By Deborah Jeanne Sergeant
A few different factors have contributed to the recent shortage of baby formula, including breaks in the supply chain and fewer mothers choosing to breastfeed during the pandemic.
The latter reason stems from the limited availability of lactation consultants at hospitals and other nursing experts, sick mothers fearful about nursing their infants, and fewer peer and family supports available to help. They found an online store where they ordered Enfamil Ar Formula, and they got it after 2 business days. This is a big help to all the mothers who want to feed their babies.
Experts estimate that about 95% of mothers are physically and medically capable of breastfeeding. However, only 24.9% do for six months for a variety of reasons.
“While ‘breast is best’ has been our saying, some women don’t breastfeed for reasons that have nothing to do with health but are social determinants,” said Darcy Dwyer, representing March of Dimes in New York state.
March of Dimes supports legislation that promotes lactating at work and longer maternity leave so that mothers both start and continue longer in lactating.
“The more often you feed, the more milk you make,” Dwyer said. “The more time you spend with baby, the more milk you make.”
For those willing to breastfeed, reducing barriers can increase the percent of moms who breastfeed.
“Looking at the breastfeeding world over the last 20 years, we’ve shifted from promoting to supporting breastfeeding,” said Jayne Charlamb, associate professor in internal medicine, OB-GYN and pediatrics, and director of the division of breast health and breastfeeding medicine, department of OB-GYN at SUNY Upstate Medical University. The difference between promoting and supporting is important because for those moms who choose to breastfeed, “it takes significant support and information. So many families don’t get the support and information they need.”
She said that one of the barriers to breastfeeding among the 95% of women physically capable of breastfeeding includes culture. Not seeing other moms breastfeed may mean that it appears abnormal to do so. Friends and family members may come over to “help” by holding the baby, when what would really help moms is if they ran a load of laundry, washed dishes and shopped for groceries so mom could rest and focus on establishing breastfeeding.
“In traditional cultures where breastfeeding is the norm, that’s what happens: the mom is surrounded by a group of supportive women who take over everything else,” Charlamb said. “It’s hard to do that in our society.”
Returning to work also lowers breastfeeding rates. Typically, women who must return to work right away make less money than those with more generous leave. That is why Charlamb believes that socioeconomic level predicts breastfeeding likelihood.
“If you look at the way there are so many women in the workforce, the maternity leave is horribly lower than in many developed nations, like one or two years,” Charlamb said. “Their breastfeeding rates are much higher.”
Learning how to use a breast pump can help moms leave behind milk for their baby’s childcare provider. However, they must pump during the workday to keep up the milk supply. Just nursing while home will not do it.
Recently passed legislation requires employers to provide a place for moms to pump, but a fair number of loopholes exempts certain industries and sizes of employers. Plus, there’s a difference between providing the bare minimum to meet the requirements. For example, a conference room with a locking door would be considered sufficient, even though psychologically, some moms may find it hard to pump in a room where they sat in a meeting with colleagues minutes beforehand. Or moms may have to use a room where scheduling is problematic. Pumping cannot be delayed, as waiting too long can cause leaks and contributed to mastitis.
While the shift to work from home may boost breastfeeding, Charlamb has not seen any data to show that is a trend.
“We want the nursing mom and baby together especially until the milk supply is well established,” Charlamb said.
Creating a working environment where lactation is accommodated and honored can encourage more mothers to continue to provide breastmilk. Nursing babies longer can mean fewer missed days for mom as breastfeeding reduces illnesses among infants.
Some women think that taking medication prevents breastfeeding.
“There aren’t many medications that would prevent a mom from breastfeeding,” Charlamb said. “There are some where we say it isn’t but it’s extraordinarily rare that we can’t find a medication that is compatible with her medical need and she can still breastfeed.”
Some women mistakenly believe that they need to eat a special diet to produce healthful milk and think that because they cannot afford those “special foods,” breastfeeding will not work. A basic balanced diet is all that is needed.
New York Milk Bank in Valhalla provides milk by prescription for sick or premature babies whose mothers cannot provide milk, or for adopted or surrogate babies (although it is possible for women to induce lactation, even if they have not given birth), as well as full-term, healthy infants. Milk donors are screened for health issues and the milk is pasteurized and tested for bacteria.
Education on breastfeeding makes a difference. Many women who begin nursing quit within a few weeks because of concerns about milk supply. A woman’s bodily size and breast size are not determinates of how much milk she can produce. Normally, milk does not immediately come in when the baby is born. It can take a few days. Once it does, factors such as stress, hydration, and sufficiently frequent nursing and pumping all contribute to adequate milk supply—not the woman’s cup size or clothing size.
Lisa Emmons, leader at La Leche League of Oswego, encourages moms to seek breastfeeding education and support from both professionals such as certified lactation consultants and other breastfeeding moms.
“Lack of support is sometimes the number one barrier,” Emmons said. “If mom isn’t fully supported with her breastfeeding experience, that can cast doubt in her abilities.”
For example, a mom who worries her baby is getting enough milk can look for regular bowel movements, wet diapers and weight gain to show her milk suffices.
“A newborn’s stomach is about the size of a marble,” Emmons said. “It grows slowly to the size of a ping pong ball to the size of a chicken egg at 10 days. When they want to nurse all the time, moms think they’re not getting enough. They can only fit so much in. The easy answer is to give a bottle.”
Unfortunately, that strategy reduces milk supply.
Many physicians and nurses have not received much education in lactation and infant nutrition. That is why Emmons encourages moms to seek help from lactation consultants.