It does a good job of talking about some of the challenges of workplace breastfeeding.
On the other side of the debate is this discussion - is breastfeeding really that much better to warrant all of this pressure on women to breastfeed? Take a look at this video where Hanna Rosin, who wrote the article “The Case Against Breast-Feeding,” and NBC chief medical editor Dr. Nancy Snyderman discuss whether breast-feeding is best for your baby. I think the evidence does say that breastfeeding gives many benefits - but, as they say in the video, it's not medicine, and it's not child abuse if you don't do it. More important is that women find a way that works for them - whether it's breastfeeding initially, doing a mix of breastfeeding and formula, or extended breastfeeding. But as we see in both articles here, breastfeeding and the workplace are not a combination that mixes well all the time. I'm glad groups like the Breastfeeding Coalition of Washington are helping businesses to find ways to move forward in this area.
This video was recently posted to the Bill & Melinda Gates Foundation about the improvements in maternal, newborn and child health in Malawi. Through education and community support, Malawi has greatly reduced the number of deaths in mothers and babies. Improving maternal-child health is one of the World Health Organization Millenium Development Goals.
One thing to note from the article as well as other surveys: The United States has one of the highest infant mortality rates in the developed world! I did however find it interesting that Washington state has one of the lowest rates within the United States - ranked 49th with a 5.1 infant deaths per 1,000 live births - but that would still be around 26-27th in the world rankings, falling far short of countries such as Singapore (2.30 deaths/1000 live births), Sweden (2.76), or Japan (2.80).
So what can we do about this? Among the causes of infant mortality in the United States, a leading cause is prematurity and low birth weight. Many premature babies die. Of the premature babies who survive, despite the advanced care they receive, many face a lifetime of learning and medical problems, including increased risk for hypertension, diabetes, and coronary artery disease. The March of Dimes Prematurity Campaign is working hard to increase awareness and funding to help reduce prematurity and its risks. Through March of Dimes funding, a number of risk factors have been identified, but one of the most interesting - and easy to reduce - factors is c-sections. From the March of Dimes website:
The Relationship Between Cesarean Delivery and Gestational Age Among U.S. Singleton Births, Clinics in Perinatology: This study found that cesarean sections account for nearly all of the increase in U.S. singleton preterm births between 1996 and 2004.
The c-section research suggests that more scrutiny is needed to ensure that cesarean sections are medically indicated. C-sections performed before 39 weeks for the convenience of the mother or the physician do not comply with guidance from the American College of Obstetricians and Gynecologists (ACOG); they may significantly contribute to the growth of premature birth in the United States.
Based on the study’s findings, the March of Dimes has called for hospitals and providers to voluntarily assess c-sections performed before 39 weeks to ensure that professional guidelines are being followed. This message supports the quality improvement initiatives now under way in many hospitals and has the potential to reduce the prematurity rate within those institutions.
In an earlier post, I discussed the success that Swedish Medical Center is having in reducing inductions before 39 weeks. This kind of work is essential if we're to improve the health of moms and infants in the United States.
Of course, another cause of prematurity is premature labor - something that we at Open Arms are helping mothers to address. By teaching the signs and symptoms of premature labor, doulas are able to help moms to identify premature labor early, before it progresses to a point that is difficult to stop, and to seek help from care providers. This education around premature labor is now a regular part of our prenatal visits and since January has already helped several moms to avoid early births.
But is the infant mortality rate constant, meaning is it distributed evenly in our population? One might think so, but it's not - African Americans in particular have a shockingly higher infant mortality rate, and overall the non-white rate of infant mortality is higher than that of non-Hispanic whites even when adjusting for socioeconomic, income, and education levels. Why is that?
If the health of a society is measured by its infant mortality rates, then the United States is not a particularly healthy population. Compared to the rest of the industrialized world, the United States is vastly underachieving in this very important area - certainly nothing to be proud of, despite touting its excellent health care. It would benefit us to really understand why this inequity exists and do something about it.
There have been many reasons put forth on why these differences exist: health care disparities including prenatal care, cumulative and chronic stress from racism and discrimination, nutritional differences not only currently but in past generations, and behavioral differences.
We at Open Arms are deeply concerned with the question of infant mortality. We believe social factors play a part in the discrepancies in infant mortality as well and are working to reduce them. For example, providing bilingual and bicultural doulas can help reduce communication barriers between care provider and mother to improve health outcomes, and connection to lactation services that fit within a cultural context can promote breastfeeding when before it might have been dropped. Information on health care and healthy parenting and nutrition must be available in a way that can be understood and followed - one way does not fit all communities.
Just in Melinda Gates' video, volunteers from the community were trained and went back the community to support women and give them the information they needed. When you have support coming from within communities rather than externally, it suddenly works.
If that model can drastically improve maternal-child health in countries such as Malawi, it can work here in the United States. For evidence of this, see some of the research from Chicago HealthConnect One on their community-based doula model, which is the basis for the Open Arms programs.
I was at the Within Reach luncheon last week and was inspired by their work. If you haven't heard about this organization, they are right there on the front lines connecting families to the programs and services they need: health care, nutrition and food resources, childcare, and immunizations. Many of their families have been hit hard by the downturn in the economy, and are needing support for the very first time and have no idea where to turn. Within Reach is doing great, necessary work to promote maternal, child and family health - check them out.
While I was at the luncheon, I sat next to Michele McGraw from the Breastfeeding Coalition of Washington. We had a wonderful talk about breastfeeding in the workplace. There's no denying the benefits of breastfeeding, but there are many obstacles to it, and one of the top obstacles is when mom goes back to work. Many workplaces are not set up for pumping breastmilk at work or if a process is in place, it is often for one or two specific mothers who have asked for it. Then when those moms are no longer pumping at work, the policy and procedures go away. There's no organizational support for it, and it seems to be too much work for employers.
To respond to this, the Breastfeeding Coalition of Washington is creating information packets for employers to not only accomodate breastfeeding moms, but to see the benefits to themselves for supporting it. A baby who is fed breastmilk is less likely to be sick, which means that mother will be at work rather than at home caring for a sick baby. Also women who are committed to breastfeeding but find that the workplace doesn't accommodate that might find that it's easier to take a different job or quit altogether, requiring that employer to hire and train a new employee. By presenting the benefits to employers as well as tried-and-true methods for making it work and sample policies to adopt with minimal expense or disruption to the workplace, the Breastfeeding Coalition is supporting more employers to make the transition to breastfeeding-friendly workplaces, and in the end, that benefits everyone.
I was so excited about the work of both of these terrific organizations and wanted to share them with you!
On another note, Michele works at Birth and Beyond in Seattle, and she told me about their Sunday Socials gatherings for birth professionals to meet and greet on a bimonthly basis. Any of you birth professionals who are interested in meeting others of like mind, we hope to see you there at the next Sunday Social on Sunday, June 13 from 3-5pm. Open Arms will be a "featured business" on that day, and our board treasurer Sarah Pulliam will do a brief introduction about Open Arms. Hope to see you there.
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