August is Breastfeeding Awareness Month. As the nation’s largest group of maternal-fetal medicine and OB/GYN hospitalist providers, we are dedicated to improving outcomes for our patients and their babies. We spoke with Barbara Carr, M.D., neonatologist and Corporate Medical Director at St. Luke’s Hospital in Kansas City, about what moms should know about breastfeeding. Dr. Carr is also the medical director and co-founder of Heart of America Mothers’ Milk Bank, a Human Milk Banking Association of North America (HMBANA)-affiliated milk bank. During her fellowship, Dr. Carr did research in nutrition and has always found the topic interesting. She says, “I am convinced that ensuring good nutrition is among the most important things we as physicians can do to help our preterm babies.”
Keep your focus
For most babies and moms, there is a learning curve with breastfeeding. It takes time to get it right. This fact is not commonly known among new mothers, which can leave them feeling frustrated and disappointed with themselves if they begin breastfeeding and it doesn’t “just happen” right away. What Dr. Carr wants moms to know is they should be patient with themselves and their baby, work with a lactation consultant, and know that any amount of breast milk is good and worth it for the baby. For most moms, the first 14 days after delivery are key for establishing successful breastfeeding. In this time of exhaustion and high emotion, it’s important for moms to stay focused on their goal. Whether successful with breastfeeding or not, Dr. Carr also wants moms to know that being a mom is much more than just making milk!
Especially as mothers of premature patients begin breastfeeding, Dr. Carr tries to shift the maternal focus away from the volume being taken in by baby to helping a mom see that her infant is successfully nursing and meeting other standards, such as appropriate growth. Dr. Carr’s team strives to implement breastfeeding first because once a baby is bottle fed, some are not easily able to switch between breast and bottle, which may eliminate breastfeeding as a long-term option and often shortens the duration of breastfeeding. And duration of breastfeeding is important! There are significant benefits for both mom and baby to long term breastfeeding. According to the American Academy of Pediatrics (AAP), for moms that breastfeed for at least six months, benefits for the baby include a 75% reduction in lower respiratory tract infection, 66% reduction in gastrointestinal disorders, 15-20% reduction in childhood cancers and potential allergy and asthma reduction. There are benefits for moms, too. Those that breastfeed for a cumulative year in their life have a 28% percent reduction in breast cancer risk.
Breastfeeding is not currently an equal-opportunity endeavor
Dr. Carr’s team places a strong emphasis on breastfeeding for moms that pass through their unit. But not all moms in our country are given the breastfeeding education and support they deserve. As an example, women of color have lower rates of breastfeeding compared to Caucasian women. The cause is not definitive, but the lower rates could be related to differences in educational resources and lack of family support after discharge. As another possible cause, decades ago, marketing efforts drove women to believe formula was the better option for babies and portrayed formula feeding as the preferred cultural norm and a sign of social status. Unfortunately, this has had long-lasting impact on lower socioeconomic groups and this mindset still lingers among some communities, driving the need for hospitals to continue working to combat this notion by providing breastfeeding education and support to all moms in their units.
Breastfeeding and COVID-19
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) agree on breastfeeding recommendations for moms who have tested positive for COVID-19. It was initially advised that women should not breastfeed directly. These recommendations have changed as more information has become available. While it may be advisable for symptomatic mothers to pump their breast milk and have a second healthy person feed the baby that milk, asymptomatic mothers may nurse their infant but need to wear a mask and ensure proper handwashing and hygiene while feeding their baby. There is currently no evidence of consistent virus transmission via breast milk but with a disease where much is unknown, it is important to remain cautious. We know there are numerous health benefits of breastfeeding and can anticipate long-term impact to population health if there is a significant drop in breastfeeding rates.
For parents that rely on milk banks to supplement or fully supply their baby’s intake, there can be added safety concerns. The milk bank for St. Luke’s Hospital in Kansas City requires screening questions for all donors. There is an existing pasteurization process in place for all donations, and this continues to keep donor milk safe amidst the COVID-19 pandemic. The Kansas City location has also established a way for donors to safely deliver their milk to the facility, while keeping to distancing and cleanliness guidelines. If you are receiving milk from milk banks, you should ask to ensure they are following HMBANA guidelines for milk processing.
Clinically reviewed by Barbara Carr, MD