BREAST IS BEST: At the Family Birthing Center at Scottsdale Healthcare Shea Medical Center, lactation nurses provide breastfeeding advice, counsel, support and instruction. courtesy Scottsdale Healthcare

Flipping the Message

"We have long maintained that the difference between breastfeeding and formula feeding should not be presented as the positives of breastfeeding, but rather as the risks of formula feeding," Chantry explained. "If you say breastfeeding is better than formula feeding for reasons A through Z, you are portraying formula feeding as a standard. To change that cultural standard, we encourage messages that say formula feeding has risks of A through Z."

The new study echoes findings from earlier national data. "Previous qualitative research done through the federal grants and the Ad Council found that mothers in focus groups did not see a message about the benefits of breastfeeding as powerful as the message about the risks of formula feeding," Chantry said. "The group was pressured to pull some of the ads with the risk message, but some were still aired. Our study reinforced that finding, in my opinion."

Chantry shares the message in her lectures to professional colleagues, as well as in her discussions with families of newborns. "There's some concern that people will feel we're being judgmental or too negative when we emphasize the risks of formula feeding, but the message can be conveyed non-judgmentally," she said.

A Straightforward Message

The research findings make good sense to Bonnie Henson, BS, RN, IBCLC, manager for prenatal education and lactation support at the MemorialCare Center for Women at Miller Children's Hospital, Long Beach, CA. "We do tell women about the risks of not breastfeeding their babies," she said. "We try not to batter the formula companies, but we do emphasize the issues that occur when babies aren't breastfed. Instead of saying, 'breastfeeding is so good because of . . .,' we say, 'if you don't breastfeed, your baby may have these specific risks.'"

That straightforward message catches many women by surprise. "They'll say, 'I never knew not breastfeeding would increase my risk of osteoporosis and ovarian cancer, as well as my child's risk for obesity and type 1 diabetes,'" Henson said. "Praising breastfeeding does not always catch the women's attention, but a discussion of those risks does open their eyes."

Breastfeeding is often viewed as a personal choice that brings a number of strong emotions into play. "But breastfeeding is not just a personal choice - it's a health decision that impacts the woman and her baby," Henson said. "This kind of message addressing risks will become even more common as our healthcare system moves toward preventive medicine. Just like we discuss the risks of smoking or not using car seats, we can describe the risks of not breastfeeding."

Henson is pleased with trends she's seeing in Southern California. "We're seeing a lot of African-American women in the Long Beach area who want to breastfeed, and are noticing a lot of support from community groups and churches," she said.

Organizational Commitment

Lori Satran, MSL, BSN, RN, IBCLC, nurse manager of obstetrics couplet care at Scottsdale Healthcare Shea Medical Center in Scottsdale, AZ, is proud of her organization's strong commitment to breastfeeding. "I pulled data, and 92.1 percent of our moms initiate breastfeeding here and leave the hospital with plans to continue breastfeeding their newborns," she said. "Our population is pretty much middle to upper class, with a lot of moms in their 30s and 40s. Many of these pregnancies are planned, and the women have done a lot of reading. They understand why breastfeeding is beneficial."

When Satran taught lactation classes in another role, she would lead discussions of the pros and cons of formula feeding and breastfeeding. "Women quickly realized there weren't many pros for formula," she pointed out. "At the end of that discussion, there would be an 'ah-ha' moment when they became receptive to learning more about breastfeeding."

Satran emphasized the need to educate healthcare providers as well as families. "There's a lot of personal bias among healthcare providers when it comes to breastfeeding," she said. "If you have a nurse who didn't have a great breastfeeding experience or is not supportive of breastfeeding, is she going to be quick to put the baby to the mom's breast? Probably not! We can educate clinicians, streamline the process and develop a consistent message, but you can still have someone who will throw in anecdotal information that's not evidence-based."

Satran drew an analogy to help new moms and other family members understand the downside of formula supplementation for breastfed babies. "[Giving a baby a bottle] is like us drinking water from a straw because it's pretty effortless," she explained. "The baby suckling at the breast getting colostrum is like us drinking a milkshake from a straw: We know it is good, but there is work to get it."

When babies get used to the flow of formula from a bottle, they may resist going back to the breast. "We need to educate [parents] that well newborns get exactly what is needed nutritionally from mom and do not necessarily need a bottle unless medically indicated," she said."Mom needs support from her family, especially her husband, and from her nurses to help her past the bumps of early lactation. That support will help her opt not to do formula feeding, and to continue that decision at home."

When a baby is admitted to the NICU at Scottsdale Healthcare, the nurses automatically place a breast pump in the room for mom to use. "We instruct her to pump as much as possible, and as soon as possible, because every little bit of colostrum she produces will make a big difference to her baby," Satran said. "We offer a free, new-mom support group called Moms on the Move that provides both lactation support and peer support for breastfeeding, including information about the benefits of continuing breastfeeding."

Sandy Keefe is a frequent contributor to ADVANCE.