Prof. Piderit

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How did NEOBEAN get started? What is the plan for organizing NEOBEAN?

(See also What is NEOBEAN?)

There have been networks of lactation consultants, breastfeeding advocates, and health care professionals who work with pregnant women, new mothers, and babies, for a long time. In that sense, NEOBEAN is not new. We do not want to replace those networks, but we would like to offer our expertise about how they can become more effective in learning from one another.

What is new is our effort to bring together those different sets of professional networks into conversation across the professional boundaries. We would also like to involve representatives from employers, educational institutions, and insurance companies in our efforts to restructure the way we work together across societal structures, so that we can more effectively support new mothers in breastfeeding their babies.

The co-facilitators launched an effort to organize NEOBEAN as a learning network in the fall of 2004 with invitations to individuals from many organizations in Northeast Ohio, such as the La Leche League, University Hospitals, the Cleveland Clinic, Metrohealth, the Northeast Ohio Lactation Association, the Cuyahoga County Board of Health, the Cuyahoga County Mental Health Board, Cuyahoga Community College, Cleveland State University, Ursuline College, John Carroll University, Baldwin-Wallace College, and Case Western Reserve University. We would like to expand our efforts beyond Cuyahoga County as soon as it seems feasible. We invite these individuals to share their knowledge with us through interviews and focus groups, and we promise to share what we learn with all those who support the efforts of NEOBEAN.

We are planning an inquiry summit to provide a forum for celebrating the successes of the past year, and for generating the seeds of new joint action projects among two or more of the members. The first summit should take place in the summer of 2005, and we hope that these will become annual events, if they prove useful to participants in the network. After the first summit, ongoing action-oriented meetings may be arranged among the participants who wish to focus on developing joint projects and will be open to all members of NEOBEAN whenever possible.

What types of projects might NEOBEAN participants take on?

Together, we will dream up far more powerful projects than we can individually, but this brainstormed list may help to get you into the spirit. We might aspire to

- work with local media to arrange for placement of Ad Council public service announcements from the "babies were born to breastfeed" campaign in Northeast Ohio newspapers, magazines, and on radio and tv

- assess the impact of breastfeeding education classes and/or participation in support groups during pregnancy on the likelihood that a new mother will initiate breastfeeding and sustain it exclusively for the first 6 months of her baby's life, assist in redesigning classes and support groups for maximum impact, and serve as a resource for staffing such efforts with paid personnel and unpaid volunteers

- increase the numbers of certified breastfeeding educators within the city of Cleveland, and support their work by securing grants for them to provide pro bono counseling to new mothers without requiring those new mothers to secure the funds or insurance to hire lactation consultants on their own

- measure rates of breastfeeding initiation and duration of exclusive breastfeeding, hospital by hospital and pediatrician by pediatrician, and study what allows some hospitals and pediatricians to support new mothers effectively and achieve high rates of breastfeeding initiation and continuation

- create brown bag presentations for local hospital personnel and medical professionals about cutting-edge research on lactation and infant care, lactation and postpartum depression, maintaining mothers' milk supply, etc.

- create a Human Milk Bank in Cleveland

- conduct breastfeeding education workshops for daycare providers, grandparents, educators, employers, and others who will serve as the primary support persons for new mothers in their day-to-day lives, so that those support people are better informed about how to support a new mother without undermining her breastfeeding relationship with her new baby

- award BFF (breast feeding friendly) stickers to area restaurants, stores, schools, libraries and employers which participate in a workshop about breastfeeding's benefits to society and agree to provide support for mothers who wish to breastfeed in public at their site

- work with area employers and insurance companies to connect pregnant mothers with breastfeeding and healthy pregnancy resources before their babies are born, so that they can maximize their likelihood of carrying their pregnancy to term, and can get customized support about how to combine breastfeeding and work

- research and publicize a list of the top 10 employers who have taken active steps to boost their support for employees who are welcoming a child into their family, and can show an impact on the rates of breastfeeding initiation and duration of exclusive breastfeeding among their staff who are new parents

- lobby the insurance companies of major local employers to ensure that they cover the cost of lactation consultant services when needed, of breastpumps if a mother is returning to work and will not be able to bring her baby to work with her, and of donor milk when it is medically advisable for an infant not to receive formula

- lobby for increased support for paid parental leave, additional part-time work opportunities that include health insurance coverage, increased onsite daycare for young babies, and tax breaks for parents who choose to stay home with their young children

Why do you advocate feeding human babies human milk? Why is exclusive breastfeeding so important?

Why do you advocate feeding human babies human milk?

1. Infants who are not breastfed do not develop immune systems that are as strong as those developed by breastfed babies, because breastmilk contains antibodies produced by the mother in response to the specific germs, bacteria and viruses with which mother and infant come in contact.
2. Infants who are not breastfed have a higher risk of developing ear infections, meningitis, diabetes, obesity, and other illnesses.
3. Because infants who are not breastfed are sick more often, their parents are more often absent from work.
4. Infants who use artificial nipples and pacifiers are more likely to experience dental malocclusions, which can lead to difficulties breathing, especially in sleep.
5. Infants who are not breastfed are more likely to die within their first year, due to SIDS, communicable diseases, and malnutrition.

Why is exclusive breastfeeding so important?

1. Use of bottles to deliver nutrition to babies in their first weeks can create nipple confusion, which can be a significant challenge for mothers and babies to overcome if they are to develop a healthy breastfeeding relationship.
2. Introducing formula or other nutrients to a baby's stomach too early can disturb the intestinal flora, resulting in poor digestion. In some babies, this experience can create a predisposition to food and airborne allergies, limiting the child's ability to receive and digest optimal nutrition throughout life.
3. Introducing solid foods before 6 months can cause an infant to metabolize the iron in breastmilk differently, leading to anemia (low iron) for the baby, which can have negative effects for cognitive development and for resilience if the baby becomes ill.

For more information, see the websites of La Leche League and ProMoM. It’s also important to note that mothers are born to breastfeed as well, and accrue health benefits from doing so. More information is available from Dermer (2001) and from the website of Dr. Sears.

What if a mother can't make enough milk to permit exclusive breastfeeding?

1. The first rule of supporting new mothers and babies in establishing a healthy breastfeeding relationship is to always feed the baby. If a mother is experiencing temporary difficulties with milk supply, or if the baby is still learning to latch on to the breast properly, then the baby must be fed. A number of possibilities exist; sometimes mothers can pump breastmilk to feed to a baby with poor latch, or sometimes donor milk is available. If not, then infant formula carefully chosen can be life preserving.
   
2. Regardless of whether a baby is being fed pumped milk from the mother, donor milk from another mother, or formula, choosing a feeding method that will not interfere with the baby's ability to learn the breastfeeding latch is crucial. Bottles are the worst possible choice of feeding method. Better alternatives include the Hazelbaker Finger Feeder (which is like a small syringe and capillary tubing that can be held alongside a finger that the baby sucks on), cup feeding, spoon feeding, and supplementary nursing systems like the one made by Medela.
   
3. If difficulties are encountered with breastfeeding, professional assistance should be sought as soon as possible. These links may be helpful for parents in Northeast Ohio in locating assistance beyond your family doctor:
   La Leche League Contacts in Cuyahoga and Surrounding Counties
   Ohio Lactation Consultants Directory
   Cuyahoga WIC and Related Programs

   This link provides information for parents from other regions in locating breastfeeding assistance.
   

4. Even if efforts to stimulate the mother's milk supply are not fully successful, there are still significant health benefits from combining breastmilk with infant formula. Mothers who wish to continue breastfeeding should not hear their efforts belittled, especially if they are doing the hardest work of combining the physical demands of breastfeeding with the logistical challenges of formula feeding.

What about creating guilt in mothers who use formula?

As members of NEOBEAN, we understand that some babies must receive formula (an artificial breast milk substitute), if they are orphans or if their mother's ill health requires treatment that is incompatible with breastfeeding, and no human donor milk is available. Our aim would be to minimize the numbers of babies who must receive formula.

We also understand that other mothers may choose formula, if they believe that they cannot combine breastfeeding with other activities of normal life, such as employment or education. Their beliefs may be accurate, if their workplace or educational site has been unsupportive of breastfeeding mothers in the past. Some mothers choose to use formula based on misinformation, though, when it might be possible for them to breastfeed relatively easily.

We believe that mothers who face constraints may feel anger or sadness, but should not feel guilt for the roadblocks that they encounter. However, we believe that guilt arises when mothers discover that they have made decisions based on inaccurate or less than complete information, and blame themselves for not seeking out more knowledge.

Our aim is to increase the availability of accurate information and of comprehensive support, so that mothers can make informed choices. Our aim is not to mandate breastfeeding initiation or continued breastfeeding, and we respect the ability of each child's parents to make the best possible decisions for the child's welfare, given all the circumstances of the family's context.

You may also wish to read Dr. Jack Newman's comments on breastfeeding and guilt.

What if mothers wish to breastfeed only in private?

Then they should do as they desire. If it is inconsistent with a woman's religious practices to reveal her body in public, or if she prefers privacy, then she should certainly be supported in her desire, and provided with safe spaces where she can retreat when she desires. Women should not be asked to breastfeed their children in unhygienic locations such as restrooms, or anywhere that would be inappropriate for other types of eating.

On the other hand, we do not believe that women who are comfortable with breastfeeding in public should be restricted in any way. We believe that it is important for young men and women who have not yet had children to see breastfeeding occurring in public and learn to recognize it as a natural act, so that they do not develop the notion that formula feeding is the normal way for a baby to be fed. While we expect that breastfeeding mothers will endeavor to be tactful, we recognize that not all babies will cooperate with a mother's efforts to keep a blanket in place while her baby latches on to the breast, and that not all mothers can afford to purchase clothing specifically designed to make nursing with minimal skin exposure possible.

More information on the topic of modesty while breastfeeding is available in this La Leche New Beginnings article.

What do we know about the factors that influence breastfeeding initiation and the duration of exclusive breastfeeding?

One of the projects we would like to collaborate with other participants in NEOBEAN on is a review of existing literature on this topic. What we do know so far is that rates of breastfeeding initiation are intertwined with rates of full-term birth (since some premature infants have not yet developed their suck reflex at birth) and with the education level and age of the mother. Rates of exclusive breastfeeding are connected with employment status of the mother, WIC status, and other factors. For these reasons, we see it as especially important to reach out to pregnant women who are younger, less educated, receiving less prenatal care, and otherwise lacking in financial resources.

Some of the strongest predictors of breastfeeding initiation and willingness to continue breastfeeding are the supportiveness of key supporters of the new mother, including her baby's father and other key supports, such as her childcare providers. For this reason, we see it as especially important to reach out not just to pregnant women, but also to their partners and husbands, and to the future grandparents and childcare providers, so that they can learn how to be supportive.

What are the current breastfeeding rates in Cleveland, in Cuyahoga County, and in Ohio?

According to the Centers for Disease Control website, in 2003 the rate of breastfeeding initiation in Cuyahoga County was 55 percent (+/- 5.7) which means that more than 40 percent of babies born in that county never received any of the health benefits of breastmilk. Of the babies who reached 3 months of age, only 30 percent (+/- 5) were still exclusively breastfed. Of the babies who reached 6 months of age, 24.7 percent (+/- 4.5) were still receiving some breastmilk, although only 9.5 percent (+/- 3.2) were exclusively breastfed. Only 10.7 percent (+/- 3.2) of babies who reach 12 months of age were still receiving any breastmilk.

While the CDC does not provide data on their webpage about each county in northeast Ohio, their statewide figures indicate that Cuyahoga County is well below the statewide average rates of breastfeeding initiation and continuation. Even Franklin County (which includes the state capitol of Columbus) shows significantly higher breastfeeding rates, with 66.3 percent of babies receiving some breastmilk after birth, 33 percent still receiving some breastmilk at 6 months (with 13.2 percent receiving exclusively breastmilk up to that age), and 19.1 percent receiving some breastmilk at 12 months.

A summary of broader trends may also be useful. In 2002, the rate of breastfeeding initiation while in the hospital was 63.7 percent in Ohio (according to the Ross Labs’ Mothers’ Survey), and by 6 months of age, only 26.7 percent of Ohio infants were still receiving some breastmilk. These Ohio statistics trail the national rates, which rose to 70.1 percent for newborns and 33.2 percent for 6-month-olds in 2002. Furthermore, according to the Parenting Magazine table which has been cited on the Kellymom website, the United States lags behind many countries with higher initiation rates, like Sweden (98%), Norway (98%), Poland (93%), and Canada (80%).

The rates of exclusive breastfeeding drop quickly. In a 2001 telephone survey of parents of young children, 59 percent reported that their infants were exclusively breastfed for the first seven days after birth (Li, Zhao, Mokdad, Barker & Grummer-Strawn, 2003). The Ross Labs Mothers’ Survey report (2002) indicated that only 17.4 percent of infants are exclusively breastfed at 6 months of age. Survey data indicate that the biggest drop occurs between 2 and 3 months of age, when mothers are often returning to work. Rates of exclusive breastfeeding also vary by ethnic group, with 54 percent of white infants, 42.8 percent of Asian infants, 37.1 of Hispanic infants, and 27.5 percent of black infants receiving only breastmilk in the hospital.

The United States Department of Health and Human Services issued a Blueprint for Action on Breastfeeding in 2000 that called for breastfeeding initiation rates of 75 percent across all ethnic groups in the US by the year 2010. The target rate of breastfeeding for 6-month-old infants was set at 50 percent, and for one-year-olds the target is 25 percent. While we seem close to achieving the breastfeeding initiation target nationally, we are a long way from doing so within Ohio, and achieving the targets for 6-month and 1-year breastfeeding rates will be even more challenging. Compared with other parts of Ohio, Cuyahoga County and the surrounding areas will face even greater challenges in attaining the target breastfeeding rates that our government advises are in our long-term best interests.

Li R, Zhao Z, Mokdad A, Barker L, Grummer-Strawn L. 2003. Prevalence of breastfeeding in the United States: the 2001 National Immunization Survey. Pediatrics, 111:1198-2010.

Ross Labs Breastfeeding Statistics, summarized on Kellymom

What are the potential cost savings from increased breastfeeding?

The Breastfeeding Task Force of Los Angeles summarizes the research this way:
- If exclusive breastfeeding was practiced for the first 12 weeks of an infant’s life, our country could save $2.16 billion annually on providing health care, because breastfeeding reduces the frequency of illness and disease.
- Another $3.02 billion annually would be saved from household expenses because of the reduced costs of formula purchases, family planning benefits and decreased health care expenditures.

This webpage does a nice job of summarizing the economic and health benefits for mothers, employees, and employers when mothers who return to work are supported in their desire to continue breastfeeding their babies.

What is NEOBEAN?

NEOBEAN is a network of individuals and organizational representatives who share a commitment to increasing breastfeeding rates and exclusive breastfeeding duration in Northeast Ohio. The co-facilitators of the network from CASE’s Weatherhead School of Management want to help participants in the network to become more intentional about using their connections with others in the Northeast Ohio area to make our individual and joint efforts at breastfeeding education and advocacy ever more effective.

Our goal: To increase the rate of breastfeeding initiation and the duration of exclusive breastfeeding among new mothers in Cleveland and Northeast Ohio.

As participants in this network, we will invite each other to share our stories of our efforts, our small wins, our triumphs and frustrations. We will share our ideas and resources. As a learning network, our aim is not to centrally coordinate projects in any way that implies that we can control the activities of network participants. Instead, we will explore ways to provide the minimal coordination required to support the initiation of new collaborative efforts among members of the network. Our aim is to create a learning space within which our members can get to know one another and can pursue ideas for joint action on projects of interest to them.

Our belief: That babies were born to breastfeed, and that portraying breastfeeding positively and supporting mothers’ desires to breastfeed wherever their babies are hungry is a key to sustaining our residents’ long term good health.

For more information, see these related entries:

• What types of projects might NEOBEAN participants take on?
  
• How did NEOBEAN get started? What is the plan for organizing NEOBEAN?

If you are interested in participating in NEOBEAN:: Please contact Professor Sandy Kristin Piderit.