In case you think maternity care in the US offers women and babies the best care available, think again. A recently released national survey of women's childbearing experiences in the U.S (Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences) accurately portrays what it means to give birth in the US today. And it's not a pretty picture.

Let's look at just one piece of the whole survey - breastfeeding. First of all, bear in mind that breastmilk and formula are not equivalent substances. Formula-fed babies have compromised immune systems and higher rates of respiratory infections, ear infections, gastro-intestinal problems. They are at greater risk for allergies and asthma, certain childhood cancers, and SIDS. They are more likely to need braces, be obese later in life, have somewhat lower IQ scores. Overall, we spend 3.6 billion dollars a year to treat conditions and diseases that breastfeeding could prevent.

Given this, The American Academy of Pediatricians and the U .S. Surgeon General recommend that women breastfeed for at least a year, while The World Health Organization and UNICEF recommend a minimum of two years. Moreover, a goal of Healthy People 2010, the nation's health agenda, is to have 75 percent of women initiate breastfeeding with 50 percent exclusively nursing at 6 months and 25 percent at a year. Plain and simple, breastmilk and formula are not equivalent substances.

So it makes good medical, nutritional, and economic (not to mention, ethical) sense for hospitals to play a huge role in helping women to successfully initiate breastfeeding. The Listening to Mothers II Survey, however, reveals that hospitals are letting mothers and babies down in droves. In fact, various practices actually sabotage breastfeeding.

In looking at women's experiences after their babies were born, the survey found that:

61% of mothers had wanted to breastfeed exclusively but only 51% were exclusively nursing one week after the birth.

The babies of 38% of mothers who intended to breastfeed exclusively were given formula or water, while the babies of 44% of mothers who intended to breastfeed exclusively were given a pacifier.

66% of mothers who intended to breastfeed exclusively were offered formula samples.

Over 33% of mothers perceived that the staff was neutral about feeding method and 3% reported that the staff encouraged formula-feeding.

Why are these findings so troublesome? First of all, imagine if one-third of the nurses on a cardiac rehabilitation unit didn't tell patients that diet mattered. In fact, a small percentage of the staff even encouraged a diet of red meat and cheesecake. Few would argue that this would be medically and ethically wrong. Yet this is exactly what happens in some maternity units. This doesn't mean that women should be coerced into breastfeeding. But clearly, hospital staff should encourage women to do so and should help facilitate it. Plain and simple, neutrality or "objectivity: has no place in a hospital setting.

Secondly, and closely related to this, women depend on hospital staff to give them accurate information. But these findings indicate that a large minority of the health care providers fail to understand what helps and hinders a woman's ability to development a nursing relationship.

Giving newborns formula, water, and pacifiers flies in the face of proper protocols to support breastfeeding and are known to contribute to premature weaning. Moreover, giving formula suggests the likelihood that nursing may fail. And women who receive formula in their discharge packs are more likely to end up using it, compared to women who don't have formula cans sitting around. Finally, this practice of hospitals distributing free formula to women actually violates The International Code of Marketing of Breast Milk Substitutes.

When I was interviewing women for the book, The Breastfeeding Cafe, women often reflected on their birth experiences and early post partum efforts to establish breastfeeding. Many expressed anger and betrayal at a system that failed to support them. They felt sadness, regret, and sometimes rage as they reluctantly reached for formula. Was this also true for the ten percent of women in this most recent study who quit within the first week?

We wouldn't teach a person to ride a bike by making her steer around traffic cones before developing the ability to ride in a straight line. We wouldn't set out on a vacation driving with a flat tire. And we wouldn't throw a non-swimmer into the sea, only to toss them a life preserver and feel good because we rescued them. It's time to stop treating breastfeeding differently. Not every woman is able to breastfeed (although most are) and not every woman wants to. But every woman deserves access to accurate information and appropriate support.

Citation: Declercq ER, Sakala C. Corry MP, Applebaum S. Executive Summary. In: Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection. October 2006. pp 1-9.

About the Author:

Barbara L. Behrmann, Ph.D., is a writer, researcher, and international speaker. The author of The Breastfeeding Café: Mothers Share the Joys, Challenges, & Secrets of Nursing, (2005), her writing has appeared in international journals, local and regional parenting publications, and on a host of websites. She a “parenting expert” on ClubMom.com and has a monthly column at RealSavvyMoms.com. Barbara maintains a growing website – www.breastfeedingcafe.com - and publishes a quarterly newsletter. The mother of two formerly breastfed children, she lives in upstate New York.

Barbara Behrmann, Ph.D.

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