongly support and protect breastfeeding in the workplace.

Robin Tucker-Falconer, MS, RD

828 Lactation Professional
Access to Lactation Care and Support As a Lactation Consultant with over 20 years of working in hospitals and in private practice, I can say that new mothers are not getting the lactation help they deserve. There needs to be more baby friendly/mother friendly atmospheres in doctors' offices, hospitals, work-places, and the community in general.

829 Concerned Citizen
Health Care Provider
Other Areas: Social Worker
Worksite Lactation Support, Onsite Child Care, and Milk Expression I work at a hospital with no lactation support for employees...I had to beg and borrow rooms to express milk in. I think that supporting women's breastfeeding when they return to work would really increase the amount of women who continue pumping after their maternity leave is over. Longer maternity leave or even paid maternity leave would also be a huge help. Breastfeeding is amazing for the mother and the child, but it is also a struggle when you have no support from your employer-if a hospital doesn't provide support how do we expect other companies too??

830 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Evidence based quailty care is strong when making protocols and practices in the hospital setting. Evidence based quality care does not mean that one person tells you one thing and another person tells you another. Quality care in the field of breastfeeding means that you have been educated and know evidence that you are basing your teaching on. Good evidence based research is out there and the health professional must be on top of his/her game to make quality breastfeeding decisions. A MD ordering supplementations based on weight loss only is not providing quality or evidenced based healthcare decisions. Looking at the big picture;is your milk in?, how is the infant breastfeeding?, what is jaundice level, is the infant waking to eat and eating well at the breast? Quality care should be to order a IBCLC consult rather then ordering supplementation.

832 Health Care Provider
Research and Surveillance Anyone making guidelines or protocols in the field of breastfeeding should have an IBCLC on the committee. The AAP just published a Safe and Healthy Beginnings pack for the clinician on breastfeeding and jaundice. Their expert team DID NOT have an IBCLC on the team. Did the expert team use the best and most up to date practices in the field of lactation?

833 Concerned Citizen
Health Care Provider
Public Health Worker
Paid Maternity Leave I feel this is something our country needs to embrace. Other civilized nations manage, we can too. How much happier our family would have been without the monetary pressure of having to run right back to work and attempting to pump enough to feed the baby.

834 Employer
Health Care Provider
Health Professional Organization
Lactation Professional
Public Health Worker
Researcher
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Critically important, especially important to educate perinatal clinicians and to eliminate formula industry from this area.

835 Concerned Citizen
Employer
Health Care Provider
Health Professional Organization
Lactation Professional
Public Health Worker
Researcher
Access to Lactation Care and Support Needs to be improved with emphasis on access for women who cannot afford private care. WIC does not take care of all these women. Many women may not qualify for WIC but cannot afford private support.

836 Employer
Health Care Provider
Lactation Professional
Public Health Worker
Researcher
Health Professional Education, Publications, and Conferences Needs increased funding. There are no resources to support this critical work.

837 Other Areas: LLL Leader
Support for Breastfeeding in Public Settings It is appalling that in our country today women are vilified for breastfeeding in public - last week a woman was escorted out of a mall in Cherry Hills New Jersey for breastfeeding her baby in the mall. That same mall carries clothing which reveals far more breast than this woman was while she nursed her baby. NJ has a law which allows women to breastfeed wherever she is allowed to be otherwise, yet mall personnel felt compelled to remove her from the premises because she was using her breasts for their primary function. We have to change this attitude that nursing is somehow obscene or disgusting and normalize it by portraying normal nursing in the media and public life.

838 Employer
Health Care Provider
Public Health Worker
Researcher
Research and Surveillance Both areas need focus. Apart from CDC sporadic funds, there is NO dedicated funding for breastfeeding. Surveillance is critical. Without reliable data research is meaningless.

840 Other Areas: postpartum doula
Paid Maternity Leave The barriers to successful breastfeeding in the United States are wide ranging. We lack role models (positive images of successful breastfeeding), appropriate lactation support in our medical institutions, poor access to home birth, and the list goes on. The majority of US mothers cannot rest and establish their milk supply and bond with their babies because they are under such intense pressure. Even before they give birth they anticipate their return to work or worry about how they will manage when their salary and benefits disappear. Many times their carrier track, all they have worked for, is lost when they make the choice of staying home over returning to work after a very short maternity leave. It is really obvious to me as a postpartum caregiver working with new mothers that we are shamefully behind in supporting families when compared to European, Scandinavian and many other countries. I am not a scholar or statistician. The statistics of how the US ranks in maternity leave (paternity leave too) is outline in the film “Motherhood Manifesto”, a devastating look at how we value motherhood as a nation. Breastfeeding is a job. It is a time consuming job and for many, a challenging job. It a woman’s work and we do not honor women's work and compensate women for this uniquely feminine function that is ideal for nourishing newborns and babies. We need to support (with paid leave and medical benefits) women and their families better in the first year of life after the birth of a child. This will go very far in increasing breastfeeding rates in the USA. Karen Fleischer, Postpartum Doula, Kensington, CA, -- Metta Doula Service

841 Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Other Areas The research has been done. We all know that breastfeeding is best and needs to be supported. We have to reach Kathleen Sebelius and Michelle Obama. Change needs to come from the top in order to have any real effect on policy and people's lives.

843 Health Care Provider
Paid Maternity Leave Mothers and infants need to bond longer then 6-8 weeks. Infants need to breastfeed for a year.....how can they if their mother has to go back to work. Lets pass the “Federal Employees Paid Parental Leave Act of 2009,” H.R. 626...at least that would be a start.

844 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Support Ban the Bags campaign. All hospitals must jump on this campaign.

845 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Please end the practice of giving free infant formula to mothers through WIC. I know some people think it helps, but it is really a detrimental program. Kids in low income households already face enough disadvantages, breastfeeding would give them such a leg up in life. Their mothers shouldn't be encouraged to formula feed through this free supply of artificial baby milk through WIC. Instead, all resources should be focused 100% on making breastfeeding, or donated human milk, available for these needy babies.

846 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression With the fast growing segment of moms in the workforce today than ever before and returning to work earlier in this uncertain economy, I would like to see more employers provide a space to accomodate mothers continued milk expression after they return to the work-site. The outcome will be a win-win-win for the employer/employee/baby. Companies currently providing a space for mothers to express their breastmilk report increased work production, employee satisfaction and morale and retention, decrease call-outs,employee turnover and health insurance costs. This powerful work-site benefit can be implemented as a part of Employee Rewards Program. Annually each state/locality can publicly recognize new businesses that support breastfeeding. B. White, Lactation Specialist

847 Concerned Citizen
Health Care Provider
Nonprofit Organization
Paid Maternity Leave I think breastfeeding mother will benefit for up to 6 month paid leave. 6 weeks maternity leave it’s not enough, a lot of mothers dropping breastfeeding while returning to work.

848 Breastfeeding Coalition Representative
Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Most hospitals provide *very* conflicting information on nursing. Hospitals with lactation consultants tend to have them on bankers' hours -- babies born on weekends are out of luck. I talk to many mothers as a La Leche League Leader, and most of them have problems because of uneducated advice given to them after delivery. If the new mom and dad aren't prepared to be extremely strident in their wishes, they are virtually guaranteed to go home with a bottle-fed baby.

849 Breastfeeding Coalition Representative
Concerned Citizen
Paid Maternity Leave Countries with higher breastfeeding rates and durations universally have longer paid maternity leave. See Norway, Sweden Finland, etc. Moms who must leave their babies at six weeks have a difficult time keeping up their supply and keeping up their milk supply.

852 Lactation Professional
Access to Lactation Care and Support Services of an IBCLC should be covered under health insurance just as other ancillary care services (PT, SLP) are covered.

853 Community Organizer
Concerned Citizen
Nonprofit Organization
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media PLEASE PLEASE PLEASE ASK MICHELLE OBAMA IF SHE BREASTFED AND ASK HER TO PUBLICALLY COMMENT ON HER EXPERIENCE. IF SHE DID BREASTFEED AND IS WILLING TO WADE IN TO THIS TOUGH ISSUE SHE COULD BE THE NEXT PRINCESS GRACE (WHO I BELIEVE SPOKE AT ONE OF THE FIRST LA LECHE CONFERENCES MANY YEARS AGO AND NURSED HER CHILDREN) AS FAR AS REIGNITING INTEREST IN INITIAIING BREASTFEEDING AND SHE MAY BE ABLE TO REACH WOMEN OF DIVERSE BACKGROUNDS AND SOCIOECONOMIC STATUS AND WORKING WOMEN.

EVEN IN THE EVENT THAT MRS OBAMA DID INITIATE BREASTFEEDING AND DID NOT CONTINUE OR HAD TROUBLE, IT WOULD BE SO IMPORTANT TO HAVE HER SPEAK OUT BECAUSE IT IS A GREAT OPPORTUNITY TO EDUCATE THE PUBLIC.

IT SEEMS TO ME THAT THIS ISSUE INTERSECTS SO NICELY WITH SO MANY OF THE ISSUES THAT MRS OBAMA HAS STATED INTEREST HER IN TERMS OF THE WORK SHE WOULD LIKE TO ACCOMPLISH AS FIRST LADY....IE, SUPPORTING WORKING FAMILIES, THE FOOD SUPPLY, IMPROVED HEALTH OUTCOMES/LOWERING COSTS FOR OUR HEALTHCARE SYSTEM. iWONDER IF AS PART OF HER TOUR OF THE AGENCIES IF SHE WOULD ENTERTAIN THIS IDEA AND GETTING THE WORD THROUGH TO THE PUBLIC ABOUT THE IMPORTANCE OF BREASTFEEDING. I HOPE THAT WHEN SASHA AND MALIA HAVE BABIES THEY WILL NOT CONSIDER ANY OTHER WAY TO FEED THEIR BABIES.

THANK YOU

854 Concerned Citizen
Paid Maternity Leave The facts are there if we just look, the USA has one of the worst breastfeeding rates in the world, and the shortest paid maternity leave in the developed world. It is a very obvious link. What is more valuable, our children, or business? When we invest in people, it comes around to better business too, unfortunately we have all been told otherwise. The USA is supposed to be wealthy, so how can people argue that we can't afford a long maternity leave? That business would suffer and so would our wallets? Other countries afford it just fine (Canada for one) and they are poorer in the first place! There is no argument that holds water, what we save in short maternity leave we pay in medical bills, look at the statistics for breast fed and bottle fed babies, we are buying drugs, Dr. visits, and hospital stays for all those formula fed babies!

855 Concerned Citizen
Use of Banked Human Milk It would be good if this was more accessible in every way. I produced buckets of milk with my first son and would have made a great donor, but didn't know how to, and didn't know who to talk to or what to do. Also, new Mom's are often overwhelmed, so streamlining it to be as simple as possible would be a great advantage (getting any testing necessary done before the birth?).

856 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Breastfeeding desperately needs to be normalized in the media. It is a perfectly normal and natural thing to do. Why is it ok to show women in VERY low cut tops or revealing bikini's but not discreetly breastfeeding? In our media it is ok to show highly sexualized breasts, but showing them doing their most basic and normal function -feeding a baby, is somehow wrong? It is our culture that is wrong, what are breasts, sex objects or body parts that are biologically for nourishing our young?

857 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As a mother, a professional nurse, and now a Pediatric Nurse Practitioner, I find that a key to successful breastfeeding is during the initial postpartum period (the initial 48 hours after giving birth). Also, the following 2 weeks after discharge from the hospital.

I think breastfeeding is a public health issue. If we look at England, nurses continue to take care of the community like the US used to do.

I believe we need to bring nurses back to the community and support our breastfeeding mothers and promote the duration of breastfeeding.

As a mother, I needed someone to tell me that I was doing it right. It is very stressful to continue to do something when you think you are not doing it correctly.

As a former home visiting nurse (I conducted postpartum home visits to all women in a community hospital in IL)most women could not wait for the nurse to visit. They were overwhelmed, stressed by dad's and grandma's advice.

As a pediatric nurse practitioner so many women are needlessly supplementing with formula. There is a gap in knowledge with many women about milk supply, they are not aware the importance of nursing on demand, as well as many of the other benefits that breast milk has.

858 Concerned Citizen
Support for Breastfeeding in Public Settings I wholeheartedly support breastfeeding in public settings, Mothers need to be supported to do their job! Mothering is hard work!

859 Concerned Citizen
Peer Support and Education of Family Members and Friends I think Mom's need to be encouraged to talk about what they do, why are we not educating girls and young ladies about good mothering skills? We are teaching all sorts of information to kids these days but very few real life skills. It is almost like breastfeeding is the taboo topic of our century, sexuality is freely discussed but nursing babies is not?! I am a breastfeeding advocate and freely talk to all who are interested, unfortunately that is very few people, but the ones I have talked to are glad that we did.

860 Concerned Citizen
Health Care Provider
Paid Maternity Leave It would be nice to see the US achieve parity with other developed nations in this area. The lack of paid maternity leave is shocking in this country.

862 Concerned Citizen
Research and Surveillance Not sure what is wanted here as far as comments go but I just like to mention that truly there is very little research needed, the entire history of the human race depended on, and successfully populated the earth powered on breast milk. We don't need research to tell us that what our bodies naturally make is better than anything that man can make, we don't even understand all the details of breast milk yet, the complexity escapes us. Why replace something that is perfect with something that is not? Not to mention the expense, time, and health risks involved. The evidence is all there....

863 Community Organizer
Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care mothers need to have the opportunity to birth in water, information about risks of medications during labor on breastfeeding, and a doula provided as standard procedure. babies need Baby Friendly care providers.

864 Community Organizer
Concerned Citizen
Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Prenatal care should include breastfeeding information presented as a health care choice, not merely a feeding choice. All the emphasis is placed on the birth rather than care for the infant. The delivery takes hours, breastfeeding benefits last mother & child a lifetime. Infant formula should be provided by prescription. Hospitals should have resources in place to provide each post partum couplet with in patient & out patient access to breastfeeding assistance. Policies should support & reinforce the breastfeeding pair and providers, especially the pediatricians should be required to complete ongoing continued education in terms of new research on breastfeeding. Hospital beds should be configured to allow moms & babies to sleep together, skin to skin as desired.

865 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Health Care Provider
Health Professional Organization
Lactation Professional
Access to Lactation Care and Support Health insurance companies should cover the costs of lactation consultant visits, breast pump purchases or rentals, or at least give discounts for those who breastfeed their babies. Every woman who returns to work should be given a private, clean, secure place to pump & store her milk without fear of reprisal or harrassment.

866 Concerned Citizen
Other Areas: Working Mother
Paid Maternity Leave As a working mother, I feel that our current maternity leave system is unacceptable. Basically if a new mother can afford to take unpaid leave and if she and her company meet the requirements, she can take 3 months off unpaid. Others, unfortunately only end up with 6 weeks (if that)of short term disability and sometimes that too is unpaid. My mother worked with someone who came back to work at 2 weeks post-partum. Based on my experience, 6 weeks is not enough time to establish a good breastfeeding relationship with a new baby. I remember when my son was 6 weeks, I was still having many breastfeeding issues including lots of pain and soreness and luckily I was able to take off my unpaid time (I had 18 weeks total) and those issues finally were resolved a few weeks later. My supply was still establishing itself as well. I feel that if the new recommendations are to exclusively breastfeed for 6 months, then we need our economy, government and private companies (large & small) to support that. Ideally a minimum of 6 months should be given and in order to encourage more women to use that time off, it should be paid. Whether the whole 6 months is paid should be up to the government to institute a fair policy, so all women, whether they work at large or small companies can take advantage of it. Also I think its important to have some sort of transition period back to work, like allowing the employee to work reduced hours for a few weeks so its not a shock to her or the baby to be separated all day. For me, returning to work full time after being off for 4 months was extremely difficult especially since he was still so young. I cannot imagine going back to work in a high demanding job after only 6 weeks off. A 6 week old still needs his mother. A comparison study should be done comparing breastfeeding rates with countries with no paid leave versus those who give several months or a year of paid leave.

867 Concerned Citizen
Other Areas: Working mother
Worksite Lactation Support, Onsite Child Care, and Milk Expression In order for the mother to continue breastfeeding after going back to work, better laws need to be put in place in order for her to be able to pump without fear of losing her job or just getting flack from other co-workers for taking breaks during the day. I count myself very lucky that my company has mothers rooms for pumping and so far I have made good use of it, by being able to pump 2x per day with support from my supervisor. My son is nearly 8 months old and I feel happy that I am still able to pump enough milk for him. Others, however aren't so lucky. I good friend of mine, only had time to pump at lunch and she had to use the bathroom and her outcome was unfortunate in that her supply dropped very quickly and she had to give her son formula at 3 months old. I encouraged her to talk to her boss, but given that she had just started her new job, she said she was afraid of losing her job. I felt so bad for her. I get upset every time I read a news article where the mother is forced to pump in a bathroom or is not allowed to take pumping breaks. A lactating woman needs those breaks to express milk since it does get uncomfortable and can lead to plugged ducts or mastitis (missed days of work)if one hasn't pumped in awhile. State laws and federal laws need to be updated to include worksite milk expression for working mothers in order for them to continue being able to feed their baby breastmilk.

869 Concerned Citizen
Access to Lactation Care and Support Please require all healthcare professionals to distribute pamphlets for groups like Le Leche League International. Give more taxpayer dollars to Le Leche League. Defund Planned Parenthood.

870 Concerned Citizen
Health Professional Education, Publications, and Conferences Raise awareness among healthcare professionals of the superiority of breastmilk over infant formula. The vast majority of the healthcare industry is unaware of or UNCONCERNED with these facts.

Please require all healthcare professionals to distribute pamphlets for groups like Le Leche League International. Defund Planned Parenthood.

871 Concerned Citizen
Use of Banked Human Milk Raise awareness of the availability of banked human milk. I attended many prenatal classes and read extensively on birth and childcare including pro-breastfeeding material. However I remained completely unaware of human milk banks, and I would have donated milk if given the opportunity.

872 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I think that every health professional working on the delivery ward (at least) who interacts with the post partum mother MUST be trained and up to date on breastfeeding (establishing a latch with any nipple shape or breast size, when it's necessary to supplement, how to encourage a discouraged parent, etc)! There are far too many mothers who are confused about how to get a good start with breastfeeding because of conflicting or misguided information. Then they leave the hospital with an arm full of formula samples, instructions about formula feeding, and uncertainties about their abilities to exclusively breastfeed... Or if to continue at all!

873 Concerned Citizen
Other Areas: working, breastfeeding mother
Worksite Lactation Support, Onsite Child Care, and Milk Expression Require employers to encourage lactation support, enforce penalties on those employers who discourage and therefore discriminate against breastfeeding mothers. Encourage small employers to facilitate onsite childcare. Require large employers to provide onsite childcare. The employees who utilize the childcare can fund it via paycheck deductions, etc. Increase funding for organizations to loan free breastpumps.

874 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Access to Lactation Care and Support Many people are not interested in becoming IBCLCs because once they are certified, they cannot find work unless they are a nurse. If more jobs were available for IBCLC's, more people would work hard to get board certified. When more people are board certified, there is much more support throughout the nation.

875 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media As a nursing mother I am astonished sometimes by the joking, or negative undertones regarding breastfeeding. I think anything in media greatly affects people's opinions, so any change in this that is positive would have a nice effect on public ideas.

876 Concerned Citizen
Other Areas: working, breastfeeding mother
Paid Maternity Leave Mandate increased paid maternity leave to a minimum of 12 weeks. Give mothers the option to extend this leave by using short term disability leave. Also broaden the coverage of short term disability by allowing the mother to use it if the health of the baby would be jeopardized by the mother's return to work.

877 Concerned Citizen
Peer Support and Education of Family Members and Friends I have been nursing for 3.5 years, and spent the first year especially, with very little family or friend support. Basically everyone thought I was crazy for nursing past two months. I have gotten to the point of not caring about that, and just caring for my son.

878 Public Health Worker
Paid Maternity Leave I work in an environment supportive of me pumping milk for my children. However, paid maternity leave is not offered. I needed to return to work when my first son was only 5 weeks old to make sure the bills were paid! I'm expecting my second son in a few weeks, and I have managed to better save up for my maternity leave this time around. However, my leave time is directly corelated with how much money I have saved, not with how well my son will be doing or with how well our breastfeeding is going. The irony of this is that if I have a hard time establishing a healthy breastfeeding relationship with my son (unable to latch due to health issues, etc) I will end up spending more money and time on supplementation or doctor visits or sick leave in his first year. Having even one month of paid maternity leave would allow a mother to get her child off to the best start possible. This would benefit the employer by having a more at-ease employee with a healthier infant; resulting in higher morale, more productivity due to less distraction, and less time away from work during the first year.

879 Public Health Worker
Use of Banked Human Milk Especially in the medical setting, a higher value should be placed on using human milk for human newborns. This is a crucial time for infants. Breastfeeding mothers should be able to be screened locally to donate locally to better enable hospitals to use human milk for sick/premature or healthy supplemented infants. If the medical community clarifies to a postpartum mother how this can benefit her child, not only will she value her own contribution to her baby's milk, it can also open her eyes to the vast difference in formulated infant milk vs natural. In other words, if a doctor tells her that he would like the newborn to use banked milk vs formula while in the hospital, that mother will be more likely to continue her own breastfeeding (or pumping) while buying/using less formula once at home.

880 Concerned Citizen
Other Areas: Mother
Access to Lactation Care and Support As a former recipient of WIC, I took advantage of all breastfeeding support offered, including a double electric pump. However, it seemed that many mothers in the clinic opted to receive formula benefits. Programs like WIC should do more to promote breastfeeding among their clients. Ideally each WIC clinic should be staffed with an IBCLC rather than the lactation consultants they now have who lack this credential.

881 Other Areas: mother of four
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media That's how you feed a baby. No comments needed.

882 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care There needs to be more assistance and support in our hospitals. The first few days after a baby is born is critical for mom. If she can get that support from the start, she has a much better chance of sucess at breastfeeding.

883 Public Health Worker
Worksite Lactation Support, Onsite Child Care, and Milk Expression Having access to pumping at work in a clean safe environment along with administrative support for breastfeeding moms is crucial to promoting breastfeeding for today's working moms.

884 Public Health Worker
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) In my daughters' childcare facility formula (and food) was included in the cost of childcare. We were allowed to bring in breast milk if we chose, however the cost was the same. It would actually be an incentive for moms to breast feed and bring in pumped milk if they had to pay less for childcare given that the center would not have to pay for formula for that child.

885 Concerned Citizen
Nonprofit Organization
Other Areas: post partum doula
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Nurses and other hospital staff need to be trained in supporting women following C-section. There is a lack of support nationwide in this regard.

886 Concerned Citizen
Nonprofit Organization
Other Areas: post partum doula
Access to Lactation Care and Support In addition to La Leche Leauge, women need to made aware of other resources in their respective communities.

887 Public Health Worker
Paid Maternity Leave It is very difficult for young families these days just to make ends meet. If we could pass some type of legislation that would allow moms that want to breastfeed and stay home with their babies to do so. It would make our nation a much healthier place to live. Moms are so pressured to get back to work, get these new babies in daycare. Very little support at most jobs for breastfeeding if it could even be arranged. It would be great if more employers would and could offer onsite daycare. That way moms could be there to breastfeed and know that their babies are in a safe place. I think these employers would see a degress in sick days and an increase in productivity.

888 Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media It would be great if the media could portray breastfeeding as a normal way to feed a baby. If more of these sitcoms and the movie industry would incorporate it into their shows as a natural part of life, then it would become a natural part of life, as it should be. Kids learn what they see, and we as a nation should make sure that what they see is natural and healthy.

889 Concerned Citizen
Nonprofit Organization
Other Areas: post partum doula
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media The current controversy about whether or not to breastfeed started after a recent segment on the Today Show has been very detrimental to moms. It has only served to divide women instead of unite them.

890 Concerned Citizen
Other Areas: Mother who has breastfed three children
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care To be truly breastfeeding friendly, the medical industry must cut ties with the formula industry. Instead of being bedfellows with formula companies, professional associations should diligently rout out such blatant and harmful conflicts of interest. Until a woman is not bombarded with formula propoganda from the time she is a girl, until pregnant mothers are not surrounded by formula advertisements in their OBs offices, magazines and television shows, mothers are going to continue to assume that formula is just as good, exactly as the formula companies imply.

If the United States would finally get serious and implement the WHO Code for the Marketing of Breastmilk Subtitutes, ending the harmful relationship between care providers and formula companies to help create a truly breastfeeding friendly medical industry would be exponentially easier. Professional associations like the APA are acting unethically in continuing to encourage and accept the marketing of formula to their clients.

891 Other Areas: Breastfeeding Mom
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals need to stop giving breastfeeding mom's formula when they leave the hospital and more support on Breastfeeding.

892 Other Areas: Breastfeeding Mom
Support for Breastfeeding in Public Settings National laws are needed to support Breastfeeding in public. In some states it is considered indecent exposure to breastfeed in public.

893 Concerned Citizen
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As a first-time mom who successfully breastfed my child for 18 months I found that having access to affordable classes, a lactation consultant and a hospital setting that was conducive to breastfeeding extremely important. I had retained some of the placenta duirng delivery and did not know that until a weeek post-partum. Consequently my milk did not 'come in'. Without all of the things I listed above I would not have been able to eventually breastfeed, which I did exclusively until my daughter was 6 months old (and she started some solids) I was never encouraged to give up by the hospital staff. I was showed how to use a pump to help with my supply while we were figuring things out and after the D&C I needed (which then allowed my milk to come in). When I had to supplement until my milk did come in,I was shown how and encouraged to use a tube to deliver the milk at my breast, to keep my daughter interested in breastfeeding rather than become used to a bottle (we never used bottles). I visited a lactation consultant at the hospital we delivered at regularly during the first three months of my daughters life and had access to support groups. After my daughter was born the hospital also gave me the chance to nurse her right in the delivery room before anything else happened. She slept next to my bed and noone suggested I should place her in a nursery away from me and the chance to breastfeed. My husband was also given the information he needed to support me. When I needed to stay at the hospital for my D&C to remove the placenta I had retained I was able to bring my daughter with me and she stayed with me the whole time I was hospitalized. This allowed us to maintain our connection and breastfeeding relationship as I was able to nurse her right up until my surgery, pump with a hospital pump right after and continue nursing her as soon as it was safe. During my process of learning to breastfeed, many others (family and 'friends') told me to give up and often I wondered if they were right, doubting my ability to provide for my daughter in this way. Other times I was frustrated and thought maybe it wasn't worth it. But the hospital and post-delivery care staff never doubted me, provided me with research based information to guide me and helped me reach my goal for which I am eternally grateful. All of this was covered by my insurance. I would hope not only lucky people like me would have the support I recieved and that the services I was provided with would be available to ALL mothers and children.

894 Concerned Citizen
Health Care Provider
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I breastfed my daughter until she was 18 months old and exclusively until she was six months old (she started solids then). I definitely am a strong supporter of breastfeeding. However, I have been sad to see and even angered by the way breastfeeding is being promoted in some commericals. One of these features a pregnant woman riding on a mechanical bull and then the comment is made to the effect that 'you wouldn't approve of something as risky as this so why would you take the risk of not breastfeeding'. Commericals like these are shaming to women and do not get to the heart of why women don't breastfeed. Many women don't breastfeed because they don't have the support from friends, family, hospitals, lacation consultants, peditricians,and work places. Many women don't continue or try to breastfeed because they are overwhelmed with parenting without extended family and helpers. Breastfeeding is taxing, can be painful when you don't have the 'latch' thing figured out, and can be isolating (so many restrictions about when and where,etc). Media attempts to encourage breastfeeding need to understand these factors and make use of this knowledge or they will not succeed in their efforts. Don't 'blame the victims',confront the reality and educate with care.

895 Concerned Citizen
Support for Breastfeeding in Public Settings As a culture we need to accept and support mothers doing what is natural and right for themselves and for their children; breastfeeding is one important example of this. Personal comfort should be secondary to the wellbeing and comfort of our infants & children; mothers should be able to feed their babies at any place, at any time neccessary, and without feeling malice or pressure from onlookers. It's time we acknowledged and accepted the breast for it's true meaning and purpose, beautiful and lovely and wholesome as it is- why are we more comfortable and accepting of a barely-there top or massive faux implanted breasts hanging out of a woman's shirt, than a mother caring for her child on a most basic level?

896 Concerned Citizen
Support for Breastfeeding in Public Settings There needs to be designated comfy chairs with breastfeeding signs, just like for baby changing tables. This should be a bigger part of society's norm.

897 Concerned Citizen
Health Care Provider
Support for Breastfeeding in Public Settings One of my biggest challenges as a mother who wanted to exclusively breastfeed was the isolation I felt as I tried to achieve that goal. My daughter did not accept a bottle or a pacifier. I also breastfed on demand to ensure a healthy supply and to meet my daughter's needs, which meant in the first several months I was often breastfeeding every hour. Furthermore, I never saw why I should have to put my daughter and myself (already sleep deprived and stressed) through pumping, preparing bottles, carrying around bottles and trying not to spoil them, forcing my daughter to accept a bottle or get on a schedule when babies are meant to breastfeed and I was being encouraged to do this! For all these reasons not breastfeeding in public seemed next to impossible to me - unless I went outside for 30 minutes at a time (and you try grocery shopping or running any errand with a baby in thirty minutes having gotten two to four hours of sleep- ha!) At the same time I found that others did not understand any of this and were often downright rude (staring, making nasty comments, suggesting I might want to go 'somewhere else'). I often felt as though I was trapped in my house and completely alone. I thought during these times about giving up and it made an otherwise enjoyable activity for myself and my daughter feel like a burden. I found myself going to Babies R Us alot because they had a nursing station in their store. I didn't need anything there, I just needed to be out in the world with other people. I can't express how difficult it is and depressing to feel trapped, alone, with a small baby and feel the choice is between your sanity and giving her what you believe is best and want for her! I eventually was able to let go of my hangups and others and did what was best for my daughter and I. This took alot of courage and at times was scary. I am fortunate that it is against the law where I live to harass or cite a woman for breastfeeding in public. That doesn't mean people don't but I could at least repeat that to myself again and again (as well as my husband) as I braved the public. I wished during that time that there were special rooms and signs even in public places everywhere that welcomed women to breastfeed. Something like that would truely have sent a message to others, legitimized what I was doing was a natural and the right thing for my baby, reduced my feeling of isolation, and made it one less hassle I had to deal with during those trying early days of first-time parenting. I believe if such a thing were to happen you would have many, many more women breastfeeding sucessfully.

899 Concerned Citizen
Lactation Professional
Public Health Worker
Other Areas I think breastfeeding will become the norm in this country if and only if the United States government backs it 100%. Less than 100% of the government (HHS,for example) being 100% behind it will not work. When we pass legislation that backs the WHO International Code of Marketing of Breast-milk Substitutes and then enforce it, I will know that we are serious about making breastfeeding the norm. Right now we allow the pharmaceutical companies that manufacture formula to advertise and sabatoge breastfeeding in any way they can. Breastfeeding initiation and duration rates will rise and fall, but breastfeeding will never be accepted in this country until formula becomes the much needed substitute when nothing else is available and nothing more than that.

900 Concerned Citizen
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I feel it would benefit the mother & baby's health if all OB would put the baby to the breast as part of the delivery process, much like suctioning them. It would help control blood loss in mom and boost the baby's immune system. Mom's could still decide not to continue breastfeeding, but this would be a health benefit the baby would get before formula is introduced.

Many of our health care workers aren't aware of the benefits of breastfeeding and don't support it as the first (only if no contraindications) feeding choice and educatoin in that area would help. At prenatal visits and yearly physicals the benefits of breastfeeding and know how should be given to women. Example of supporting could be by telling an early prenatal that her breast are tender because they are preparing for feeding her baby and 2nd trimester visit telling them colostrum is there waiting even if they don't see it, etc. Always something about positive about it. Even if a mom has a risk for low supply encourage her to breastfeed, but refer her to the lactation consultant at the hospital when baby is born.

The diaper bags given out at hospitals should have to all support breastfeeding and in place of formula put a good quality manual breast pump in them and breast pads. Take out formula samples, but leave compaines option of mail in coupons that moms could send in for formula sample if they want them AND leave it up to moms to find the coupon on their own and mail it in. (it isn't supportive of breastfeeding if hospital staff encourage moms to fill it out).

Too many doctors tell mom's it is ok to change to formula without telling them what health benefits they are giving up. And many mom's say that doctors aren't supportive of breastfeeding past the six months and will even ask them why they are still breastfeeding. This is why I think educating health care workers is important.

Before we can help a mom breastfeed she has to want to. Understanding the health benefits of human milk and believing it (doctor's actions even before pregnancy)may help more women consider it. When teaching or doing a breast exam teach on one breast and have mom do the other while observing. This will give women confidence that they are doing it correct and help them remember how to do it while at the same time get them used to their breast which could impact feelings toward breastfeeding. Women need to take back their breast.

901 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Access to Lactation Care and Support It is such a struggle to find help out in the community for moms who have Public Health insurance. Please continue to support the efforts of the Public Health and WIC's initiatives to provide breastfeeding assistance.

902 Concerned Citizen
Health Care Provider
Worksite Lactation Support, Onsite Child Care, and Milk Expression My employer has a mother's room for use and allowed me to take as much time as I needed for the purpose of expressing milk when I returned from maternity leave. The mother's room was private (one person at a time in a dedicated location) and it had a rocking chair, a refrigerator exlusively used for storing milk and cubbies for each woman to place her pumping supplies, etc. I used the room initially four times a day without any problems whatsoever. I was allowed to arrange my work schedule around my pumping needs and was not docked any pay for the time I was using the mother's room. I believe these benefits provided to me by my employer were crucial to avoiding the use of any formula throughout my daughter's life! The privacy of the mother's room setting let me actually relax and focus, so I pumped a large amount of milk and never saw a dip in my supply. I also could be assured of the sanitation of the milk I collected and maintain my own privacy by not having to put it in a more public refrigerator or risk spoiling by having to figure out my own arrangement with icepacks. Currently, too many employers say they provide similar things but everyone knows you really shouldn't ask for it and it is privately discouraged in political ways on the job. These services need to not only be provided for women at work but the penalites for using them need also to be taken away.

903 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The hospitals need to stop giving out formula after birth. Advertisements from any formula companies should also be forbidden in the hospital. This only promotes the practice of formula-feeding when breastfeeding is the best for baby.

905 Concerned Citizen
Support for Breastfeeding in Public Settings It should be made clear in advertisements that women have a right to breastfeed on airplanes, in restaurants, in movie theaters, etc....wherever they are allowed to be they can also feed their baby. Women do not breastfeed now in public because they feel they may be harassed or will be forced to breastfeed in a bathroom. I have breastfed in a bathroom and it is truly disgusting!! Sitting on a toilet seat (as many bathrooms do not have separate sitting areas or even a chair)...listening to others go to the bathroom for 20 minutes or so while you feed your baby...and having to endure the AWFUL smell! I did that when I was younger, but now that I know my rights...I would stand up to anyone who approached me and refuse to go to a bathroom area. Until this is done...where women feel protected to breastfeed in public...you will not increase breastfeeding rates. Women have to go to the store, they have to go buy clothes, run errands...and they will not breastfeed if they are forced into bathrooms and are humiliated in public.

906 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression All workplaces, regardless of size or type, should provide a space and the opportunity for women to pump. The major cause of breastfeeding being discontinued is working mothers who do not have the opportunity or the support to pump in the workplace. Breaks should be allowed for working women who are paid hourly to pump, and they should not be penalized for it. As a working mother, the hardest part of breastfeeding has been the pumping and the difficulty surrounding it. I have been fortunate that my employer provided me with an office with a lock on the door where I could pump. It does not cost much, and could make a huge difference.

907 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media When Facebook, the world's largest networking site, won't allow any pictures of women breastfeeding their children because it deems it to be obscene, it is clear that this country has a long long way to go before people can see breastfeeding in a positive and normal light. More effort needs to be made to allow these images to become as ubiquitous as women baring their breasts in a sexual way in the media.

908 Concerned Citizen
Paid Maternity Leave Paid maternity leave will allow women and families to focus on their children and establishing breastfeeding rather than worrying about the lack of financial security. Paid leave for three months would begin to move the United States towards the standards of the rest of the world in supporting women who have children and their families.

909 Breastfeeding Coalition Representative
Lactation Professional
Public Health Worker
State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Baby Friendly needs to be the standard of care. Hosptial accredation should rest on this standard for all maternity care.

910 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Nonprofit Organization
State or Local Government
Worksite Lactation Support, Onsite Child Care, and Milk Expression businesses should be encouraged to develop on site child care and/or lactation rooms for pumping with adequate break time.

rational

employee will be absent less often to care for sick children

lowered cost to health plans as mother and children will be sick less often

valuable employees will remain with the company

911 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Nonprofit Organization
State or Local Government
Other Areas Breastfeeding can not be successful as long as formula industries are allowed to spend millions of dollars advertising an inferior product for profit.

The United States should support and enforce the WHO code for the marketing of breastfeeding substitutes. Making replacement baby milks available by doctor order and prescription only.

913 State or Local Government
Paid Maternity Leave Until we are interested in dialogue that supports women staying home with their babies to breastfeed them for a full 6 months we will not see the issues surrounding duration of breastfeeding resolve. A universal message that the United States values infants and mothering needs to accompany any messages surrounding breastfeeding.

914 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospital practices are heavily driven by physicians and there continues to be poor education for medical and nursing students in respect to human lactation. A greater effort towards influencing the curriculum for medical and nursing students would probably have a greater and more sustainable impact on hospital practices.

915 Concerned Citizen
Support for Breastfeeding in Public Settings I think we need to have ways for our society to embrace it like they do in Europe, it is just natural there. Even my sister-in-law was appaled I would nurse my very hungry child in public with my jacket over us. I wasn't even exposing any part of my body, but just the idea. I am sorry, but I have a hungry child and he needs his milk. Our soceity makes it out to be a sexual thing, when it isn't at all. Yes, it is our breast, but it was made to nurish our children. It is our God given right as a mother.

917 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The Healthy Start Coalition of Indian River County and the local Health Department collaborate on a very succesful and unique program. TLC Newborn pro-actively contacts Breastfeeding Moms shortly after they return home from the hospital. The trained Breastfeeding prof's are able to support the mom for the first year with telephone contact, internet contact and newsletters. They work with the hospital to help initiate a seamless quality of care for the breastfeeding mom. Funded by local grants, the service is free to all county families.

918 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression all employers should be required to provide accommodations for mothers who wish to breastfeed. it would also be useful for lower income families if the cost of a good quality breast pump were subsidized.

920 Concerned Citizen
Paid Maternity Leave paid maternity leave should be granted by all employers up to one year.

921 Public Health Worker
Worksite Lactation Support, Onsite Child Care, and Milk Expression Work to provide laws that allow a safe and private place for working moms to express their milk at work. Many of our mom's NEED to go back to work in less than 6 weeks post partum. In order for them to be successful in continuing the breastfeeding process they need supportive, educated and cooperative employers.

923 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Empowering patients with the important information about the skin to skin and breastfeeding within the first hour of delivery is important so that she can express her wishes in the L+D prior to delivery improving the chances that she will have that opportunity is essential.

925 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Please enlist the services of a high profile celebrity spokesperson! Rumor has is that Michael Jordan was breastfed till he was 3 years old and that Oscar De La Hoya was breastfed till he was 5 years old. There have to be other examples of public personalities that were breastfed and would be willing to make a PSA. Also, Noah Wylie (sp?) and his wife are vocal advocates for natural childbirth and I'm sure their babies were breastfed. Don't try to re-invent the wheel, just copy what the formula companies do when they advertise their products! (Brook Shields has done ad work for formula in the past).

926 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care GET THE FORMULA COMPANIES OUT OF THE HOSPITALS> THEY HAVE TOO MUCH INFLUENCE ($) ON THE POLICIES AND PRACTICES PREVALENT IN AMERICAN HOSPITALS> MANDATE THE BABY-FRIENDLY HOSPITAL INITIATIVE!

927 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Lactation Professional
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Finding Pediatricians who are truly supportive of Exclusively Breastfed babies and their unique growth patterns etc is very difficult :(

928 Concerned Citizen
State or Local Government
Paid Maternity Leave the United states needs to emulate those countries, such as Sweden,or switzerland that offer pay maternity leave for 6 MONTHS TO A YEAR. If women had the financial back up , I'm sure we will have a higher breastfeeding rate and duration.

930 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Access to Lactation Care and Support Equipping pregnant women with the various options for breastfeeding help so that if she needs help, she will be able to get help right away and not wait until her milk supply is low and there is a greater chance of her stopping breastfeeding. The Public Health Nurses, who go out to the patient's home within one week pospartum, have an wonderful opportunity for early breastfeeding problem intervention and need to be equipped with the bereastfeeding resources.

931 Health Care Provider
Health Professional Education, Publications, and Conferences Medical schools need to include in their curriculum in depht breastfeeding education, Many OB DOCTORS AND PED HAVE NO CLUE REGARDING BREASTFEEDING INFORMATION , AND IN RETURN DO NOT PROMOTE BREASTFEEDING TO THEIR PT.

932 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Making sure pregnant women are aware of the rights to take time out to pump her breasts at work and how to manually express the breast can increase the length of time a child is given breastmilk. Not only expressing her own breasts instead of using a pump is less expensive but it has been found to be able to get more milk from hand expression than a pump.

933 Concerned Citizen
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression I do NOT want more ways for mothers to breast Milk feed. I want mothers to be empowered and encouraged to meet the needs of their babies for the presence of the woman attached to the breasts! Breastfeeding requires a mother and baby being together and this is what needs support. Mothers do not need more help separating and babies do not need more 'quality other care'. Babies need mothers and mothers need babies and together they breastfeed.

Pets need sitting, babies need mothering.

Any support of breastfeeding and work place responsibility needs to be about a dyad...a mother and a child as a unit. The choice to leave your baby should not be in the balance with shelter and food for your family.

934 Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media The times I have read articles or seen evidence of famous people breastfeeding or talking about breastfeeding have been effective. I think more of this with greater diversity would be helpful. I also believe highlighting breastfeeding friendly work environments would be beneficial.

935 Concerned Citizen
Health Care Provider
Paid Maternity Leave The United States' maternity and paternity leave system is disgraceful. It is very telling of how little value we truly place on the relationship of the family and the health of the child. Having NO paid leave and unpaid leave ONLY for certain members of our society (under FMLA) is both inequitable and unacceptable. This is not a states issue, and should not be left to the state to implement. This is a human rights and public health issue. Our national government must implement paid leave comparable with other industrialized countries. Please consider this issue very carefully and issue strong recommendations or policy providing for adequate parental leave for ALL parents following the birth or adoption of a child. The health and future of our society depends on it.

936 Concerned Citizen
Health Care Provider
Researcher
Support for Breastfeeding in Public Settings Before breastfeeding rates in the United States will improve, breastfeeding in public MUST become socially and legally acceptable. This is not a states issue, and it should not be left up to the states to implement protective policy. This is a human rights issue, and our national government MUST issue policy protecting the rights of the mother and child to nurse whenever and wherever the need arises, for as long as both mother and child desire, in accordance with recommendations by the World Health Organization. The policy must make it very clear that breastfeeding of a child of any age, whether the breast is showing or not, is legal, protected, and enforceable through injunctions, fines, and/or damages.

937 Concerned Citizen
Health Care Provider
Researcher
Worksite Lactation Support, Onsite Child Care, and Milk Expression Combined with dismally inadequate maternity leave, lack of support in the workplace is one of the most impacting conditions leading to non-initiation of breastfeeding or early weaning. Recent statistics on the status of lactation programs showed that only 1 in 4 employers provide any sort of lactation support for milk expression. For government employers, the rate is only 11%. This is not a states issue, and it should not be left to the state to provide regulations requiring support for the working mother of a nursing child. Our federal government MUST provide strong incentive for our workplaces to recognize the importance of breastfeeding in maternal and child health and strong policy to create space, time, and support for milk expression or nursing of the child.

938 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals should be required to have a certain number of lactation consultants per number of deliveries (i.e. 1 per 5 deliveries). Every mother should have a consultant available for problems/questions. JCAHO should evaluate whether the hospital provides AAP recommended breastfeeding support.

939 Health Care Provider
Worksite Lactation Support, Onsite Child Care, and Milk Expression Employers should be required to provide a clean/safe place for mothers to pump on their break. A restroom is not considered adequate for pumping.

940 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression I work with the Healthy Start Program with the Native American population. Most of the women choose to feed formula even when informed of the benefits of breastmilk. When asked why, most responded they planned on going back to work. While many tribal areas have rooms for the BF moms, there usually isn't sufficient time. The moms state it is just easier and they dont want to get into trouble with their employer. There needs to be more worksite support, maybe legislation to protect the moms. There also needs to be discreet methods to express milk. I remember seeing a breast pump that fits under the clothing but have not seen it since. There also needs to be more onsite child care along with the worksite support.

941 Concerned Citizen
Peer Support and Education of Family Members and Friends As a parent, I feel frustrated when I read books to my child that portray a baby being fed with a bottle or when my child gets dolls with bottles included in the packaging. I think that our society is slowly beginning to accept the importance of breast-feeding, but what kind of subliminal messages are we sending to our children and young people? FIrst-time parents get so much input and support (or disagreement) from their families; we need to make breastfeeding practices more of a cultural norm rather then spreading more images of bottles around.

942 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care A national hospital lactation program needs to be established. This should include 1.outpatient lactation education and support for pregnancy 2. inpatient lactation support for mothers 3. Outpatient follow up support for post partum mothers and babies. If each hospital provided this type of care mothers would have a resource for support. Most hospitals have inpatient care only and once the mother is discharged she is on her own or dependent on Physicians who are a are a great deterrant to breastfeeding in this country. Obstricians and Pediatricians wean mothers from breast to bottle due to lack of interest in breastfeeding and lack of knowledge. The obstricians and pediatricians must change their attitude about breastfeeding if you want to see any changes in the breastfeeding rates in this country. They allow discharge formula packs to be distributed to their patients during pregnancy and are the ones who most often recommend supplementation for no medical reason. Baby Friendly Hospitals are impossible in this country because hospitals depend on the funds provided to them by formula companies for programs. The AAP MUST be held accountable for this problem. We need to begin looking at formula marketing the same way we look at the marketing of medications and it must cease. You will be continuously paddeling upstream if you do not stop the marketing of formula in this country and get physicians to be held accountable for their actions in supporting formula feeding.

943 Health Care Provider
Lactation Professional
Access to Lactation Care and Support Lactation support should be provided by each hospital. Pre natal, during hospital stay AND POST PARTUM at NO ADDITIONAL COST. Mothers have two options, the pediatrician, who recommends formula because they dont know what else to do, or expensive private lactation consultants who many mothers cannot afford. Nationally hospitals should provide post partum lactation support at no additional charge.

944 Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I am very concerned about the ways in which women and infants are treated before, during, and after birth and its affects on breastfeeding. Studies have shown that it is more difficult to establish a good breastfeeding relationship after a cesarean birth, and yet the newly released CDC statistics demonstrate that cesarean births continue to rise. Shameful induction rates and bans on vaginal births after cesarean are just two factors contributing to this crisis. I urge our federal government to support policies that promote mother and baby-friendly hospitals and birth centers, reward those institutions that are committed to improving womens health throughout their pregnancies and childbirths, and urge hospitals and birth centers to practice evidenced-based care while caring for pregnant and laboring women. These institutions need to demonstrate their commitment to womens health by making a sincere effort to lower cesarean, induction, and epidural rates, and create calming, supportive spaces for birthing and for the bonding and breastfeeding period following the birth. Our representatives should support legislation that requires both public and private health insurance to cover the costs of homebirth and birth center births with certified nurse and professional midwives, who are proven to produce excellent results for mothers and babies, as well as doula support and access to highly qualified lactation consultants.

946 Lactation Professional
Paid Maternity Leave As a mother and a soon-to-be Lacation Consultant, I have found that the very short amount of time given for maternity leave is an insult. The general 6 weeks given for leave must have been put into place by a man who has neither experienced childbirth nor the privledge of giving the gift of human milk to their new baby. We should be looking at other countries and seeing what works and how society can benefit, in a countless number of ways, by more children breastfeeding for longer.

947 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Ob's should discuss the benefits of breastfeeding at Prenatal visits. More education of OB's about skin to skin and the importance of initating breastfeeding in the first hours of life. Prenatal breastfeeding education is essencial, with consistent information given at each facility

948 Breastfeeding Coalition Representative
Health Care Provider
Lactation Professional
Paid Maternity Leave Providing women with 6 months to 1 year of maternity leave and assurance of returning to their current job, plus having their income supplemented by the government would by far and away increase breastfeeding rates, make Healthy People 2010 Goals attainable, and decrease health care costs because of healthier babies!

949 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Working with women in the immediate post partum unit, I find it so very obvious that the majority of knowledge a woman has about breastfeeding has been received by her own (active or passive) doing. They either pursue literature, classes, website ed, etc. or they have learned via family/friend experiences and stories. I feel that prenatally the caregivers are extremely lacking in providing good education re. what to expect with breastfeeding. It seems as though they are asked during their pregnancy how she plans to feed her baby, breast or bottle, and they check the box. This is a prime time, 9mos of time, to help a mom know what to expect as a norm with breastfeeding. When we see them after 32hrs of labor, birth, and up for a day and a half learning to care for a new baby, the education window is pretty much closed. We, as a country and society have done moms and babies a disservice in taking away a healthy, normal feeding pattern and substituted it with plastic and milk-in-a-can. So, now, women need help from their careproviders (ob/gyn's, nurses, midwives, pediatricians, LC's) to learn what the aunts, neighbors and grannies would teach women years ago before the formula makers came into existence.

950 Health Care Provider
Health Professional Organization
Lactation Professional
Public Health Worker
Health Professional Education, Publications, and Conferences I am a WIC Coordinator and breastfeeding coordinator at a tribal health clinic. Our breastfeeding rates are below the national average. We need more peer counselors, nurses, and dietitans with senstivity to the needs of the Native population. There is strong research that shows the bf can help prevent diabetes. We need education on why and how to bf for health professionals during initial training. We need continuing education as well.

951 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression We need a law in all states that breastfeeding mothers have a clean, private area to take a fifteen minute break every 3 hours to pump their milk. This is no different than the biological need to use the restroom.

952 Breastfeeding Coalition Representative
Concerned Citizen
Public Health Worker
Other Areas In our community the breastfeeding rate for our Native American mothers is 3%.

Native Americans are prone to chronic health conditions (diabetes, obesity, etc).

Breastfeeding is proven to prevent many illnesses in both the mother and the baby. By increasing the Native American breastfeeding rate, we can reduce or eliminate many chronic health conditions.

Please look at ways to include the Native American population in any breastfeeding outreach efforts.

953 Breastfeeding Coalition Representative
Concerned Citizen
Public Health Worker
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Having a home visit by a qualified lacation specialist will increase breastfeeding duration rates.

Hospitals are doing a fair job of initiating breastfeeding - but there is not adequate (free) home based support for new moms.

A home visit can reveal many potiental barriers to breastfeeding. A knowledgeable lactation specialist who is aware of community resouces can assess any early problems and link mom to ongoing support (WIC, mothers groups etc).

Passively waiting for mom to initiate help limits the help to only those most able to ask for it. Those most at-risk do not seek out support.

Just a couple home visits can make a lifetime of difference for the woman and her infant.

954 Breastfeeding Coalition Representative
Public Health Worker
Paid Maternity Leave The US needs to raise the bar on maternity leave so we are on par with other developed countries.

It is unthinkable that we are forced to return to work at 6weeks. It is a set up for failure - on all fronts.

Infants need their moms. Moms need to be a diad with their baby. Moms need rest to be good mothers.

Asking moms to leave thier infant in childcare in not acceptable.

955 Concerned Citizen
Health Care Provider
Other Areas: birth and postpartum doula
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The use of birth and postpartum doulas is critical for increasing breastfeeding initiation rates. Birth doulas help reduce use of unnecessary interventions in birth, resulting in healthier and more alert newborns. Birth doulas also help with initiation of the first breastfeeding.

Postpartum doulas help with ongoing support as new mothers adjust to the demands of the breastfeeding relationship and are able to troubleshoot problems with the latch and refer moms to professional lactation help, if necessary.

Doulas are low-cost, high-touch way to improve not only breastfeeding rates, but also mother and baby outcomes.

956 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As a community health worker, I feel that it's crucial for health care professionals, (i.e. doctors and nurses) to know the importance of breastfeeding They are the first contact that mothers and babys have. They lay the ground work for the outcomes of mom's decision to exclusively breastfeed or not.

957 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Paid Maternity Leave I understand that in countries like Switzerland and New Zealand mothers have 12 months of paid maternity leave. Having to go back to work is a huge barrier when it comes to mothers being able to exclusively nurse. However, if they were able to provide thier infants with their breastmilk and still be able to support them financially without having to leave them with someone else that would be ideal!

958 Concerned Citizen
Other Areas: A Mother
Paid Maternity Leave Having a paid maternity leave would increase the chances of successful and prolonged breastfeeding across the board and allow for greater bonding and increased stability both emotionally and financially for families of all types throughout the country.

959 Concerned Citizen
Other Areas As with vaccine reporting, medical professionals should report any adverse reactions to artificial infant formula. There should be a federally mandated and funded entity (CDC, DHS or the AAP) that would record and publish these reports to the public. Adverse reactions including intollerance to artificial infant formula that warrants a visit to the health provider for care managment and other more severe reactions. All artificial infant formula that has been recalled should also be recorded. Federal funds should support watch-dog agencies that monitor these serious threats to the public's health.

960 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Artificial infant formula samples should be banned in all hospitals by the hospital accrediting system.

961 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care All new mothers should be formally assessed for lactation problems/concerned. This should be formally charted with appropriate follow-up provided and documented if problems are detected. No new mother should be discharged from the place she gave birth without an appropriate assessment.

963 Concerned Citizen
Paid Maternity Leave Homeland security funding should include paid maternity leave.

964 Concerned Citizen
Other Areas The cigarette tax has provided incredible funding for anti-smoking campaign. Why not tax the artificial infant formula companies and provide states with funds for special projects for low income moms... oh wait...then we might have to tax our own government since the US is the single largest buyer of infant formula for the WIC program... well, you might have to sort that out. Maybe a tax-free purchase for the government and a taxed system for the general public?

965 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) There are a lot of staff from community support programs that would benefit from basic training in breastfeeding. Im not talking about 35 hours of continued education, but even 2-4 hours of grant-funded training would go a looong way dispelling common myths about breastfeeding and also giving folks some tools to be more supportive for those moms who are breastfeeding.

967 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Work to get the majority of hospitals in the United States to achieve BABY FRIENDLY STATUS. www.babyfriendlyusa.org

Hospital protocol surrounding breastfeeding consistently undermine and contradict the practices that get women off to a good start breastfeeding. Women need to room in with their babies, nurse on demand, and immediately have the baby at the breast no matter how they birth. Women need doctors and nurses who are trained in breastfeeding -- most have no formal training or understanding of how breastfeeding works. Hospitals are a barrier to successful nursing.

968 Concerned Citizen
Paid Maternity Leave American women deserve at least 6 months paid maternity leave - this would remove many of the barriers to breastfeeding. Compare the US's breastfeeding rates to a nation like Canada where women get a full year of paid maternity leave. If women can focus on bonding and breastfeeding in the early weeks rather than panicking about going back to work, pumping, daycare, etc then they would be more likely to succeed.

969 Health Care Provider
Access to Lactation Care and Support We need additional breastfeeding support for American Indians

970 Other Areas: Nursing mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care When I gave birth to my twins via c section, I was separated from them for more than 4 hours after delivery because the hospital refused to bring them to me. The problem was that there was a woman in the large common recovery room with me who had just lost a baby and they did not want to upset her by bringing in my newborns. One of my babies had great difficulty in learning to nurse. I think this was possibly caused by this initial separation.

In addition, I do not think that formula companies should be allowed to give out formula samples in hospitals to nursing mothers. It is truly undermining.

971 Other Areas: Nursing mother
Access to Lactation Care and Support Lactation specialists should be available in hospitals on weekends. And they need to see each nursing mother and ensure that their babies are latching on properly within one day of birth. This should be a mandatory part of their responsibilities. I was an experienced nursing mother, but could not get my 4th daughter to latch on properly for days, and no LC ever really helped me. I finally got help from a nurse.

New nursing mothers need follow up care from lactation professionals when their babies hit the normal growth spurts, so that mothers know that when their baby wants to nurse every hour, that is normal and expected at those times.

972 Concerned Citizen
Other Areas MAKE ALL DOCTORS AND ALL MEDICAL STAFF TAKE CLASSES TO KNOW HOW TO DEAL WITH LACTATING MOTHERS and nursed infants. STOP them from pushing formula at the first road bump.

973 Concerned Citizen
Paid Maternity Leave With government-mandated paid maternity leave like the rest of the modern world enjoys, ALL women would be able to establish and maintain healthy breastfeeding relationships with their babies. Come on, seriously, even CANADA gives new moms a year off at 95% pay! It's pathetic that we're the ONLY country that has no requirements for paid maternity leave, and I believe this is a major reason why we also have such abysmal breastfeeding rates in this country. Even under FMLA, I had to use all my saved vacation and sick days in order to keep paying the bills so that I could stay home for just 12 paltry weeks with my newborn. Fortunately, we are still breastfeeding today, and he will turn 1 this week. We are LUCKY. Most women in the US never make it this far. And the WHO recommends breastfeeding for 2 years, so we still have a long way to go to get this country healthy.

975 Other Areas: Nursing mother
Paid Maternity Leave This should be the norm and not the exception. We need to value our nursing mothers and provide them with support.

977 Concerned Citizen
Health Professional Organization
Support for Breastfeeding in Public Settings Women need to feel that breastfeeding in public areas is accepted and they should not feel ogled or that they need to cover up or go into privacy to feed their child.

978 Concerned Citizen
Other Areas: nursing mother
Paid Maternity Leave Many moms find the inadequate maternity leave to be the _end_ of the breastfeeding relationship. It is not always long and it is seldom paid. Mothers need at least 4-6 months of paid maternity leave as incentive to stay home with their infants. Sometimes the 'maternity leave' clock starts ticking too soon, if the mother is required to go on bed rest; making the time after the birth even shorter and more stressful.

980 Community Organizer
Concerned Citizen
Other Areas: Pastor
Paid Maternity Leave I work with many moms that also work full time. The average paid maternity leave is 6 weeks long. I do not see how this supports a woman to establish a healthy and comfortable breastfeed relationship, build up a frozen supply at home and feel comfortable enough to be away from her child and pump at work. This is a lot to happen in 6 weeks. I have a 5 week old and I currently do not have to return to work until my son is 6 months old (unpaid). I am making this decision because I know I would be too stressed to keep up with constant pumping at this point. When my son is 6 months the number of feedings go down and it will be easier for me to either pump or find a way to be with him for his feedings. At 6 weeks old my son will be needing a feeding every 3 hours still and this is too much for a person to deal with. Pumping for those feedings and not getting a full night sleep. This is hardest on blue collar workers. The work environments do not promote pumping. Sure, it's the law to give space, but when the space is the same break room share with others, or an open cubical or the corner of a room where other employees are told to avoid if they hear the pumping machine, that does not make for a very comfortable environment to pump. Also, in blue collar jobs your breaks are very rigid. 45 minutes for lunch and a 10 minute break. If you are watching the clock the entire time you are pumping you probably are not going to get that much milk because you are stressed. Paid maternity leave and availability of pumping space on the job is a major hindrance on promoting a healthy and established breastfeeding relationship.

982 Community Organizer
Concerned Citizen
Other Areas: Pastor
Support for Breastfeeding in Public Settings I often breastfeed in public and I feel very comfortable doing so. I've never been told I can not do it or to move. I feel very supported in public places for breastfeeding my child. I live in Chicago.

984 Concerned Citizen
Nonprofit Organization
Other Areas: La Leche League leader
Other Areas The comment I offer concerns women who work outside the home and wish to continue breastfeeding their children. Substitute caregivers must have specific knowledge to support and protect the breastfeeding relationship the nursing dyad share. This requires a standardized curriculum and method of instruction. Perhaps a certification of some sort would incite caregivers to learn and make use of the material.

985 Community Organizer
Concerned Citizen
Nonprofit Organization
Other Areas: LLL leader
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Women and their health care providers seem to have little understanding of how women make milk and how babies breastfeed. I suggest the book titled Breastfeeding Made Simple as required reading for anyone who aspires to promote effective breastfeeding practices in their profession.

The information I believe many women lack includes an understanding of individual storage capacity and frequency of feeding, normal infant growth and feeding, and how to establish a full milk supply. (Each of these areas is addressed in Breastfeeding Made Simple.)

986 Community Organizer
Concerned Citizen
Nonprofit Organization
Other Areas: LLL leader
Access to Lactation Care and Support Most breastfeeding difficulties do not require the support of a certified or licensed health care professional. Most problems stem from mothers' lack of understanding of how they make milk and how babies breastfeed. Usually it is a simple matter of breastfeeding management and rarely is it a medical issue.

Experienced peer support offers the information and support most moms need to reach their personal breastfeeding goals. However, this support must be readily and conveniently accessible since mothers are most often unaware of the simplicity of their troubles and make rash decisions about discontinuing breastfeeding.

Women call their nurse hot-line when in dire need. Let's staff a peer counselor at that calling center. Women also go to their babies' doctors first. Let's staff those clinics with peer counselors so these women and health care professionals have immediate access to useful and accurate information.

987 Community Organizer
Concerned Citizen
Nonprofit Organization
Other Areas: LLL leader
Health Professional Education, Publications, and Conferences Let's require health care professionals be trained in infant feeding and nutrition if they feel the need or desire to support breastfeeding families. Otherwise, encourage these professionals to refer families to others with the proper training.

988 Community Organizer
Concerned Citizen
Nonprofit Organization
Other Areas: LLL leader
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I'd like to see breastfeeding in the media where it is not the focus of the ad or story, but just a fact in the setting. Breastfeeding is normal.

990 Lactation Professional
Nonprofit Organization
Public Health Worker
Access to Lactation Care and Support Barriers to Lactation Consultant and clinical prenatal and postpartum services and support include: 1- Financial Barriers(i.e. Lack of insurance coverage for lactation consultation clinical services; lack of breastfeeding clinical services offered, even through WIC programs) 2- Availability of lactation clinics in communities

Other Issues/Barriers: * Lack of free, high-quality, timely, issue-based educational opportunities for Health Care Professionals.

* Bottlefeeding Cultural Norms Continue to Exist. Lack visible and continual marketing of nutrition, breastfeeding, health messages targeting new parents, infants, and care takers, including where to access help from qualified individuals.

* Lack of Funding to Support Every Institution and Agency interested in providing some sort of support for breastfeeding.

991 Concerned Citizen
Health Professional Education, Publications, and Conferences I'm a nursing student, intending to become an IBCLC down the road. I breastfed my own son for three years, and I've been advocating for and assisting nursing mothers for seven years as a peer counselor. One issue that has cropped up over and over again is the poor advice from medical professionals. I'm well aware of how little training HCPs get regarding practical support for nursing mothers, and really, that's understandable. There's a lot that we have to know, and lactation support is most certainly a specialization. However, here's the problem: these untrained professionals give out breastfeeding advice, and it's taken seriously because it comes from someone in scrubs or a white coat, and it's very often poor advice. Anesthesiologists telling mothers to pump & dump for imaging without contrast - or even with a contrast that's perfectly safe. Pediatricians telling mothers to schedule and withhold feedings, and applying growth charts appropriate for formula-fed babies to breastfed babies. Doctors telling mothers - this is my favorite - that they have to pump and dump for the same anesthesia and painkillers that were administered at birth (and which weren't perceived as posing any risk at that time). It's bad enough that HCPs aren't aware of Thomas Hale's book, but worse - they often aren't even aware of the AAP's list of medications compatible with breastfeeding!

And that's just in regard to medications - there are other areas in which HCPs are giving out uneducated, incorrect advice.

The solution, to me, is not to turn every HCP into a lactation consultant. As I mentioned, it's a specialized field, and most of us are more general practitioners. But HCPs need to recognize that they are not educated in giving practical assistance to nursing mothers, and refer them to those who are, i.e. IBCLCs, LLLI leaders, etc. And on the pharmaceutical front, I would love to see Hale's book getting more widespread use and recognition - and at the very least, the AAP's opinions could be followed.

Thanks,

Tristyn Underwood tristynu@gmail.com

992 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Our hospitals need to encourage, support and help mothers initiate breastfeeding by asking every mother if they would like to put their baby to breast or pump, even if it is just for a few days. Often this is enough to get a mother to continue to breastfeed. I have seen it too many times where a woman gives birth and her baby has to go to an NICU,(for instance) and noone gets her a pump and it will be a day or two before she starts pumping and subsequently her supply never gets to where it needs to be, nor does it last often. We need to, as a society, expect that every mother is going to breastfeed, and bring in formula only when asked to by the mother. Currently we do it the other way, assume she is formula feeding and only when asked by the mother for help with lactating does she than get assistance. Women need to know how much better breastmilk is for their child and if they did not get any education before they gave birth, it is the responsibility of the delivery and post partum nurse and doctors to educate and support alll women in the quest to get all babies breastfed, even if it is for a short time. If any of us were posed the question;

993 Concerned Citizen
Lactation Professional
Nonprofit Organization
Public Health Worker
State or Local Government
Access to Lactation Care and Support Thank you for the opportunity to comment. Every employer should offer lactation support and care just as it offers employee assistance services. Supporting a mother postpartum with lactation care and services provides benefits to the employer as well as the mother. The return of investment includes less sick days taken, more likely to return to work after maternity leave, less health insurance claims for breastfed baby and a greater satisfaction with employment. Providing lactation support is a small and inexpensive way of supporting new mothers and babies to begin a healthy life.

994 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care In many instances, health care providers give varying and often misguided advise to new mothers about breastfeeding. Especially for those who are new to breastfeeding, without anyone else to turn to for advice, this causes great confusion and frustration when attempting to establish a breastfeeding relationship with their child. Such as not allowing for a newborn to latch on as soon as he or she is born. This critical moment can define whether a child is will be able to instinctively latch on in the future or not. The child also delays getting much needed colostrum. Instead, babies are often given glucose water from an artificial nipple causing other confusions. The advice given is often outdated, causing major mistakes which instead of helping, actually undermine a healthy and successful attempt at breastfeeding. For example, some nurses and doctors often say to supplement with formula until one's milk comes in. This causes problems such as nipple confusion in the infant and actually reduces the ability of one's milk to come in successfully.

995 Community Organizer
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) I believe more should be done to promote awareness and being comfortable with public breastfeeding. As a new mom I was terrified to have to feed my baby outside the home, mainly because I hardly see women doing so. Of course eventually I became more comfortable but I think I would have felt differently sooner if there were more public awareness and support for breastfeeding. Also during all during my prenatal care and hospital stay we are given tons of items with formula information and free formula supplies. Why not give expectant mothers breast-feeding supplies and accessories, such as creams, pads, gels for the breasts, etc.

996 Concerned Citizen
Access to Lactation Care and Support It is my experience that lactation support is hart to come by. Aside from a lactation consultant at the hospital who was only there 3 days a week, there were no other interpersonal resources for me provided my the hospital, and an understanding of what the cost, if any, there may be when contacting them. It felt as if you had to be well off in order to afford contacting someone. My friend on the other hand, who receives WIC had regular consultations with a lactation consultant as well as a weekly support group. I am so grateful that she was able to get that kind of support. I feel like that kind of support should be easily available and advertised to all new moms.

998 Health Care Provider
Lactation Professional
Nonprofit Organization
Access to Lactation Care and Support Access for lactation support needs to be increased, Medicaid moms get inconsistent support and mixed messages from WIC clinics, physician support is negligible, increase private insurance coverage for lactation services, tax breaks for breastfeeding Moms?

999 Concerned Citizen
Support for Breastfeeding in Public Settings Women need to feel comfortable nursing their babies and toddlers in public settings. They should not be asked to move to a different location to nurse, unless they want the privacy themselves.

1000 Concerned Citizen
Other Areas Why is there not an option for supporting women who choose to stay home and breastfeed. Why are all the funding and support options offered to working mothers, and nothing is available to provide a mother the opportunity to be financially secure to stay home and raise her child in a supportive and loving environment, to bond with the child over the first years instead of the first weeks?

1001 Concerned Citizen
Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Free formula samples and incentives in the hospital should be banned. I received more information from the formula companies than on breastfeeding while in the hospital, plus had nurses telling me how to mix formula rather than helping me learn to breastfeed, despite my insistance that I would be breastfeeding exclusively. All women should be given face to face support immediately following birth and pediatricians should be discussing breastfeeding with every parent at every visit in the first year.

1002 Other Areas: Peer Counselor
Worksite Lactation Support, Onsite Child Care, and Milk Expression Most of our mothers are having trouble getting the opportunity to pump and store at work. They are also not getting a long enough lunch hour for them to go and feed their baby. I would like to see some sort of legistlation to protect the rights of these mothers to enable them to continue to breastfeed for longer than their maternity leave allows.

1003 Concerned Citizen
Health Care Provider
Support for Breastfeeding in Public Settings All public places would benefit from having a sanitary, comfortable environment for mothers to breastfeed. I strongly support breastfeeding and encourage women to breastfeed whenever and where ever they choose, but there are moms who simply are not comfortable nursing in a public setting (myself included). By providing a discreet place for these moms to nurse, the comfort level with breastfeeding in public would be elevated and take out an obstacle women encounter.

1004 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Preparing a woman in what to expect from breastfeeding before the need is upon her will calm her and relieve some anxiety associated with some problems that are bound to arise. After delivery the baby should be immediately placed on the mother so as to bond with the baby. Help should be readily available during the first two weeks, especially in the hospital or at home right after the birth.

1005 Researcher
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe that adopting the mother/baby friendly guidelines set forth by the WHO is necessary as a step towards promoting breast-feeding. If we do not normalize birth again, and allow women's bodies to birth naturally and without unnecessary medical interventions, then the rates of breastfeeding will continue to drop. Evidence based medicine is not being used in birth and postpartum care.

1006 Concerned Citizen
Access to Lactation Care and Support Extremely important for first time mothers or mothers who have special needs in lactation concerns. Mothers and baby need to be observed by supportive and caring indiviuals to offer advice and practical information on breastfeeding. This should be by volunteer basis and not a government agency.

1007 Researcher
Other Areas Nutritional support is also vital for breastfeeding women who need more caloric intake during breastfeeding to have an adequate milk supply and maintain her own health.

1008 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression I feel that if mothers had more support in the workplace with breastfeeding we would see an increase in overall duration for a lot of moms. an increase in duration would mean healthier babies,fewer missed days from work for mom, and lower health care cost.

1009 Concerned Citizen
Health Professional Education, Publications, and Conferences Health Care Professionals should be aware and taught on the benefits of breastfeeding, however, there should not be interference or financial support through government on breastfeeding. There are many publications and conferences already available to the public and could be promoted more so by health professionals as to these resources.

1010 Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media if we had more comercials on the benefits of breastfeeding instaed of particular formula ads this would show that breastfeeding is the norm it's what babies are suppose to have.

1011 Concerned Citizen
Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Education on breastfeeding needs to start early. Prenatal visits NEED to cover evidence based benefits of breastfeeding, and where to find breastfeeding support in the community. The hospital caretakers ie Doctors, Residence, Nurse Practioners, Nurses, Lactation Consultants, Social Workers, Case Managers, and all others caring for the breastfeeding dyad need to be educated on the benefits of breastfeeding and SUPPORT the breastfeeding dyad. One way this can be done is by NOT ordering or encouraging supplementing with formula, especially when human milk is available. Hospital staff needs to encourage 24 hour rooming in, and not sending baby to nursery, so dyad can learn breastfeeding on demand. Post-Delivery Care- Breastfeeding support should be readily available and encouraged throughout the breastfeeding experience with ongoing community and workplace support. Thank you for allowing me to post my comment. Diane Upton RN IBCLC

1012 Concerned Citizen
Other Areas: La Leche League member
Worksite Lactation Support, Onsite Child Care, and Milk Expression As an employee of the HHS, I was offered a lactation room and I had my own office to express milk for my child. I keep hearing about how hard it is for teachers to express milk and often give up - too soon. I am not sure what can be done to help this, but it seems like a real problem. Teachers should be allowed time 3x a day to pump, they should have access to a substitute or another teacher to stand in while they pump.

1013 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Work places are a huge support or hinderance to the breastfeeding mother. The employer can elivate some of the pressure associated with pumping/expressing at work if a room has been set aside and adequate breaktime specifically for expressing are outlined to the mother. Milk expression is sometimes a long process to express if the mother doesn't have an appropiate pump for her needs and the work place is uncomfortable emotionally or physically. Onsite child care would be the prefect solution to even expressing. It is easy on baby and mother and less time would be used at breaktimes because storage and clean-up would be eliminated.

1014 Concerned Citizen
Other Areas: recent mother
Paid Maternity Leave This country is so backward - I am often embarassed by so many of our policies. As a govt employee, I had to empty my entire sick and annual leave and request donated leave to stay with my child and bond with my child after she was born. Canada, Sweden and almost every other developed (and undeveloped) country have paid maternity leave - but not this one? It is pathetic and downright embarassing as a developed country.

1015 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care More emphasis needs to be made and education given during prenatal care to expectant mothers about the benefits of breastfeeding and the risks associated with formula feeding. Information on available resources or education should be clearly communicated - not just as hand out leaflets, but covered verbally during the prenatal appointments.

1016 Concerned Citizen
Access to Lactation Care and Support Lactation care should be available 24 x 7 rather than just during business hours. Failure to provide round the clock care leaves this to nurses who may or may not (generally not) be skilled or knowledgeable in this area - many a nursing relationship has been ruined by an ill-informed nurse who convinced a tired and desperate mother that her child was starving or could not assist a mother with getting a good latch.

1017 Concerned Citizen
Researcher
Worksite Lactation Support, Onsite Child Care, and Milk Expression It would make sense to have a national policy that makes it a priority for workplaces to give women clean places to pump breastmilk in privacy. If we look at the law in Tennessee (where I live), there seems to be a lot of leeway for employers:

1018 Concerned Citizen
Paid Maternity Leave Paid leave is an earned privelge and to force a company to pay their employees because of maternity would not be a wise decision. There are nine months of planning on the part of the employee and employer in preparation of the leave. Earned credits and incentives are ideas instead of strictly enforced payment to birthing mothers.

1019 Concerned Citizen
Use of Banked Human Milk If a child is in the PICU or NICU and the mother's milk has not come in yet, if it is deemed necessary to feed the child, the FIRST choice should be banked human milk - NOT formula.

1020 Lactation Professional
Nonprofit Organization
Use of Banked Human Milk Breastfeed babies in need of supplement should be able to receive banked human milk. Health Care providers should have this option available. Facilities should have banked human milk available. If breastfeeding is a priority lets make it 100% supported!

1021 Public Health Worker
State or Local Government
Paid Maternity Leave all new motehrs must have one year paid maternity leave or infant must be allowed to bring at work so mother continue to nurse her baby...look at Canada what they do for their infants, why can't we.

1022 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression There should be laws protecting working mothers and allowing them sufficient breaks and appropriate lactation areas to express their milk AS OFTEN AS THE MOTHER DEEMS NECESSARY!

1023 Concerned Citizen
Paid Maternity Leave Paid Maternity Leave in the US is the LOWEST of all industrialized/western cultures. A minimum of 6 months paid maternity leave, especially for nursing mothers, should be mandatory.

1024 Concerned Citizen
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Peer conseling program is working so invest in it...WIC and hospitals should work together to make difference. Other wise we are wasting our tax payers money...all programs must work together to make difference.

1025 Concerned Citizen
Support for Breastfeeding in Public Settings I have been pleasantly surprised and delighted at the support businesses and partically malls that have areas dedicated to breastfeeding. It has changed dramatically in the last 15 years and public outcry and demands have been heard. Government only needs to support these steps and not enforce them because public demand will be the deciding factor whether these businesses succeed or fail.

1026 Concerned Citizen
Public Health Worker
Access to Lactation Care and Support people should know if they need help.

1028 Concerned Citizen
Public Health Worker
Health Professional Education, Publications, and Conferences Train doctors and get rid of formula companies to save our children

1030 Lactation Professional
Access to Lactation Care and Support Lactation assistance should be available during the antepartum /postpartum period & as needed throughout the breastfeeding relationship. Insurance coverage needs to be addreseed by commerical insurances. The cost savings is unmeasureable (meaning we would save lots of money ) since health care cost will be reduced if breastfeeding was the norm. Breastfeeding needs to supported by health care professionals and access to help needs to be easy to get & find!

1031 Concerned Citizen
Public Health Worker
Worksite Lactation Support, Onsite Child Care, and Milk Expression Extended maternity leave will help, if mother has to come back to work so she should have support fro employer to continue breastfeeding.

1032 Concerned Citizen
Peer Support and Education of Family Members and Friends This is an extremely important factor in determining the continued long-term beastfeeding of the child. However, if the mother is determined and taught how to inform others this can be an educating time for the family and peers. Pre-natal support of breastfeeding is vital to educating the mother and having family and friends in attendance.

1033 Concerned Citizen
Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media breastfeeding is not sexual, our TV programs should give breast as a positive than negative.

1034 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Availabililty of home birth for low risk mothers (and insurance coverage) will make breastfeeding much simpler since minimal disruptions happen for mom/baby!

1035 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care To encourage skin to skin within the first two hours after delivery providing mother and infant are stable

1036 Concerned Citizen
Public Health Worker
Support for Breastfeeding in Public Settings look at the Eurpeon countries, breastfeeding is a norm.

1037 Nonprofit Organization
Support for Breastfeeding in Public Settings I think it is going to be helpeful, if we have room for mom who nurse in public. for example in hospitol/restaurant/grocery store/malls/work places/schools and everywhere that breastfeeding mom goes to.

1038 Concerned Citizen
Public Health Worker
Peer Support and Education of Family Members and Friends mothers, mother-in-laws, husbands and partners must work as a team to support mother to breastfeeding her baby. need a community to raise a good citizen, we can't even have a family together to do it....invest on the family structure...where is family unit? our future is gloomy, we need a family values back in the plate.

1039 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) Many organizations teach parents the vital information of supporting breastfeeding, however the government needs not duplicate these programs that are already in place that work and are not tax-funded. Elimiating government sponsered programs for breastfeeding would allow money to be used for other important resouces.

1040 Concerned Citizen
Public Health Worker
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) if motehrs can stay hoema dn family works then we don't need to waste our funds on tehse services...

1041 Nonprofit Organization
Paid Maternity Leave I reccomend to pay breastfeeding moms for the time they spend in pumping at work.

1042 Concerned Citizen
Public Health Worker
Research and Surveillance look at what otehr contries do, it is a natures way...invest in search but not much, we need to invest in marketing ans support than evaluating because we already know it-it works!

1043 Health Care Provider
Health Professional Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care We should insist that OBGYN as well as pediatricians offer encouragement to mother to breastfeed. Talking about breastfeeding early throughout the pregnancy, giving handouts, or other reading materials could make an inpact on whether the mom breastfeeds or not. Pediatricians should encrourage the continuation of breastfeeding if initiated. It all seems to common that by the time mothers consult our institution their minds are made up about breastfeeding because there is such a lack of support overall.

1044 Concerned Citizen
Research and Surveillance What research needs to be done on something that has been done for thousands of years and Surveillance? What does that have to do with breastfeeding. As a mother of five, who has breastfeeding for over ten years, I and others like me are the best resource available on breastfeeding that research or surveillance could never duplicate. It would surely be a waste of time and money to not depend on the vast resources already here and willing to voluteer time.

1045 Concerned Citizen
Other Areas Invest on family values...human is the only memmal that thinks baby can survive right after they come out of the womb...we should look at othe memmals how they care about their infants..we have the biggest brain but we are using it wrong way when it comes to raise an infant.

1047 Concerned Citizen
Paid Maternity Leave Nothing is more frustrating than when a hard working Mom has to make the decision to be separated from her baby due to finanacial constraints. I am a 33 year old non-profit local WIC program director and my employer only allows you to be paid for your maternity leave by utilizing the vacation or sick time you have earned, which I understand is better than some women get. When my son was born in Nov. 2007. After my 8 weeks of paid time off and my husband's new job wasn't creating as much income as we had planned, I felt a huge amount of stress and pressure to return to work before I reached my 12 weeks of FMLA. My son was also diagnosed with low birth weight due to my poor milk supply at this time. The most frustrating part is that there are so many other countries that have provisions for new mothers to stay home with their babies. Why can't our country allow at least 6 months to a year for a Mom to stay home and still return to her job that she worked so hard for. I have a wonderful job as a local WIC program director, but now being pregnant with my second child I am struggling to find a way to balance my committment to exclusively breastfeed my baby and return to work by 12 weeks so that I won't lose the job that I worked 12 years to get.

1049 Concerned Citizen
Paid Maternity Leave We are one of the four countries out of 170 that don't compensate for any maternity leave. Our society makes it difficult for middle class Americans to raise children and need to work to keep up with mortgage, taxes, food and bills but don't qualify for any assistance programs. The middle class families are suppressed and are forced to limit the amount of children they can have because of money and lack of support. We are forced to return to work early because it is hard these days to have three months of salary savings in the bank to cover for the time out of work. It is just not fair when other countries give a lot more support to working families. How are we so behind these other countries when is comes to paid maternity leave and support?

1051 Health Care Provider
Lactation Professional
Access to Lactation Care and Support Please provide incentives for hospitals to offer outpatient lactation visits. After hospital discharge, the breastfeeding rate drops precipitously because patients do not have access to covered services for lactation. Most ob/gyn and pedi offices are not staffed with qualified lactation professionals and provide limited and, many times, outdated help. Hospital outpatient lactation services would give nursing mothers the needed continuity of care to continue breastfeeding successfully.

1052 Concerned Citizen
Health Care Provider
Lactation Professional
Paid Maternity Leave Please move our government toward the goal of providing some paid maternity leave for new mothers. Too many new mothers are forced to send their babies to poor-quality daycare facilities in order to return to paid employment too soon. Our society would be best served by placing the welfare of young children first and allowing them to stay with their mothers for a longer period.

1053 Concerned Citizen
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother
Health Professional Education, Publications, and Conferences All the healthcare workers need to be on the same page with breastfeeding education. Many a mother has had trouble keeping straight the information she gets regarding breastfeeding because every person seems to have differing info. Lactation training needs to be required for not only nurses, but also doctors (especially those dealing with woman and infant/child health). There are many who got their licenses years ago and still treat nursing moms and babies as though they are formula-feeding. They advise these pairs as such, giving really poor breastfeeding advice, and in many cases, just advising a mom to supplement in lieu of giving good information or references to a local lactation consultant.

Also, I would like to see the WHO growth charts used as te standard in all doc offices and hospitals. The current growth charts used for infants are based on formula-feeding, and that is not the natural way a baby grows.

1055 Concerned Citizen
Health Care Provider
Researcher
Worksite Lactation Support, Onsite Child Care, and Milk Expression When I went to nursing school we had a small but cozy lactation room that enabled me to pump for my infant. It had a refrigerator and a locking door. I belive that all schools and major businesses should have lactation rooms available. They don't require much space.

1056 Concerned Citizen
Health Care Provider
Lactation Professional
Other Areas Please do not make it so easy for new mothers to get free formula from WIC. If new mothers had to pay even a small portion of the cost, it might be an incentive to breastfeed. The federal government is spending a fortune to provide inferior nourishment to babies who would benefit so much from their mothers' own milk.

1057 Concerned Citizen
Researcher
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Any effort to make it easier to breastfeed in this country is a positive movement; let's avoid the flipside of villainizing women who, for whatever reason, are unable to breastfeed.

1058 Concerned Citizen
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: Mother
Paid Maternity Leave This country is ridiculous in its lack of maternity and supportive family leave policies. Some employers use the excuse that a mother has a choice as to when she gets pregnant, so she doesn't deserve paid leave. That is just plaion discriminatory.

Forget that staying at home longer makes for more stable families and society. It takes a woman's body almost a full two years to recover from one pregnancy. Studies also show that the longer a mother stays home, the more likely she is to be able to exlusively and successfully nurse. Many women are victims of the rush to get back to work; they feel as though they have a deadline to get it right by 6 weeks or they're done. This results many times is either ending nursing abruptly or prematurely once mom returns to the work force. Mothers, and especially mothers with small children, are going back to work en force. Mothers many times do not have the option of staying home with their children even for a short period of time because there is no icome coming into the house if they don't work. Providing for our children is nothing new, but having to choose between nurturing and nourishing your child in the healthiest way possible and keeping a roof over your head is not a choice any mom should have to make. A paid maternity policy for a minimum of three months postpartum would put us only the path to healthier moms, babies, and in turn, a healthier society.

1059 Concerned Citizen
Lactation Professional
Other Areas: WIC peer
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Moms must be encouraged by all nursing staff and doctors to do skin to skin with baby immediately after birth and at least through first feed. All hospital staff must be educated on benefits of this practice and follow through with assisting mom whenever possible per AAP guidelines. Currently the only people encouraging this are the breastfeeding helpers, the moms would be much more apt to do skin to skin with everyone stating the same thing. Sometimes moms are even prevented from doing this when they want to.

1060 Lactation Professional
Access to Lactation Care and Support Lactation is seen as a specialty in some hospitals and they hire only 1 or 2 IBCLC's, who work only in the daytime hours. In working with moms they say that their babies seem more willing to breastfeed at night and then there is very little help in the hospital. At our facility, we have daytime and evening assistance, maybe up to 11pm. When we can, we have had someone up to 1pm but due to cut backs, we had to eliminate that time slot. But we noticed that when we had the additional help during the evening hours, that the mothers did better and the percentage the mix fed dropped. Perhaps, because the main help they need is general education and latch on, if the facility can not afford IBCLC's they can hire lactation educators with a IBCLC team leader ( if baby has specialized issues) The educators are affordable and they can halp the mothers with more one on one. This is what will help moms feel comfortable with their breasetfeeding skills.

1061 Other Areas: Nursing mother
Health Professional Education, Publications, and Conferences Doctors (Pediatricians) know little to nothing about breastfeeding and are too ready to suggest or insist on formula. When a baby fails to gain, the pressure is immediately put on the mother to give formula, which is the worst thing a nursing mother with supply issues can do, from a increasing supply perspective. We need a standard approach in this situation that includes referrals to lactation consultants, La Leche, etc. Doctors need to know and internalize that switching infants to formula increases their chances of death, allergies and various other serious problems. Suggesting fornula should be the last resort, not the first.

1062 Other Areas: nursing mother
Use of Banked Human Milk I would donate milk if the opportunity were publicized and made easy. But who knows where to go?

1063 Concerned Citizen
Support for Breastfeeding in Public Settings Breastfeeding is not a sexual thing, it is biology. Just because we can stick a bottle in a baby's mouth does not make it better for the baby. In nature, everything afffects something else, what are we messing up by not encouraging breastfeeding - the pulse and connection between mom and baby , passing on of antibodies. We have become to attached to convenience and like fast food, it may be convenient, but not necessary healthy or good for us. We need to make breastfeeding normal. Have we over sexualized the breast so much that a mom can not feed her child without someone passing judgement on her. People need to know that its not someting to be snubbed but a skill and art that has been around as long as human kind reproduced.

1065 Other Areas: nursing mother
Worksite Lactation Support, Onsite Child Care, and Milk Expression I nursed two children while working - for a year each. It was hard. The state I lived in (UT) does not require employers to give employees any breaks, so I had to make a special request. I was given two ten minute breaks to express milk - not really long enough, since I had to wash pump parts, too. And I ended up expressing my milk in a telephone maintenance closet, which while better than a restroom, was still not great, as it did not have a lock on the door.

Nursing mothers need breaks, they need a secure place to express milk, and they need support from employers. I don't think employers understand the benefits of breast milk for them, mainly fewer sick days for mom due to baby being breastfed. And there still is a level of embarrassment that women have to overcome due to the sexualization of breasts in the US. This is part of the reason I try to nurse in public often, so that people can start to see it and know it is normal.

Onsite daycare is a dream. How about just a quality daycare close by so that mom can nurse at lunch?

1066 Other Areas: nursing mother
Paid Maternity Leave Well, I did HR consulting for 10+ years and I don't see this happening any time soon. There is not the political will and the costs to employers would be huge. For many employers just having their workers out on leave is a huge burden.

Of course this would be ideal.

1067 Other Areas: Mother
Paid Maternity Leave In the U.S. 12 weeks of unpaid leave is HORRIBLE considering other countries such as Finland allow for 13 MONTHS of leave with the guarantee of a woman's job being there for her when she decides to return to work. This short term leave sabotages breastfeeding relationships before they've had a chance to start, and leaves a lot of women with no options other than supplementation.

1068 Concerned Citizen
Other Areas: Nursing Mother
Paid Maternity Leave Until we have a Maternity Leave program that allows women more then a few weeks to be with their children, breastfeeding will suffer. The 6 weeks of protected leave now is not enough time to recover from childbirth, establish a good nursing relationship, and figure out how to get organized enough to go back to work when most mothers aren't even sleeping 8 hours a day. A minimum of 6 months paid leave would benefit employers as well as the new mothers.

1069 Other Areas: Mother
Worksite Lactation Support, Onsite Child Care, and Milk Expression Women need to know the importance of pumping to keep up their nursing relationship, and workplaces need to be supportive of women's needs when they return to work. Pumping in a bathroom is disgusting, and if its a shared bathroom, one has to deal with co-workers coming and going along with the cleanliness issue. Time needs to be allotted to pumping moms. It would be best to have onsite daycare, but so many workplaces aren't conducive to the U.S. governmental/state governmental regulations, so perhaps those need to be changed for onsite daycare specifically. One example that barred my workplace from having onsite care is the need(?) to have an outdoor play area. I would gladly give that up if I could bring my daughter to work with me, but its a regulation that can't be overcome where we are.

1070 Breastfeeding Coalition Representative
Community Organizer
Concerned Citizen
Employer
Health Care Provider
Health Professional Organization
Lactation Professional
Public Health Worker
State or Local Government
Peer Support and Education of Family Members and Friends Hospitals should develop a policy that offers Peer Support to postpartum patients that include inpatient support and immediate home follow up. Peer Support should be from women who have successfully exclusively breastfed and have experience in mother to mother support.

1071 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Peer counselors should be used in Post-Delivery care.

1072 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media How about an ad campaign (posters, commercials, pamphlets...) where celebrity and non-celebrity moms openly breastfeed and discuss how wonderful, convenient, bonding, health promoting, etc. the experience has been for them?

1073 Concerned Citizen
Access to Lactation Care and Support Lactation support should begin prenatally and be covered by all insurance.

1074 Concerned Citizen
Industry Representative
Nonprofit Organization
Other Areas: Doula
Peer Support and Education of Family Members and Friends It is essential to teach about breastfeeding in school along with biology, nutrition, sexual education, and/or family living classes. It is important to know what the function of breasts are. It is not enough to say that breasts produce milk - we have to say why. We have to explain the immediate nutritional value for the infants, the lifelong benefits for women and babies who breastfeed, and the bonding that occurs to improve the maternal relationship. Reaching youth is key to changing our culture.

1075 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Maternity care centers have to step up and provide evidence based practice and information to parents, allowing healthcare providers and personnel to use opinion and outdated practice is a large part of the issue for moms initiating and establishing successful breastfeeding, that and follow up information or assist after discharge. Just saying you offer it isn't enough,

1077 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals need to become baby friendly by never giving formula to anybody to take home after delivery. Not just the breastfeeding woman but all woman delivering. Formula should be only given to the baby while in the hospital if mother is unwilling or unable to breastfeed.When these formula giveaways are given it make it look like the formula is the best choice to feed baby. Formula companies have caused a lot of the disruption of breastfeeding. There should be consequences for nurses and staff member at hospitals that discouraged mothers to breastfeed.

1079 Public Health Worker
Access to Lactation Care and Support There needs to be more peer counselors for breastfeeding in public health and in the hospital. More breastfeeding counselors available at a nominal cost and health insurances including medicaid should pay for breastfeeding post delivery visits by lactation specialist.

1082 Concerned Citizen
Support for Breastfeeding in Public Settings Even the most comfortable breast feeding moms can feel uncomfortable nursing in a busy public area like airports and malls. It always amazes me that we donate huge private rooms to smokers but nothing for a nursing mother and baby except a smelly, dirty bathroom. The fact that private nursing areas are not spotted all over our towns, cities, states and throughout our country is surprising at the very least. Breast feeding is something that has always been here and always will be and should be supported and encouraged.

1083 Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Provide breastfeeding classes prenataly. Extend invitations to moms to attend breastfeeding support groups before they deliver to be exposed to women breastfeeding and ask questions obtain information. Skin to skin care immediately following delivery in the hosptial, do not separate mom and baby the first hour of birth unless medically indicated. Refrain from giving the newborn bath until after the first breastfeeding. Offer follow up care, by either phone calls from lactation consultant upon discharge, aand breastfeeding support groups.

1084 Public Health Worker
Worksite Lactation Support, Onsite Child Care, and Milk Expression I feel this is so important for continued breastfeeding after 6 weeks postpartum. Woman have told me in the WIC program that they would continue breastfeeding if the workplace was helpful and allowed pumping and time at lunch to breastfeed if infant was close.

1085 Lactation Professional
Support for Breastfeeding in Public Settings Signs posted for designated areas for breastfeeding mothers. Not all mothers are comfortable breastfeeding in public. Area could be a lounge setting next to a public restroom. In stores could be a dressing room provided for a breastfeeding mom.

1086 Lactation Professional
Access to Lactation Care and Support Phone numbers for Lactation Care and Support could be listed in phone book or if hospital setting under hospital directory.

1087 Nonprofit Organization
Public Health Worker
State or Local Government
Worksite Lactation Support, Onsite Child Care, and Milk Expression If employers don't give women long enough breaks to express milk or the ability to go breastfeed their infant (onsite child care)then they are not going to do it. Fifteen minute breaks just don't do it! Also having to express milk in a bathroom stall is not possible! We need to give breastfeeding mothers more time to express at work or more time to actually go to the child care and breastfeed their infant. I have so many mother tell me that they aren't even going to try to breastfeed at birth because they'll have to stop it when they go back to work in 3-6 weeks. We need to support those mothers that want to do this for their children but can't jeopardize their jobs to do it.

1088 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Time set aside for the working mom to be able to pump. If she does not have a pump a quality hospital grade pump avaialble at the worksite where she could be able to purchase attachments to use while away from her baby. If possible, Onsite Child Care where mom is able to stop in for feedings to be able to eliminate pumping or milk expression. In some instances that the child care provider can bring baby to mom for a feeding mid day, to eliminate one pumping session.

1089 Lactation Professional
Peer Support and Education of Family Members and Friends MSU extension has a breastfeeding initiative program to support and assist moms that qualify for WIC. Peer couselors are a valuable source for these moms. To have this type of program in place would be beneficial in every WIC office.

1090 Concerned Citizen
Paid Maternity Leave 6 weeks is in NO WAY enough time to establish a successful breastfeeding relationship with you child. 6 weeks is just enough time for your body to recuperate from giving birth. Not only has your supply not settled into supply and demand mode, your child is still very dependent on you. Many babies don't take to bottles as easily or if they do, have trouble returning to the breast. Each of which can seriously effect a mother's supply. Maternity leave should be AT LEAST 3 months, though personally I would hope for more. 12 months is the ideal time to have a child bond with their mother, successfully breastfeed as long as they need. Though I know paid maternity leave can't last that long, job security and benefits should for the sake of a happy healthy family.

1092 Concerned Citizen
Support for Breastfeeding in Public Settings It's difficult to find a space to sit comfortably to nurse my son. If I'm not near a Babies R Us an Ikea or my house, there are no baby and mom friendly areas. Many times, I've had friends be told that they should nurse in the bathroom if they want privacy or a quiet place. That is just unacceptable. Would you eat your lunch in the bathroom? If the sense of community were brought back to neighborhoods, everyone would be more comfortable, not just nursing moms.

1093 Health Care Provider
Health Professional Organization
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I think the single most supportive thing that can happen to help mother and baby to be successful with breastfeeding, is to give them at least an hour together skin-to-skin with no procedures beyond drying baby and covering the two with a little blanket. Eye-to-eye and skin-to-skin until the infant starts hunting for the breast naturally, and then with a little help from mommy, the baby will initiate breastfeeding and imprint

1094 Concerned Citizen
Health Care Provider
Public Health Worker
State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Many hospitals are giving out formula to moms who are breastfeeding (even to exclusively breastfeeding moms). For the establishment of a good milk supply, this practice should be limited to those moms whose milk has not come in yet. Many moms are also getting information, when they deliver, that it is OK to breastfeed just once or twice a day--and then when their supply disappears they don't understand what happened. We need a push for exclusive breastfeeding for at least a month before the introduction of formula, even in moms who plan to partially BF and partially formula feed.

1095 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Public Health Worker
Other Areas: WIC Agency
Paid Maternity Leave Having a 3 month paid maternity leave for all working moms would allow new moms time to establish an adequate supply of expressed milk and prevent the need for supplementation and the pressures that come with returning to work at or before 6 weeks postpartum.

1096 Concerned Citizen
Health Care Provider
Public Health Worker
State or Local Government
Other Areas: WIC
Use of Banked Human Milk Here in St. Louis, we don't have access to a human breastmilk bank. However, we desperately need this service, and we have many mothers who would donate milk to a milk bank. Every state (or at least those with large metropolitan areas) should have a human milk bank available.

1097 Health Care Provider
Health Professional Organization
Lactation Professional
Access to Lactation Care and Support Insurance companies should be reimbursing families for Lactation Consultations.

1098 Concerned Citizen
Access to Lactation Care and Support As a breastfeeding mother, I wish the lactation consultant at the hospital was more available or even on-call for questions.

Mothers need to know that there are many avenues of support, and that nursing isn't inconvenient. Midwives and doctors need to provide information about La Leche, Kellymom, and the lactation consultants. And they should strongly encourage mothers and partners to attend meetings. It's easy to get support if you know where to look. Care providers need to make it easy to get support.

I suppose paying for it is an issue, so insurance should cover it. Or state aid programs like WIC. WIC will buy formula, why not a lactation consultation or breast pump?

1099 Health Care Provider
Health Professional Organization
Lactation Professional
Use of Banked Human Milk Whenever the mother of an infant cannot provide her own milk, the infant should be able to receive safe human milk. Human Milk Banks are way too scarce.

1101 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Add the following standard of care (or a similar statement) for all prenatal clients: Inform all pregnant women about the risks of not breastfeeding, the reasons to breastfeed and exclusively breastfeed, and provide resources in the community for breastfeeding support. Add the following as an industry standard of care for in hospital care: All well babies, and other babies who do not need immediate nursery care, should be placed skin to skin with their mothers and helped to breastfeed (if mother willing). Skin to skin should be where initial assessments are done, and baby should be transitioned to extrauterine life there.

1102 Concerned Citizen
Use of Banked Human Milk I have donated milk to moms who can't produce enough or have preemie babies or are on medication that prohibits nursing.

This needs to be encouraged and talked about in birth classes, post partum appts, and well baby visits. the benefits of breastmilk can be shared!!

1103 Health Care Provider
Lactation Professional
Support for Breastfeeding in Public Settings Goal: for all 50 states to have favorable legislation protecting mothers rights to breastfeed their children anywhere. We need a big public health push and campaign, radio, TV, print, showing mother/child breastfeeding and saying this is OK and desirable.

1104 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression It is absurd that employers are not required to provide a nursing lounge that is not an office, closet, bathroom, etc. Mothers should have a designated area just for them to pump or nurse. And it should be comfortable and clean and have the supplies necessary (a fridge, sink with hot water, comfy chairs, magazines, electricity). The breaks to pump should be paid. and be available as the mother sees fit.

If smokers can take breaks without ramification, why can't nursing mothers???

1105 Concerned Citizen
Support for Breastfeeding in Public Settings Thank God I live in MN where breastfeeding is protected!!! I'd fight to the death to get it protected if it weren't. It's hateful to forbid a woman from feeding her child in public. Read the MN law and get every state and the federal gov to adopt that.

1106 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Public Health Worker
Other Areas: WIC Agency
Worksite Lactation Support, Onsite Child Care, and Milk Expression All nursing woman should have access to a private, sanitary space to express milk while working or attending school. Working women should also be allowed ample time to express & store milk in addition to bathroom breaks. Employers should have a written Lactation Support policy in place so women do not feel embarrassed or guilty about expressing milk at work.

1107 Community Organizer
Concerned Citizen
State or Local Government
Support for Breastfeeding in Public Settings I am an American living in Europe as my husband is in the military. I think Americans need to realize that breastfeeding is not obscene and educated that it's normal. When I have been with Americans breastfeeding, I have experienced people getting up and leaving even though you couldn't see a baby underneath my coverings. When among Europeans nursing in public, if you are covering up, they look at you like you are smothering your baby. Who wants to have their face covered with a blanket anyway? On the other hand, they don't even seem to notice if you aren't trying to be modest while breastfeeding.

1108 Concerned Citizen
Support for Breastfeeding in Public Settings I think it would be great if every women's public restroom had a louge area for breastfeeding. Then we wouldn't have to feel awkward breastfeeding in public and there would be a safe and comfortable place for us and our baby.

1109 Public Health Worker
Support for Breastfeeding in Public Settings As a health care professional, and mother, I would strongly encourage all public settings (especially shopping malls, targets, wal-marts, restaurants) to make a special place in the women's bathroom for nursing mothers. If you want mothers to breastfeed we need your support in an appropriate location. For example, one day while shopping at Target my daughter was hungry so I had to sit in a bathroom stall in order to find a place to sit down while nursing her. Some stores have taken the initiative to set aside breastfeeding rooms which is fantastic!!! I am a huge supporter of breastfeeding in public settings, but there needs to be somewhat of a comfortable place to do it, instead of trying to nurse while standing up. I personally applaud those stores who have set aside a special place for mothers to nurse their infants, and obviosly like to frequent them more often. If it were mandatory that businesses have nursing rooms for mothers, their business might seen an increase in sales! Once I was also at a conference for work and had to pump while away from my child in a library meeting room, where there was very limited privacy. If we want to encourage mothers to breastfeed we're going to have to have some privacy.

1111 Concerned Citizen
Health Professional Education, Publications, and Conferences Comparing my positive experience with less positive ones of friends and families in other areas of the US ( South primarily) has lead me to believe that pediatricians need better training in regards to breastfeeding, benefits to older infants , toddlers and children as well as how to support nursing moms.

The disparity between my doctors and theirs was unacceptable, breastfeeding needs to be the norm, and all doctors and nurses need to be properly educated . It's a public health issue and needs to be addressed as one.

1112 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression Every office should have a designated area for a woman to pump or bring her baby in to breastfeed. The company should allow a breastfeeding women more breaks, a longer lunch period and/or flexible work hours in order to accomodate her and her breastfeeding child. A company should also allow women to bring their babies into work with them - at least for a certain period of time. Babies up until about 4 months of age usually sleep and eat a majority of the day. If it is not affecting her work, then the mother should be allowed bring her baby with her. Also, if there are mulitiple women in an office setting who have babies and are breastfeeding, then in-office child care should be allowed, and at the mother's expense. Mothers can then combine funds to help cut the cost of the child care and the babies would have their mothers close for feeding and any other needs only the mother can provide. Companies should also be more flexible in allowing a breastfeeding mother to work from home for the first year - if she is able to perform her job out of the office. A company should also not make a mother who is breastfeeding travel over night or work longer than normal working hours.

1113 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) It would be great if more DVD's/videos were available regarding Breastfeeding, it's benefits, CPR, First-Aid, where to find support etc. Sometimes it can be difficult to go to classes. I was on bedrest for 8 weeks and couldn't attend any of the baby classes I signed up for. I felt very lost when my baby arrived.

1114 Public Health Worker
Paid Maternity Leave I am a huge supporter of paid maternity leave, especially in this day and age when so many women are working outside of the home. It would be great for our employers to offer this as a benefit, instead of us having to try to build up extra PTO, only to use it all during maternity leave and have nothing left when we return to work and need a day off for a sick child. The United States is greatly lagging behind other countries in this area. I think in the end everyone especially families would greatly benefit form this, and mothers could feel good about taking their time off to bond with their new infant instead of having to rush back to work b/c they have no time to take off or can't afford to. And in order to be fair to those people who don't have children and are in the workforce, maybe they can get compensated somehow with extra paid leave as well.

1115 Concerned Citizen
Use of Banked Human Milk More information regarding banked human milk is needed! Women who breastfeed should be encouraged to pump and donate. Pumps should be more affordable or at least be able go through insurance to purchase them.

1117 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care After the births of my 2 daughters, I found both hospitals to be supportive of formula-feeding and not breastfeeding. I would very much like to see more breast-feeding friendly hospitals (while still allowing mothers the info and choices for formula.)

1118 Concerned Citizen
Access to Lactation Care and Support I had a fantastic pediatrician that employed two lactation nurses. My son had trouble latching on so I probably made use of these specialists 5 or 6 times in his first month. I credit them for my success with breastfeeding (I have been doing it for 6.5 months now). There needs to be more access to these specialists because I have many friends who have not received help from lactation nurses other than what is provided in the hospital and they have given up breastfeeding very prematurely because of misinformation that they have been given.

1119 Concerned Citizen
Use of Banked Human Milk My sister adopted a baby and used a lactaid nurser filled with donated breastmilk from lactating friends. While this worked for her, I'd like to see more support of milk banks, ensuring donated milk is available for healthy adopted infants, and not only preemies.

1120 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I believe we should make breastfeeding within the first hour of life a priority for every newborn. We should facilitate this by placing the newborn skin-to-skin with mother the first one to two hours of life. Hospitals should discontinue the receipt of free formula samples and make it necessary to get an order to supplement breastfed infants. A lactation professional should be readily available 24 hours a day, 7 days a week, for that new mom in order to get her through the most difficult first few weeks of breastfeeding.

1121 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Health Professional Education, Publications, and Conferences Breastfeeding theory and management needs to be part of every health care worker training. It should also be part of hospital practices/policies. It should be mandatory for reliscensure for nurses and physicians/apn's. Somehow we need to educate these practioners or there is no point in doing what I do. I am simply damage control.

1122 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Our nation still sees breastfeeding as sexual. This is because women, men and kids don't see it in everyday society. We embarrass, even criminalize moms who breastfeed in public. How are moms supposed to be comfortable nursing outside their homes? We need more ads, shows, promotions for breastfeeding to help our nation become comfortable.

1123 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Use of Banked Human Milk There should be at least one milk bank in each state.

1124 Public Health Worker
Support for Breastfeeding in Public Settings As a nurse/mother, I have noticed several healthcare facilities have a special location for smokers, why can't there be special lactation rooms for mothers. For heavens sake we are in the healthcare field after all, we should be doing all we can to support breastfeeding in public locations and in my opinion there is no excuse for not having designated public locations for mothers to provide the best nutrition possible for their children!!!!!!

1125 Breastfeeding Coalition Representative
Community Organizer
Health Care Provider
Lactation Professional
Paid Maternity Leave The United States is so far behind in our care of new moms and their babies. No wonder moms have trouble breastfeeding! They are pressured to return to work way too early and once there, run into very unsupportive employers and coworkers. In fact, in my organization, a health care company, there is NO employee breastfeeding policy.

1126 Health Professional Organization
Researcher
Other Areas: Educator/Professor
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Breastfeeding education needs to start much earlier and needs to involve the entire family and support structure. Pregnancy is too late. Also need to educate our teens and up that this is natural behavior to be encouraged, get away from the whole sexual consideration of the breast. Hospital stays and healthcare visits can offer information but do not have the wherewithal to change the behavior so should be encouraged to employ supportive strategies primarily.

1128 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care GET RID OF THE DIAPER BAGS AND FORMULA SAMPLES EVERYWHERE!

1129 Health Professional Organization
Researcher
Other Areas: Professor/Educator
Access to Lactation Care and Support WIC continues to fail to adequately supply such support. Lactation consultants are the first to be cut in tough economic times. Allow them to charge for their services as part of Medicaid reimbursements specific to breastfeeding and separate from the overall drg for giving birth.

1130 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
Access to Lactation Care and Support All women, not just WIC or the women wealthy enough to have insurance or the money to cover, should have access to an IBCLC. Public health is just that- public. Stop denying access to IBCLC's from Health departments to see non-WIC clients.

1131 Other Areas: WIC
Worksite Lactation Support, Onsite Child Care, and Milk Expression many of our mom's comment they can not pump at quicktrip and mcdonald's. Employers of this type need to have more encouragement to allow their employees BF.

1134 Health Professional Organization
Researcher
Other Areas: Professor/Educator
Research and Surveillance We need so much more. There is truly a need for a National Institute of Nutrition that would include breastfeeding as part of its mission. Every aspect of normal nutrition gets hugely ignored in the research arena. Because it is not technically exciting we neglect some very basic needs.

1136 Concerned Citizen
Access to Lactation Care and Support We all know that nursing is best for babies, but it can be very difficult for a new mom to get the support she needs. A lactation consultant can make all the difference.

1137 Breastfeeding Coalition Representative
Concerned Citizen
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Even if the Hospital have Breastfeeding policies, we still have problems with formula bags given to moms and formula put in basinettes on postpartum floors. We need to inplement stronger policies or protocols for formula distributions. We need a lot of support from our Providers. Thank you.

1139 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I believe the state should consider providing subsidies to employers to provide onsite childcare. Allowing mothers to have easy access to their children would promote ease of breastfeeding by eliminating the cost and inconvenience issues of expressing milk.

In addition, the state should pass legislation requiring healthcare providers to provide hospital grade pumps for nursing mothers. Breastfeeding promotes affordable healthcare and should be encouraged and supported by government and all healthcare plans. If healthcare plans are truly interested in reducing overall costs they must start supporting and fully funding preventative healthcare measures such as breastfeeding. Hospital grade pumps could be checked out from the healthcare provider. These pumps would make it easier for working moms to effectively and efficiently express their milk.

1141 Concerned Citizen
Health Care Provider
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care If more hospital staff (nurses, doctors etc) had the same education and information as lactation consultants and other health care workers it could be eaiser to teach mothers how to breast feed. I have found that many mothers recieve conflicting information about breastfeed both in hospital and in the community from different, and well meaning, health care staff.

1143 Concerned Citizen
Health Care Provider
Nonprofit Organization
Other Areas: Doula, Massage Therapist
Access to Lactation Care and Support Have more lactaion consultants, or breastfeeding classes held in hospitals for new mothers to attened post delivery. Or have more organizations in for support, such as La Leche League.

1144 Concerned Citizen
Health Care Provider
Nonprofit Organization
Other Areas: Doula, Massage Therapist
Use of Banked Human Milk Have more milk banks in major cities

1145 Concerned Citizen
Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care As a lactation consultant for over 10 years, I consistently see that physicians are rarely if ever targeted and given the responsibility not only to educate themselves about breastfeeding, but to be the ones responsible for educating their clientele on research based information about breastfeeding. Not that they can do this single handedly. My recommendation would be to somehow enforce a policy requiring all OB/GYN and Pediatric physicians to have a Board Certified Lactation Consultant on staff at their facility. It would be this properly educated individual that would be able to instruct and support the patients and staff members on all of the very important matters regarding breastfeeding. I feel physicians are very negligent about how serious of a health issue breastfeeding really is. They need to be held accountable. Also, hospitals need to make it mandatory for any nurse working in the Maternal/Child field of nursing to take continuing education classes in breastfeeding. I have worked in facilities that do not require this for their staff and I have even seen a facility where at one time it was mandatory but later dropped as a mandatory rquirement with no explanation as to why educating their staff about breastfeeding was no longer a priority. Hospitals are not required to comply with the recommendations of the ILCA policy and procedure guidelines that plainly state how many board certified lactation consultants should be on staff at a facility according to the volume of babies delivered at that hospital. Why doesn't JAHCO enforce these policies?

1146 Lactation Professional
Health Professional Education, Publications, and Conferences Can education include the ingredients of the formulas in plain and simple language? Our local pediatricians seem to promote the use of the formulas (canned cooked cow milk) over breastfeeding.

1147 Concerned Citizen
Health Care Provider
Lactation Professional
Access to Lactation Care and Support The big problem here is that almost every single health insurance company that exists makes it just about impossible for a lactation consultant or the client themselves to get reimbursed for the services provided for a breastfeeding problem. I have worked in the community as a provider of lactation consultations and have only known of a very few number of clients that received reimbursement for the cost of my visit. Even though I provided the necessary super bill or other insurance form to them, they were told over and over that lactation consultations were not covered by their health insurance. Why has there never been a standardized method to address this serious problem?

1148 Concerned Citizen
Paid Maternity Leave Standard paid maternity leave of at least 12 weeks would be a HUGE help towards establishing breastfeeding.

1149 State or Local Government
Worksite Lactation Support, Onsite Child Care, and Milk Expression Our data indicate that the greatest drop off in our rates occurs when women return to work. There is little support there especially for disempowered, low-income women.

1153 Concerned Citizen
Other Areas: breastfeeding mom
Health Professional Education, Publications, and Conferences Strongly recommend or require all doctors who have contact with women and babies to have a copy of _Medications and Mothers Milk_ by Dr. Hale so they can see the latest studies showing which medications are safe for breastfeeding. Many unnecessary weanings occur when a doctor does not realize a medication is considered safe. Pharmacists and maternity floors would be another excellent location for this resource.

1154 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I had the great opportunity to have a lactation consultant employed by my hospital. I don't think that a maternity ward at a hospital is complete without one.

1155 Concerned Citizen
Access to Lactation Care and Support I had access to one because she is employed by the hospital I delivered at. However, the other two hospitals in the area do not have one.

1157 Concerned Citizen
Support for Breastfeeding in Public Settings I was shocked to discover that many places/states do not allow public breastfeeding. I have fed all of my 3 children discretely in public without ever having a negative experience. One of the biggest benifits of nursing babies is the fact you don't have to juggle bottles. You don't have to go into a dirty bathroom to feed a baby a bottle so why should you have to nurse there?

1158 Health Care Provider
Lactation Professional
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Nursing should be presented as the healthiest choice for newborns. The stress should be put on the newborns inability to fight bacteria and infections without the antibodies present in mother's milk.

1159 Health Care Provider
Access to Lactation Care and Support As an RN, I endorse making lactation support and care universal for childbearing women. We could save 10's of millions of dollars if we could increase the number of breastfeeding women. Lifelong reduction in allergies, asthma and diabetes not to mention increased IQ, improved bonding. It is time to advocate for women and children!

1160 Concerned Citizen
Support for Breastfeeding in Public Settings People shouldn't look at us weird when we feed in public! Its NORMAL! What these things were made for! Its not some indecent exposure to feed our children. the public needs to be enlightened about how to act around a breastfeeding mother.

1161 Community Organizer
Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care New mothers often do not receive adequate breastfeeding support in the hospital. They can receive inaccurate information that pressures them to supplement with formula unnecessarily (I did when my baby had jaundice). Artificial nipples are introduced by hospital staff (in the form of pacifiers and/or bottles) with little concern for the affect they can have on a newborn's ability to learn to latch well onto a mother's breast.

In addition, the current practice of sending mothers and babies home 48? hours after birth often means that the mother is sent home before her milk comes in. This can mean being at home with little to no support if she faces common breastfeeding difficulties such as engorgement and/or poor latch. And the free package of infant formula that she received from the hospital or in the mail becomes a very easy solution to a confusing and often scary situation when a mother is worried that she is unable to breastfeed her baby well.

1162 Community Organizer
Concerned Citizen
Access to Lactation Care and Support As a volunteer La Leche League Leader, I find that at least in my area (Lehigh Valley, PA) there are very few certified lactation consultants to whom I can refer mothers who call me with issues outside my ability to provide support.

1163 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Better breastfeeding education is needed for nurses. Some nurses are very quick to suggest supplementing with formula before the breastfeeding relationship even develops. Also,formula samples should not be given to breastfeeding moms. I was given a bag full of formula samples, and on the bag it said for breastfeeding moms.

1164 Concerned Citizen
Paid Maternity Leave All moms should have access to at least twelve weeks paid maternity leave. It takes time to establish a milk supply and get in sync with the baby.

1165 Community Organizer
Concerned Citizen
Health Professional Education, Publications, and Conferences As a La Leche League Leader, I receive many calls from mothers reluctant to wean after a doctor has told them that they need to in order to address some other medical concern for the baby or mother. Upon further investigation, weaning is rarely the only alternative and I have found that too often health care professionals fail to include the risk of weaning (in terms of the long-term health benefits of breastfeeding) in their considerations.

1166 Concerned Citizen
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) I would like to see breastfeeding information given in school within the context of reproductive education. I think this would help encourage future moms to breastfeed.

1167 Concerned Citizen
Other Areas: new mother
Access to Lactation Care and Support I am lucky to live in a town where both hospitals have excellent lactation programs and professionals. My sister delivered her child in a town where the hospital does not have lactation support. Lactation support should be available in all hospitals that deliver babies, especially rural areas.

1168 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression When I returned to work in education, I was able to keep breastfeeding by expressing milk in my office twice a day. But I know most teachers are not able to do this because they have a classroom to manage. It seems a shame that the profession that focuses on children does not provide the very best start for children of educators. Arrangements should be made to support teachers who return to work and wish to continue breastfeeding their babies.

1169 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I work for a large scale pharmaceutical company and the areas provided for pumping are appauling. For instance, in my building, women are reduced to using a single individual bathroom in order to pump. The company provides a 'room' in another building that is 10 mins away from mine with old musty couches and old magazines and considers that an adequate area for pumping. They do not provide hospital grade pumps that mothers could use either. I find it disgusting to use a bathroom that people use to have a private bowel movement and then have to sit for half an hour in the stench to pump milk for my son.

1170 Concerned Citizen
Paid Maternity Leave I work for a large company and our paid maternity leave is 6 weeks for natural birth and 8 weeks for cesaerean section births. I have many friends who live in Canada and they are given ONE FULL YEAR of paid maternity leave. I don't understand how a country considers it healthy to put a 6 week old child in daycare. There are many sick children due to this and this is causing healthcare costs to rise. I had to take 2 months of unpaid maternity leave in order to make sure that my son was taken care of. I would have preferred to be out for 6 months (the maximum amount of time my company will allow for unpaid leave) but with the current economy issues, I was forced to go back to work early.

1171 Concerned Citizen
Access to Lactation Care and Support Lactation Care should be standard for all births - many women do not know they need to request to see an LC - it should be part of the process with every single birth.

1172 Concerned Citizen
Other Areas: Nursing Mother
Paid Maternity Leave Paid leave is far more valuable than a lactation room and a breast pump. Babies benefit from the physical act of nursing, as do postpartum mothers. We need to look at models like the one used in Canada.

1174 Community Organizer
Concerned Citizen
Nonprofit Organization
Support for Breastfeeding in Public Settings Fear of retaliation for breastfeeding in public areas represents a major barrier to breastfeeding, in particular among low-income, WIC populations. Federal legislation that unequivocally protects the right to breastfeed in public which includes a strong enforcement provision will be a major step toward ensuring that no mother is afraid to nourish and nurture her child regardless of where she is.

1175 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media I think breastfeeding is important enough to do PSA's. (public service announcements) I am a lactating mother and feel that even though I know my rights to do it in public, publicly feeding my son can be awkward, embarrassing, and uncomfortable. I myself am not too shy to do it, but feel that it isn't widely accepted and feel pressure to not make others uncomfortable.

1176 Concerned Citizen
Paid Maternity Leave If the government is serious about encouraging mothers to breast feed longer than 12 weeks a government sponsored paid maternity leave needs to be put in place. I am currently visiting Sweden were mothers are given a year-long paid (~80% of their salary) maternity leave. Here is Sweden their rates of exclusive breast feeding at 6 months exceeds 70% (I believe). When I speak with mothers in Sweden they wonder how women continue to breast feed if they are expected to return to work after 12 weeks. And that I believe is the biggest barrier to extended breast feeding in America.

1177 Concerned Citizen
Nonprofit Organization
Support for Breastfeeding in Public Settings Promoting breastfeeding in public is extremely important. Too many women choose not to breastfeed because of lack of public acceptance.

1178 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care all hospitals should be required to be baby friendly in order to receive any kind of governmental funding

1179 Concerned Citizen
Paid Maternity Leave Many women do not breastfeed (or continue to breastfeed once returning to work) because their maternity leave is so short and they cannot afford to take an extended leave without pay. As a breastfeeding women that has recently returned to work after 6 months off (un-paid leave) I feel that a new mom needs AT LEAST 3 - 4 months home with baby to establish a strong breastfeeding relationship before returning to work. I took 6 months unpaid leave because establishing our breastfeeding relationship was so important to me. If all women had at least 3 - 4 months paid maternity leave they could have that important time home with their baby without worrying about money or if there would still be a job for them when they returned.

1180 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Access to Lactation Care and Support should be quaranteed to all through inclusion as insurance benefit

1181 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Health Professional Education, Publications, and Conferences should be a required component of training for doctors, nurses, and dietitians. continuing education should also be required. questions related to breastfeeding should be included in exams leading to certification.

1182 Concerned Citizen
Other Areas: breastfeeding mother
Access to Lactation Care and Support I believe women need more lactation care and support after delivery. Hospitals need to have lactation consultants on staff 24 hours, and these nurses and professionals should be experienced in helping women with difficulties such as flat/inverted nipples, poor sucking reflex, and engorgement. I did not receive the support I needed after the birth of my first child and could not successfully breastfeed her. When my second child was born, I knew more, and I did receive more help, but only because I sought it out myself. With more staff, hospitals could offer women on-going support, and even appointments after they leave the hospital. Without the help of La Leche League Leaders, I would not have been successful the second time around. Not every woman has the energy or initiative to seek out a new group when they need help, so returning the the hospital would be a beneficial option.

1184 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Being a full-time working expectant mother, I have much concern for the welfare of my child's health after my return to work. I have continuously wondered how I will go about paying for a double electric pump that will pump fast enough for me to keep up my milk production as well as not take away to much time from my employer. I have done all the research and found that the pumps with the power and speed I will need are expensive. Why couldn't the manufacturers of these pumps pair with the hospitals or independent practices to ensure that a breast pump is available to purchase and could be included in the medical bill, or at no cost to qualified individuals, and not just to rent, as this is more expensive than buying one?

1185 Concerned Citizen
Other Areas: breastfeeding mother
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Yesterday, I saw for the first time, a commercial for Medela products, which showed a woman breastfeeding her baby. The media is always showing bottle feeding, or assuming bottle feeding as the norm. We need more public service announcements about breastfeeding on television, on you tube, in parenting magazines, everywhere. Once people see breastfeeding in the media, it can compete with the cultural norm of bottle feeding as a more acceptable alternative in people's minds. This will also help women and their families feel more comfortable with breastfeeding in public areas. In addition, the media can help promote breastfeeding of toddlers, to encourage women to continue breastfeeding past infancy.

1186 Breastfeeding Coalition Representative
Health Care Provider
Nonprofit Organization
Paid Maternity Leave Our future citizens are our most precious resource and their best interests are served by supporting their parents and, if necessary, assisting them in having the time and resources to be parents to their own children. Most businesses are not going to implement paid maternity leave without societal pressure or governmental action. In addition, businesses and society at large need to be made aware of the multiple benefits to them of a mother breastfeeding her child, not only as an infant, but through toddlerhood.

1187 Health Care Provider
Paid Maternity Leave I believe that if Moms had paid maternity leave it would be an incentive to initiate and continue breastfeeding. Many moms that I work with do not attempt to initiate breastfeeding because they can not afford to have a maternity leave and must return to work earlier than 6 weeks.

1188 Concerned Citizen
Other Areas: breastfeeding mother of 5 children
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care It was very helpful with our 1st child to be able to call the LaLeche League and the lactation consultant consultant with breastfeeding questions any time of the day or night.

1189 Concerned Citizen
Health Care Provider
Support for Breastfeeding in Public Settings Breast milk is the best for your baby. Women should be able to provide this wonderful source of nutrition to their child at any public venue without harse comments. Breastfeeding is a natural thing.

1190 Lactation Professional
Use of Banked Human Milk I am a RN IBCLC in No Virginia and I have been involved with the International Breastmilk Project since its inception. I have also travelled to South Africa and have personally visited the facilities that use the IBMP Donor Milk for their HIV-affected, critically-ill babies. There is no doubt in my mind, as to the improvement that these babies make when obtaining Donor Milk as well as ARV medications.I am sure that we have babies in the USA that could benefit from Donor Milk and the IBMP has numerous mothers who are eager to pump and donate breastmilk, being turned away as the volume of Donor Milk has exceeded the ability to process it. www.breastmilkproject.org

1191 Public Health Worker
State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care During prenatal care I think the women should be getting some information on breastfeeding and some encouragement by their health care providers. Many of these women are receiving formula samples as soon as they find out they are pregnant. By providing formula from the first appointment women may be developing the idea that formula is actually better because that is what the doctors are giving.

1192 Concerned Citizen
Peer Support and Education of Family Members and Friends For me the WIC Peer Mom services have been invaluable. I'm not sure I could have breastfeed my first until he was 15 months without their support. I am currently breastfeeding my second. She is happily nursing away at 10 months old. I am in touch with my WIC Peer Mom frequently. She helps me with any little question that pops up.

1193 Concerned Citizen
Support for Breastfeeding in Public Settings I feel it is important to support nursing mothers in public settings. With out our support and encouragement they may have a tough row to hoe. Why not help these mothers do the best for their babies. They are our future.

1194 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Throughout my entire pregnancy I cannot recall ANY discussions between my health care provider and myself in regards to breastfeeding. Upon delivery of my son at the hospital, I was given a diaper bag, courtesy of a formula company, complete with formula samples and coupons. I was given no literature on breastfeeding. The hospital had a strict policy against rooming in with your baby and the nurses were very resistant to bringing my son to me when he cried. There was a lactation consultant available who offered very little assistance when I experienced difficult with the first day of nursing. The only help that I recieved was from my wonderful lamaze instructor. Unfortunately, I only knew her from a class that I had to pay for. If I wasn't such a stubborn woman, determined to do what I want to do, I would have likely given up on breastfeeding my child due to health care ignorance.

1195 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I 'get to' pump in the bathroom at work everyday. My employer tries to make me feel like this is a privalage not a right. Like they are doing something special for me so I can balance my pump and pumping accessories on my lap while sitting on the toilet pumping. This is not right. Something needs to be done.

1196 Concerned Citizen
Other Areas: Certified Breastfeeding Educator
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media We need to encourage advertisers to portray more images of mothers breastfeeding and less advertisements with bottles and formula. Our media can be extremely helpful in creating an idea that breastfeeding is normal and healthy and should be supported within our community and society. Women should not be made to feel ashamed of breastfeeding or be forced to only breastfeed in the privacy of their homes. We need to stress to the media industry that they can have a positive impact on the culture of breastfeeding in America and encourage them to change their perceptions and support breastfeeding.

1197 Concerned Citizen
Use of Banked Human Milk Why not give babies the best start in life?

1198 Concerned Citizen
Access to Lactation Care and Support Access for me was something I had to search for rather than being readily available. The lactation consultant provided at the hospital was of little help to me and I had to fight with the nurses to keep them from giving my baby a pacifier. Again, the only help I really recieved was from my lamaze instructor, who also taught a breastfeeding class, which of course had to be paid for by me.

1199 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I cannot recall ANY job where I would have had an opportunity to express milk during working hours let alone recieved support. Onsite child care is pretty much unheard of in this country.

1200 Concerned Citizen
Worksite Lactation Support, Onsite Child Care, and Milk Expression I cannot recall ANY job where I would have had an opportunity to express milk during working hours let alone recieved support and I am a former public health worker. Onsite child care is pretty much unheard of in this country.

1201 Concerned Citizen
Paid Maternity Leave Most mothers I know had to save up during their pregnancy to take the 6 to 12 weeks of maternity leave. The recieved no compensation from their employers.

1202 Concerned Citizen
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Once in a while, I am happily surprised to see a breastfeeding mother featured in the media. However, I am all too often bombarded by images of baby bottles. I have actually witnessed incidents where media has deemed breastfeeding pornographic and inppropriate. This is particularly upsetting.

1203 Concerned Citizen
Support for Breastfeeding in Public Settings Once again, I am stubborn, and would nurse my baby whenever he was hungry (modestly), usually regardless of where I was. I can recall being ushered into a closet by a well meaning hospital nurse who thought I might like a little more privacy. I was kind of confused at the time and gave in. There is very little support in most public settings for breastfeeding mothers and their babies. I know of many mothers who weened their babies very early due to this lack of support. They felt humiliated, like they were doing something very wrong if they found it necessary to nurse in public.

1204 Concerned Citizen
Peer Support and Education of Family Members and Friends Most of my family members were very supportive. Since I had no friends when first having my son, who had nursed their babies, I had no support there. They seemed to find it strange that I would want to breastfeed in the first place. Of course the media plays an important role there and since it is highly infuencial in forming the public's opinion on breastfeeding it's not going to increase that support.

1206 Lactation Professional
Access to Lactation Care and Support I work as a nurse and lactation consultant at a freestanding birth center. We offer close follow-up during the crucial first two weeks of breastfeeding. Our breastfeeding rate is 99% with most women breastfeeding longer than 12 months. I see some women with very complex breastfeeding issues who are determined to overcome the problems. I often spend 45-90 minutes with each couplet, but insurance will not recognize my services. Every breastfeeding woman and infant should have access to this kind of support. Lactation consultants should be reimbursed for their time and professional skills.

1208 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Use of Banked Human Milk should be covered by insurance if mother is unable to breastfeed or if supplements are needed. mothers who are unable to breastfeed or who need to use supplements should be made aware of its availability.

1209 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Worksite Lactation Support, Onsite Child Care, and Milk Expression employers who support breastfeeding through worksite lactation support and onsite child care should be given tax breaks. or better yet, employers who don't support breastfeeding should be charged higher taxes.

1210 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Paid Maternity Leave employer should either provide minimum of 3 month maternity leave or should be required to allow mother to bring her baby to work with her and breastfeed her at work.

1211 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media penalize through decreased funding portrayals of formula feeding in media used by anyone receiving government funds.

1212 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Support for Breastfeeding in Public Settings protect breastfeeding in public settings through federal law

1213 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Peer Support and Education of Family Members and Friends make peer support a required component of all wic projects

1214 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) make government funding contingent on providing breastfeeding support as a part of the service

1215 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Research and Surveillance require birth and death certificates and medical and school records to include information re breastfeeding initiation, duration, and exclusitivity.

1216 Concerned Citizen
Support for Breastfeeding in Public Settings I learned that babies are nursed by seeing women nurse in church, I would never have found the strength to do this for my own children if I hadn't gotten the message and seen it in action. We need to support women nursing, in all settings, and we need girls to see mom's taking care of their babies in the way they should be cared for. Please support nursing in public and get the message out to our country that it's for our benefit that babies are nursed exclusively.

1217 Concerned Citizen
Health Care Provider
Lactation Professional
Public Health Worker
State or Local Government
Other Areas: mother/former breastfeeding mother
Other Areas require that breastfeeding be presented as the norm in school curriculums beginning with elementary school. require that formula cans have warnings on them. require that people getting formula through hospitals and through wic sign a waiver saying that they understand the hazards associated with formula use. require that people who need or want formula at the hospital bring their own.

1218 Concerned Citizen
Other Areas: Employed breastfeeding mother
Paid Maternity Leave I was employed full time at the time I had my three children. Thankfully, working for a school district I was able to take unpaid maternity leaves that ranged from six to nine months based on the time of year my children were born. I cannot communicate to you the stress involved due to the fact that I wanted to breastfeed exclusively yet still needed to work. So far I have breastfed all of my children for at least two years each. My success in breastfeeding is due to working for a school district, having a very supportive husband who juggled his schedule and brought our children to my work to nurse and parents who chipped in financially to help during the unpaid leaves. In return for our struggles we have three children who are exceptionally healthy, well-connected to both of us and showing signs of giftedness. The United States needs to support breastfeeding mothers by assuring every breastfeeding mother up to two years paid maternity leave. This is not unheard of in other developed nations. If breastfeeding exclusively for six months and continuing for at least a year is recommended than there needs to be some financial support available to help all women achieve this.

1221 Concerned Citizen
Public Health Worker
Use of Banked Human Milk The last thing I would have done in the world is give my child someone else's breast milk. I am sorry but this not only seems to send the wrong message about nurturing the infant but creeps me out!

1222 Concerned Citizen
Public Health Worker
Worksite Lactation Support, Onsite Child Care, and Milk Expression I don't ever think I have had an issue with any of our clients not being able to take time to breastfeed their children. Most of the employers would rather see the mothers taking care of their child!

1224 Concerned Citizen
Public Health Worker
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media More positive advertising, etc. needs to be out there in media land!

1226 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Can you tell me how I can spread the information and support for the Breastfeeding Promotion Act of 2007?

1227 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Please ban formula advertising in hospitals, especially sending new mother's home with a can of formula and a formula advertisement diaper bag!

1228 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Fewer interventions during childbirth lead to an easier and more successful breastfeeding relationship. Several things that help women experience fewer interventions during childbirth: midwifery care, doulas, water birth options, freedom of movement during labor, no IV fluids (leads to overhydration of mom, so milk comes in later!). Work on reducing interventions during labor, and you will help so many mom's off to a much easier start breastfeeding.

1229 Concerned Citizen
Lactation Professional
Nonprofit Organization
Public Health Worker
Access to Lactation Care and Support Women need to be able to receive Lactation support more readily than they can receive formula support in the U.S. Every new mom should have the option to see a lactation consultant while in the hospital and during the crucial weeks after delivery. She should not be sent home with a free bag of formula, but rather with tools and resources to give her and her baby the best start at life! Right now women who qualify for WIC and women whose Pediatricians provide LCs have access to lactation support, but what about the women in between? In addition, breastfeeding needs to be publicized more as the natural way to feed your baby. Breastfeeding should be the norm in public and bottles should be the exception to the rule. The government can help promote lactation care and support by encouraging hospitals to go baby friendly. Tax breaks could help subsidize the money that is normal provided by formula companies. Public Health ads could include more breastfeeding awareness on tv, radio, internet, public transportation, etc.

1230 Concerned Citizen
Lactation Professional
Public Health Worker
Use of Banked Human Milk In the U.S. the use of banked human milk should be the norm in all NICUs, for adopted babies, mother's who are not able to breastfeed, babies suffering from HIV/AIDS and other life threatening diseases, etc. We know babies who receive human milk rather than formula are less likely to die to infections and diseases. The International Breastmilk Project (IBMP) is a wonderful example of how generous American moms are with their extra milk. Women are willing to donate their pumped milk to those in need. However, this is not a known or readily available option for most women. In addition milk banking is costly and difficult for organizations like IBMP to access. Currently, the IBMP is struggling to keep up with all of their donors. Please to do not let this organization or others go under because of lack of resources to process this life saving nutrition.

1231 Concerned Citizen
Other Areas It is important for the United States of America to take a lead in the promoting of an understanding of breastfeeding. When I breastfed my daughter in the 1970s, there was not a lot of support for breastfeeding in restaurants, public places, or the workplace. Today that is still the case. Doctors need to be trained to support breastfeeding and they need to discuss this with their women patients. The media needs to start approaching the female breast from the perspective of its function in providing quality food for offspring. We have no problem showing cows nursing their young, but humans are viewed as somehow different. People also need to be educated that breastfeeding should not automatically be stopped at 6 months. Finally, policies should be in place that promote breastfeeding and child welfare. This includes paid maternity leave of at least 12 weeks and facilities on site at workplaces for onsite childcare so that mothers can continue to breastfeed and for pumping so that nursing mothers have a clean and safe environment for pumping.

1232 Lactation Professional
Use of Banked Human Milk We are a group of Lactation Consultants who would like to observe the Forum on Human Milk Banking. How do we apply? Margaret Parsley RN IBCLC Inova Fairfax Hospital Falls Church, VA 22041 (703 593 5261)

1233 Health Care Provider
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Hospitals here often use sugar water to supplement or pacifiers to keep babies calmer. This hinders the breastfeeding process. I have seen many women come in with sore nipples because the baby was trying to latch on to the breast like a bottle, and moms often give up.

1234 Other Areas: WIC Dietitian
Access to Lactation Care and Support I believe that all insurance plans, including Medicaid, should cover unrestricted post-hospital visits with a Lactation Consultant as needed. Help for the short period of hospitalization after birth is not enough, esp for a 1st time Breastfeeding Mom.

1235 Other Areas: WIC Dietitian
Health Professional Education, Publications, and Conferences Extensive BF education should be part of the training for MD's, especially those in Obstetrics & Pediatrics. Mom's who have Doctor's who know about & support breastfeeding seem to do better.

1236 State or Local Government
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Examine regulations for maternity facilities. Work with JCAHO to set up standards for best practice that model baby friendly and are evidence based.

1237 Concerned Citizen
Health Care Provider
Lactation Professional
Nonprofit Organization
Public Health Worker
State or Local Government
Use of Banked Human Milk i think it is a shame that hospital can charge so much for donated breastmilk. that milk was donated to be used by babies in need. not for hosital to more money off the poor/or the rich.

1238 Employer
Paid Maternity Leave AS a WIC Certifier, I see the worry of breastfeeding mothers of going back to work and not being able to provide enough breastmilk for their babies. A lot of employers do not provide an area or time to pump and this sets up an embarassing situation for moms. We, at WIC try to educate breastfeeding moms about pumping and storing their milk. In some cases we can provide a pump for them. It would be my suggestion, that an employer provide at least 4-6months off with a salary insurance for moms that would pay them 1/2-2/3rds of their monthly pay. (a year would be perfect, but we don't want to fool ourselves).

1240 Lactation Professional
Access to Lactation Care and Support Insurance companies should be encouraged to cover home visits or outpatient visits for all patients who have any difficulty with breastfeeding at least for the 1st yr of life. This will ultimately lead to having a healthier clientele for them. The assistance should be given by IBCLCs and studies should be done to see the direct benefits of this support leading to longer duration of breastfeeding.

1241 Public Health Worker
Peer Support and Education of Family Members and Friends educate teens that breastfeeding if FREE, readily available & The Best Milk for their baby..& its NOT UNCOOL to breastfeed!!

1242 Public Health Worker
Access to Lactation Care and Support we need More lactation specialists/conselors at the bedside postpartum & in our clinics and MD offices

1243 Lactation Professional
Health Professional Education, Publications, and Conferences Physicians, especially pediatricians, should be required to have a certain amount of breastfeeding education as this is such an important part of the healthy infants first nutrition. We talk with many pediatricians in our practice who have had no education whatsoever on breastfeeding in their medical training.

1244 Concerned Citizen
Other Areas: Breastfeeding mom
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Breastfeeding in public needs more media exposure. Women doesn't need to feel we have to hide when our babies need to nurse.

1245 Concerned Citizen
Support for Breastfeeding in Public Settings I must say that I am impressed with the Westfield corporation. They include several breastfeeding spaces near their family bathrooms. Each space is equipped with a comfortable chair, small table with light reading material, enough space for a stroller and a curtain for those mothers who prefer to breastfeed in private. I have utilized these small rooms on several occasions, and have never been made to feel uncomfortable. Nursing in public is becoming more common, but there is certainly room for improvement.

1246 Concerned Citizen
Employer
Health Care Provider
Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Where is the support? Women continue to make the choice between BF and work.

1248 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care I previously commented about skin to skin contact and bonding following a CS. I failed to mention that my own experience included two highly evolved HCP's who allowed me to nurse my son immediately following my CS...a fact that saved my experience of birth and boded well for our subsequent nursing relationship. Hospitals should spend some energy figuring out how to minimize the harm and disruption a CS causes in the mom/ infant bond and nursing relationship. Also...prescribed probiotics would be smart.

1249 Public Health Worker
State or Local Government
Other Areas: WIC
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care No infant should receive formula from WIC until the infant is 1 month old or older unless a physician orders it for the infant.The hospital should not give out formula at discharge unless the physician orders it for the infant. WIC staff encourages breastfeeding when an expectant mother applies for benefits, but it is not supported by the hospital staff or attending physicians when formula use is encouraged....and then WIC staff are obligated to continue to provide formula when new mothers request formula at the infant's first WIC visit. ALL health care staff-doctors, nurses, dietitans- should be encouraging and supporting breastfeeding prenatally, perinatally and post natally!!!! (I have worked for WIC for 18 years! We have been trying so hard to encourage breastfeeding, but it feels like swimming against the current in our community. )

1251 Public Health Worker
State or Local Government
Other Areas: WIC
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) You didn't mention WIC as a Breastfeeding promotion Agency. WE try really hard to do this, but WIC program policy still allows formula issuance over strong breastfeeding promotion.

1252 Researcher
Research and Surveillance The recent concern about chemicals (e.g. BPA) in plastic milk bottles could be an opportunity to encourage parents to nurse their infant from a more natural source. However, there is limited information about the content or toxicity of the BPA (and other environmental estrogen) in the breast milk from many regions of the world (ncluding the US). Studies of both the contest of these lipophilic contaminants in the lipid-rich breast milk may allay the concerns before they emerge widely or show that women with high levels of contamination should limit the term of their breast feeding. More scientific information is needed here.

1254 Community Organizer
Concerned Citizen
Other Areas: Breastfeeding mother
Support for Breastfeeding in Public Settings Lack of support for mothers who breastfeed in public, and a negative societal view and sexualization of breasts has led to a low breastfeeding rate. This is because mothers will often choose to formula feed, rather than deal with the persecution and isolation they may face if choosing to breastfeed. Mothers will formula feed as they are frightened of harassment when nursing in public, or of having to stay at home or find a place to sit by themselves whenever they need to nurse their child. As most breastfed children eat every 1-2 hours throughout the day, this is a cause for isolation. I am sure I don't need to explain the ramifications of this, but I will anyway. The end result of this is that children are being deprived of vital breastmilk, and a special bond with their mothers. This results in diminished mental and physical health for the child. The mother too suffers diminished physical health, and breastfeeding has many protective factors. She also suffers more mental health issues due to isolation from the community when she is forced into bathroom stalls or sequestered within her own home. I believe that there are a number of things which can help work towards making brestfeeding more accepted by the community, such as laws to protect against discrimination of nursing mothers, in public, and in the workplace. Public service announcements on TV with imagery showing nursing mothers as a normal part of life, as well as posters, billboards, signs, magazine ads and other printed media doing the same can help. Banning formula makers from advertising their products as equivalent to brestmilk, and from gifting formula to new mothers could certainly help. I would even go as far as to suggest that formula be available by prescription only, as it is responsible for the death of many children, and should only be used as a last resort. I also feel that the creation of communicty areas for parents to congregate would help to restore a sense of the community raising family, and would help with the problem of isolation that brestfeeding moms often feel. Thanks for listening! Kristin Skrydlak-Simlai

1256 Concerned Citizen
Other Areas As the mother of a 2-year-old who I intended to still be nursing right now, the biggest barrier I encountered was lack of support. We all KNOW that breast is best. It is jammed down our throat at every turn. Education is not the problem here. Availability of formula in hospitals is not the problem. The fact that I had to pay $80 a visit for a lactation consultant is the problem. The fact that my husband had to go back to work two days after my daughter was born and I had no family nearby to help is the problem. The fact that I had to pay $300 for a pump or rent one for $30 a month is the problem. The fact that I had to go back to work after only a 7 week (unpaid) leave that was really only a part time leave as I had to answer emails and field calls is the problem. I gave up breastfeeding after two weeks because all the various demands on me physically, emotionally, and financially, just weren't worth it. My child deserved a sane mother more than breast milk in my mind. If I have another one I will try harder to line up support and save more money beforehand, but I feel like it's a battle that I probably won't win. Please put energy toward dealing with some of these very real problems rather than running more ads about how not breastfeeding is as dangerous as bullriding while pregnant. We KNOW it's best, now work on making it possible!

1257 Concerned Citizen
Research and Surveillance There seems to be little research based information about breastfeeding past 6 months of age. Yet American Acad. of Pediatrics recommends breastfeeding 'till two and then after as long as is mutually beneficial. Yet todller nursing can be difficult and there is little support. Research on benefits in the toddler years, might help.

1258 Concerned Citizen
Paid Maternity Leave The 3 months of unpaid maternity leave is hardly enough to care for oneself and prepare to reenter a job. Extended maternity leave as well as some sort of financial benefit would relieve some stress, and probably improve family life, and alleviate some postpartum depression and anxiety.

1259 Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Doctors offices and hospitals should stop giving formula samples, coupons, and literature related to formula feeding to every mother who is pregnant or delivers a baby. This is prohibited by the WHO code, yet the health industry in this nation seems determined to violate this policy. For mothers to be truly successful at breastfeeding, they need to be given easy access to lactation consultants and tools that make breastfeeding easy; NOT shown that if they give up quickly, it's ok, because the formula is always right there...

1260 Concerned Citizen
Nonprofit Organization
Worksite Lactation Support, Onsite Child Care, and Milk Expression This nation needs a federal policy that supports a mother's prerogative to pump her milk at work to feed to her baby. There is a mentality that a mother who does this is somehow cheating the company or is less productive; this is simply not true. The facts show that a child who receives mother's milk is healthier, which therefore helps the mother miss fewer days at work due to her child's health.

In addition, more workplaces need to be given the legal and financial support of the government to establish child care centers, so that mothers can be close to their children. This will help reduce the amount of time a mother is away from work, and will help her to be even more productive because she'll have peace of mind that she can tend to her child's needs more easily.

1261 Concerned Citizen
Nonprofit Organization
Paid Maternity Leave It's deplorable that our nation is near the bottom few of the entire world when it comes to paid parental leave for childcare (whether mothers or fathers). We rank near the poorest of third world countries when it comes to this benefit. Facts show that paid maternity leave helps establish better breastfeeding relationships, which in turn helps children and in fact all of society to be healthier. The long term benefits of paid maternity leave should not be underestimated.

1262 Concerned Citizen
Nonprofit Organization
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media More work needs to be done by the healthcare industry and women's groups to show that breastfeeding is not equivalent to sex acts or unsanitary bodily fluids. This mindset is far too prevalent, and the best way to combat this mentality is to use scientific facts to show how breastfeeding differs from sexual acts and other bodily fluids. Mothers should not be made to feel ashamed for providing the most natural and healthy food to their child in public. Eating is eating, and if breastfeeding is considered gross, then so too should neverending buffets that contribute to the obesity epidemic in our country -- these buffets cause far more health issues than breastfeeding ever could.

1264 Concerned Citizen
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Infant formula should NOT be distributed to each and every mom & baby leaving the hospital after birth. This sends a clear message that the hospital supports formula feeding! Also, if a mom is having difficulty, pumping should be suggested as an option - I have a number of friends who were sent home with a bottle instead!

1265 Concerned Citizen
Nonprofit Organization
Support for Breastfeeding in Public Settings The U.S. shouldn't need laws to reinforce the right of women to feed their babies wherever they are, but perhaps we should have some federal statues or some other reinforcing statements that support public breastfeeding. Mothers know their children well enough to be able to choose when they need privacy for nursing, such as when the child is at an age of being easily distracted by their surroundings. The choice should be up to the mother regarding whether she needs a private location or not, and she should not be forced into a back room just because someone else is uncomfortable.

1266 Concerned Citizen
Public Health Worker
Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training) The WIC Program supports breastfeeding but as long as we reward mothers with 9 cans of formula a month there is little motivation to breastfeed. We should think about reducing the monthly infant formula by 50% and use that money to give a lot of extras to the breastfeeding mother. Why should the formula fed baby receive more of our tax dollar then the breastfed infant?

1267 Health Care Provider
Lactation Professional
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media We need to make breastfeeding the norm. Families should be seen together with mother's discretely nursing.

1269 Breastfeeding Coalition Representative
Concerned Citizen
Researcher
Support for Breastfeeding in Public Settings Encourage use of breastfeeding friendly signs in public places (perhaps the universal symbol?). Discourage or ban publicly displayed images of formula feeding. Offer incentives for media representations of successful breastfeeding in movies and on TV. Create a federal law to guarantee the right of mothers to feed their children anywhere they are entitled to be.

1270 Breastfeeding Coalition Representative
Concerned Citizen
Researcher
Other Areas Immediately put into place all of the recommendations of the WHO Code.

1271 Breastfeeding Coalition Representative
Concerned Citizen
Researcher
Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media Implement the WHO Code. Regulate portrayals of bottle feeding in the same manner as portrayals of other unhealthy behaviors such as smoking. Make direct advertising of formula illegal. Offer incentives for TV/other media to portray successful breastfeeding. Create effective PSAs, such as those used in Scotland.

1272 Breastfeeding Coalition Representative
Concerned Citizen
Researcher
Access to Lactation Care and Support Increase use of mother-to mother support through peer counselors trained for hospital and home visits. Reduce the level of medicalization of feeding practices: discourage early use of breast pumps and over-reliance on lactation consultants. Make sure pediatricians are trained to offer support or to have staff who can.

1273 Public Health Worker
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care Physicians and Nurses receive next to nothing on lactation training and perpetuate more fallacies about lactation than truth. Please consider funding for lactation training to nursing and medical schools from Le Leche League, International--the true experts.

Also, birthing practices in hospitals diminish initiation.

Direct marketing (almost free formula to hospitals)decreases supply from the beginning.

1274 Health Care Provider
Other Areas Please consider banning bags in hospitals, as this increases artificial milk given by mothers sooner. Massachusetts tried this and Romney replaced his Public Health Committee members to go against Public Health Official's recommendations. Later, a pharmaceutical company opened it's doors in Massachusetts.

http://banthebags.org/?p=27

http://www.businesswire.com/portal/site/bms/?ndmViewId=news_view&newsId=20081211006287&newsLang=en

1276 Breastfeeding Coalition Representative
Concerned Citizen
Health Care Provider
Public Health Worker
Researcher
Other Areas Cultural competency in breastfeeding education, promotion and support for all health care staff is imperitive to its success. It is especially important for maternity care services and staff including Physicians (OBGYNs, Peds and Family medicine providers). There are numerous cultural reasons why a woman decides not to breastfeed and unless educators/ promoters/ supporters understand her needs they are not going to be successful. There is research to help understand the cultural influences and aspects of infant feeding that need to be looked into. When a culturally supportive message comes from a primary care provider, it makes a huge difference. With increasing cultural diversity in the U.S, cultural competency in patient education is an urgent need. Research also tells me that though the need is great, understanding is less.

1277 Breastfeeding Coalition Representative
Lactation Professional
Nonprofit Organization
Peer Support and Education of Family Members and Friends It is very important that every woman should have the support they need before, during and after birth. No matter what finacial status they may have.

1278 Breastfeeding Coalition Representative
Concerned Citizen
Nonprofit Organization
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care In all honesty, I do not think that we will improve breastfeeding rates and duration in this country until we improve birth practices. When she is pregnant, a woman is on a trajectory that lasts through the birth and into the first year of her baby's life. How well she has eaten, how well she understands self-care, and her expectations for her delivery are important and a part of this trajectory. But so are the practices of her caregivers-- her doctors or midwives, and every other professional she encounters. And most of the time, these medical professionals operate in a vacuum and know little or nothing about breastfeeding and how their decisions and practices have an impact on their patient and her decision to breastfeed, her ability and success at breastfeeding, and how long she continues.

If I were making policy, then I would increase the numbers of midwives (CNMs and CPMs) across the country. I would move as many low-risk women into their care as I could and I would encourage the continuation of the midwife-client relationship in the event of transfer of care because of complications.

Then we would see prenatal care/education, birth practices, and postpartum follow-up that are conducive to fostering healthy successful breastfeeding relationships among women and their babies.

We would see a drop in epidural use, a drop in inductions, and a drop in the cesarean section rate.

And while we are at it, let's encourage the use of birth and postpartum doulas.

More midwives. More doulas. That would be a very cheap way to improve the breastfeeding outcomes in the US.

1279 Breastfeeding Coalition Representative
Concerned Citizen
Nonprofit Organization
Access to Lactation Care and Support In general, it seems to me, that women find it hard to get good lactation support and care. There are not enough IBCLCs. Obstetricians and pediatricians know little or nothing about lactation. And they seldom even know enough to refer women to IBCLCs.

What if we were to eliminate the access that artificial baby-milk makers have to the medical profession? Now that would be a positive step towards improving things. Then when a mother comes in and says she is having difficulty with breastfeeding, the first response might not be to suggest artificial baby-milk.

Perhaps the government could consider launching a reward campaign, not unlike that the formula companies have. So for every referral to an IBCLC, a doctor's office or the nurses at a hospital could win points towards a cruise or a nice dinner.

1280 Breastfeeding Coalition Representative
Concerned Citizen
Nonprofit Organization
Worksite Lactation Support, Onsite Child Care, and Milk Expression Let's work towards real support: the option of paid maternity leave that lasts from six months to a year. And especially for the women in minimum-wage jobs. Help protect the most vulnerable babies and mothers-- give them a real chance at succeeding at breastfeeding!

1281 Concerned Citizen
Nonprofit Organization
Other Areas: La Leche League Leader
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The growth charts by which breastfed babies are compared needs to be from breastfed infants. I understand the WHO has one but most health clinics do not have it.

1282 Concerned Citizen
Other Areas: Mother
Support for Breastfeeding in Public Settings Breastfeeding has become an anti-social thing and woman who do it in public are often looked down on. Breastfeeding is the BEST thing you can offer your baby and you should be praised for doing it. It is the most natural way to feed your baby. It should be a crime to refuse a woman the opportunity to breastfeed in public.

1283 Lactation Professional
Use of Banked Human Milk Using milk from a member of the Human Milk Bank Association of North America should have provisions not to result in the physician being sued for using the milk for a patient. This will result in more use of this vital milk. And healthier babies when mother cannot or will not provide her own milk. -Carol Arcuri, IBCLC

1284 Concerned Citizen
Other Areas: Mother
Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care The support offered in hospitals is TERRIBLE!! The constantly push formula on you. Even if you breastfeed, they send formula home to your house. The woman working in the Mother/Baby wing do not have enough knowledge and training in breastfeeding. They should be taken through extensive training to help mothers.

1285 Concerned Citizen
Other Areas: former nursing mother
Other Areas I think that if basic healthcare were framed as a right, not a privilege, it would go a long way toward encouraging breastfeeding. In the current system, mothers can be separated from their babies because if they quit their jobs, the whole family will be without health insurance. If that weren't an issue, mothers could be free to choose jobs that would allow them to be with their babies most or all of the time, instead of separated from them for 8-10 hours of every day. Of course one can breastfeed while working full time--I did it--but so much separation from the baby is detrimental to milk production, and it means that some of the precious few hours that one *does* have to spend with one's baby is taken up by pump use and maintenance.

1286 Lactation Professional
Worksite Lactation Support, Onsite Child Care, and Milk Expression Many women return to work attempting to pump milk for their babies, yet many employers make it difficult for mothers to succeed, as they are forced to pump in bathrooms with too little time and too much stress. Mothers need appropriate places to pump and the time necessary for it to succeed.

1287 Health Care Provider
Health Professional Education, Publications, and Conferences Should be mandatory standardized education for all healthcare staff caring for labor a