Breastfeeding In America

In America, only 13% of infants are exclusively breastfed at 6 months of age according to the World Health Organization (WHO). Around 73% of new mothers start out breastfeeding, but by 4 months, only 33% have continued (U.S.A.). Breastfeeding has multiple benefits for an infant, lower risk of multiple diseases and childhood illnesses and provides optimal nutrition for a growing infant. The benefits also extend to the mother who is less likely to develop certain cancers after breastfeeding, with her risks lowering the longer she breastfeeds. Breastfeeding is the healthiest way to feed an infant, because so few mothers in America are doing it, America should adopt WHO and UNICEF’s Baby-Friendly Hospital Initiative.


The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have partnered together to create the Baby-Friendly Hospital Initiative (BFHI). The BFHI is a detailed plan to give hospitals in all countries the tools to help increase breastfeeding rates. BFHI offers 10 steps for hospitals to complete to be considered “Baby-Friendly”. The steps all have a distinct purpose and way that they will aid new mothers, the community and mothers who have already established a nursing relationship.

The first step to completing WHO’s BFHI is to write a breastfeeding friendly policy for the hospital and communicate the policy to all staff regularly. Medical training, even for physicians, only briefly covers breastfeeding. In fact, in the book he wrote with his wife, Dr. William Sears admits that he had minimal knowledge prior to having his own children. When a nursing relationship is at it’s weakest is when medical professionals are often sought out. In the first few days of life, any small amount of criticism or doubt placed in a mother’s mind can destroy her confidence in nursing. Medical Professionals in birth centers and hospitals need to be prepared to offer encouraging assistance so as not to hinder the nursing relationship. Another instance when a mother may need support is when she or the infant are going through medical trouble such as childhood illnesses, the routine flu, or something more. Medical professionals need to be prepared to deal with these issues in a way that encourages the mother to continued nursing and they need to know about medications that are appropriate for a nursing mother to take. All staff will need to be aware of the rights of nursing mothers. With competent medical professionals who are trained in their policy, hospitals can expect nursing mothers to be more comfortable receiving services there and for pregnant mothers to seek out physicians affiliated with their hospital (babyfriendlyusa.org) (WHO).

The medical staff will need to be aware of the breastfeeding policy, but the actual health care providers will need to know steps to assist in implementing the policy. They must learn the anatomy of the breast, the benefits of breastfeeding, steps to establishing a healthy latch, how to evaluate a latch and how to care for the mother and infant without damaging the nursing relationship. The more closely a provider will be working with mother’s and infants, the more training and information they will need (WHO, babyfriendlyusa.org).

All soon-to-be mother’s need to receive information on breastfeeding, regardless of their intentions. Just because a mother thinks she would prefer to formula feed, does not mean she has the facts on breastfeeding. Women are frequently given false information by well meaning family members and friends, it is a health care professional‘s responsibility to ensure that she has the correct information to make her decision with. Information should begin with how her body is preparing to nurse during pregnancy, information on colostrums and the size of an infant’s stomach at birth, information on growth spurts, health differences between formula and breastfed babies as well as the thousands of benefits to her child if she does choose to breastfeed. While health care providers may not condemn or make a mother feel guilty for not breastfeeding, they should ensure that any and all questions are answered and all basic benefits are understood (AAP, WHO, babyfriendly.org).

Within the first hour of it’s life, an infant’s natural instinct is to begin “rooting” or sniffing and feeling around for a nipple. It is characterized by the distinct “eh” sound the infant makes as they do it. Their body and the mother’s body have a biological connection and are made to respond to each other’s cues. Hospital’s that wish to become Baby –Friendly should do everything in their power to assist new mothers in latching their babies on within the first hour. Dr. William Sears and Martha Sears say “Studies show that early-contact newborns learn to latch on more efficiently than babies who are separated from their mothers. This is a time when baby will be in a quiet state of alertness, the optimal behavioral state for interaction with you,” in their book, The Breastfeeding Book. The health care providers should ensure that the latch is correct and that any questions and concerns are taken care of before they leave the new mother and infant. If the infant is not well enough and needs to receive further medical care, the first latch should be established as soon as medically safe (Sears, AAP, WHO, babyfriendlyusa.org).

Whether a mother is separated from her newborn or already successfully latching, health care providers need to explain how to continue the breastfeeding relationship. They should explain growth spurts, feeding on demand, how to check that baby is getting enough milk, pumping and not judging your supply by how much you pump, the amount of milk a newborn baby needs and necessary steps to ensure that the nursing relationship is positive. This information will help boost a mother’s confidence in her body and allow her to continue nursing. Mother’s often experience insecurities in regards to their supply, so health care professionals need to make sure they are leaving mother’s with confidence in their ability to nurse and provide them a way to gauge if their infant is getting enough. If a mother is confident in her body, her body is more likely to cooperate (Sears, WHO babyfriendlyusa.org).

For the first 6 months, WHO recommends giving an infant only breastmilk unless medically necessary. For hospitals to gain BFHI they must agree to only give newborn infants breastmilk, no sugar water, water or any other substance. They also need to communicate this with new mother’s to prevent cereal bottles or other harmful things from being given to infant’s. Many people do not understand that an infant’s stomach is the size of a marble at birth and that colostrum can fill that. They may believe it is necessary to supplement but health care professionals should ensure mother’s that there is no medical reason to do so. There are several health benefits to this practice and it must first begin in the hospital (AAP, Sears, WHO, babyfriendlyusa).

Hospitals must encourage mother’s to breastfeed on demand. Breasts work on “supply and demand”. If an infant is suckling the breast the breast“knows” it and will begin milk production. Howver much an infant sucks, is how much milk will be made. If a mother is feeding everytime her child shows “cues” (small signs indicating a need) for hunger and feeds until the infant has finished, the breasts will make the correct amount of milk for that specific infant. Attempting to put an infant on a feeding schedule can alter this system and possibly destroy a mother’s confidence in nursing and cause malnutrition in the infant (Sears, WHO, babyfriendlyusa.org, Laemmy).

Nursing from a breast requires work. The infant must create a strong suction while using it’s tongue to stimulate the nipple. WHO asks that hospitals seeking BFHI refrain from giving pacifiers and bottles to infants who will be breastfeeding. The ease of the bottle will deter the baby from wanting to work for milk or colostrum from the breast. Pacifiers satisfy the sucking instinct, an instinct designed to help an infant help it’s mother’s milk to come in. If that instinct is artificially satisfied, the infant may not want to suckle the breast and the milk may not come in. Bottles and Pacifiers should be delayed until a healthy, happy, nursing relationship is established (Sears, WHO, babyfriendlyusa.org) .

Out of 30 developed countries surveyed by the Organisation for Economic Co-operation and Development, America was the 5th least likely country for an infant to be breastfed in. The top 3 countries, Norway, Finland and Sweden, have breastfeeding rates of nearly 100%. “The incidence of exclusive breastfeeding and its duration tends to be higher/longer in countries with long periods of maternity/parental leave,” (OECD) suggesting that returning to work is a major contributing factor to low breastfeeding rates. In other countries, there are laws and regulations on employers to allow mothers to pump. Many follow WHO’s Strategy for Infant and Young Child Feeding, which suggests “Governments should enact imaginative legislation protecting the breastfeeding rights of working women and establishing means for its enforcement in accordance with international labour standards,” with the belief being that if women are more comfortable pumping at work and their employers allow it, they are more likely to continue breastfeeding after their return to work..

Breastfeeding rates in America are significantly lower than most developed countries, despite the fact that breastfeeding provides optimal health benefits to both mothers and infants. If America were to adopt WHO’s Strategy for Infant and Young Child Feeding rates would rise, but ultimately, the relationship needs to begin before birth. Breastfeeding is the healthiest way to feed an infant, because so few Americans are doing it, America should adopt WHO and UNICEF’s Baby-Friendly Hospital Initiative.