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Why Women Don't Nurse Longer

You've heard it by now: A mom should breastfeed her baby for at least the first year of life, as recommended by the American Academy of Pediatrics. Today, more new moms than ever try to nurse. In 2004, the most recent year for which government statistics are available, about 70 percent of U.S. mothers reported that they had tried breastfeeding, according to the Centers for Disease Control and Prevention (CDC). That's up from 55 percent in 1993.

But then consider this: At 6 months, only 36 percent were still nursing. At 12 months, the number dips to 17 percent - fewer than one in five mothers. While moms know that breastfeeding gives babies the best start in life, legions of them find it difficult - if not downright impossible - to nurse longer than six months, let alone up to the one-year milestone.

Whether it's a baby who has trouble latching on, a work schedule that doesn't allow time for pumping, or a lack of support at home, the forces that conspire against women who want to breastfeed are far-reaching in their scope. And despite the medical establishment's wholehearted endorsement of breastfeeding, the general public hasn't gotten the message. A full 57% of Americans disapproves of public breastfeeding (according to a recent survey by the American Dietietic Association). Breastfeeding moms are stared at, get rude comments, and are even asked to leave restaurants and stores. For many women, the public disapproval is the last straw when they're having other breastfeeding difficulties....so they give up.

Many moms who plan to nurse are caught off-guard by the challenges breastfeeding can present. In fact, according to a nationally representative Babytalk survey, 46 percent of moms said that breastfeeding required more time than they'd expected and 56 percent wished that they had been able to nurse longer than they did. Here's what's undermining women's efforts, and how you can get the support you need to keep going.

Nursing problems
Experts agree that much of breastfeeding success hinges on getting off to a good start. After delivering, however, many women only take a single hospital class or secure a brief session with a nurse or lactation consultant. Odds are that a new mother is home by the time her milk comes in and problems arise.

Frustrated, exhausted, and panicked that her child isn't getting enough to eat, a mom can lose confidence and quit nursing. "I breastfed my firstborn for about a week and then gave up. He wasn't latching on properly, and it hurt so much that I'd cry every time," says Diane Burdick of Pensacola, Florida. Like Burdick, nearly half the moms in Babytalk's survey stopped nursing because they had trouble getting the baby to latch on correctly, felt that they didn't produce enough milk, or had other problems, such as clogged ducts.

If you're having trouble, it's critical that you get help as soon as possible, before your milk supply decreases. A lactation consultant can help (find one at http://www.gotwww.net/ilca/),as can a free breastfeeding support group (visit http://www.lalecheleague.org/ to locate one). Your child's pediatrician may have advice, too - and should let you drop by to weigh your baby as often as you want to make sure she's eating enough. You can also read Babytalk's award-winning story You Can Breastfeed. But don't beat yourself up if it doesn't work out, says breastfeeding expert Marianne Neifert, M.D. "Success isn't always related to the amount of effort a mom puts in."

Katherine Kam is a journalist in Northern California.

Negative public attitudes
The convenience of breastfeeding - you don't need to bring along formula when you go out - is considered by some to be a major selling point. The downside of this perk is that Americans are surprisingly squeamish when it comes to the sight of a mom nursing in public. In fact, nearly a quarter of the moms in Babytalk's survey (22 percent) were made to feel uncomfortable at some point.

A national survey of public beliefs about breastfeeding published in The Journal of the American Dietetic Association found that 57 percent of those polled said that women should not have a right to breastfeed in public. And a whopping 72 percent said that it's inappropriate to show a woman breastfeeding on TV programs.

Don't let anyone make you feel that you can't nurse your baby. Most states have laws that specifically protect a woman's right to breastfeed in public, and no state outlaws it, says Jake Marcus, a Pennsylvania attorney and legal advisor for La Leche League International. That said, it can be helpful to plan in advance how you'll handle an annoying comment, Marcus adds.

Moms in Kansas don't need to spend time crafting a comeback. In honor of a 2006 breastfeeding law, the state has printed up cards that mothers can flash in the face of anyone who tells them to stop nursing. The card states, "Kansas License to Breastfeed in Public - It's the Law." Don't live in Kansas? You can still tell disapproving strangers to bugger off - download Babytalk's breastfeeding-rights card.

Time commitment
Many moms are overwhelmed by how much effort goes into breastfeeding: Nearly half of respondents to Babytalk's survey said that they didn't feel prepared for the time commitment. A newborn nurses 8 to 12 times a day; by the time the baby has been fed, burped, and changed, it's time to start the cycle all over again. "It really is a shock to women how much time is involved, at least initially," says health psychologist and international board-certified lactation consultant Kathleen Kendall-Tackett.

Without time to sleep, eat, or do much of anything besides breastfeed, a new mom's energy and morale can get depleted quickly if she doesn't get the support she needs at home. "Fatigue is a huge problem," says Kendall-Tackett, who adds that it's helpful for new moms to realize that the intensity of early breastfeeding lasts for a limited period of time.

Women need to give themselves permission to make nursing their top priority - at least for the early weeks. That means letting laundry, cleaning, and hospitality for visiting relatives slide. "Everything has to take second place to Mom and the baby working on breastfeeding," says Kendall-Tackett. Other survival skills include nursing while lying down and trying to sleep when the baby sleeps. And moms cannot be shy about requesting help, such as asking others to watch their older children or bring over a meal.

Perfectionism
Under pressure to breastfeed exclusively during the first six months, many moms are crippled by an all-or-nothing mentality that nursing must be done flawlessly or not at all. Almost half of the moms in a recent Babytalk poll said they were made to feel that they were "cheating" if they supplemented breastfeeding with formula. But the bottom line is that you'll have more flexibility if someone else can help feed your baby.So relax. A 2005 Babytalk poll found that 82 percent of breastfeeding babies were able to alternate between breast and bottle. And many experts (and moms) will tell you that it's fine to introduce a bottle between 2 and 3 weeks if breastfeeding is going smoothly - rather than wait until 3 to 4 weeks as is often recommended.

While supplementing with expressed breast milk is ideal, there's no need to feel guilty if you're a "combo mom" who feeds her child breast milk and formula. That's what helped Rebecca Jones, a New York City teacher, stick with it. "I nursed my younger daughter for 18 months and supplemented with formula. With an older child and a full-time job, it would have been too hard for me to pump for that long."

The goal is to get some breast milk into your child - as much as you can manage. "What I try to tell mothers is, obviously, the more they breastfeed, the better," says Joan Meek, M.D., editor-in-chief of the AAP New Mother's Guide to Breastfeeding. "But the baby is going to get some benefit from any amount of breastfeeding." For example, nursing for three or four months may still give a baby a year of protection from ear infections, Dr. Meek adds. "Each mom has to decide what's right for her."

Work hassles
Lack of support in the workplace can sabotage a woman's plans to continue breastfeeding when maternity leave ends. Many lack a clean, private place to pump in addition to having a boss or coworkers who don't understand. Only 10 percent of mothers who work full-time are still breastfeeding their baby at 6 months, according to a 2005 CDC report.

"I breastfed my first child for five months, but I was working in retail at the time and found it really difficult to pump at work. My breaks didn't always agree with my pumping schedule," says Kristi Vasquez of Beaufort, South Carolina.

Nationally, employers aren't required to provide moms with a place to pump at work. There's no overwhelming support to make workplaces friendlier for nursing moms, either. The Journal of the American Dietetic Association's survey found that only 47 percent of respondents favored longer maternity leaves, and only 43 percent supported giving women a private room to pump in at work.

If you want to pump at your workplace, discuss your intentions with an approachable supervisor. Request a room with a lockable door, a place to sit, and an outlet for your pump. Reassure your employer that breastfed babies get sick less often, so you'll have more time to focus on your job. But moms will need more than a pump room to reach the one-year breastfeeding milestone. As a nation, we have to give nursing moms more support at home and in the workplace, says Kathleen Kendall-Tackett. "We're better than we used to be, but an awful lot of women are falling through the cracks."

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