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New AAP Breastfeeding Guidelines: 6 Months Breast-Only Is Best, and It Takes a Village

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The AAP has released new guidelines for breastfeeding, updating its already pro-breastfeeding stance to recommend babies nosh exclusively on breast milk until approximately six months of age. Nutrition and breastfeeding experts among the association’s ranks previously differed in this recommendation, with the former group thinking four months is sufficient, and the latter advising moms shoot for six. Now all the AAPers are happily in agreement, and, to back up its updated guidelines, their report delivers a good roundup of recent research around breastfeeding’s impact on baby and mama well-being. It also offers suggestions for how hospitals, pediatricians and workplaces, as part of the successful-breastfeeding big picture, should help facilitate that picture of success.

It’s interesting to read through the summary of recent studies, and their associated quantifiable data. Too many blogosphere breastfeeding debates revolve around whether breastfeeding is or isn’t actually beneficial in preventing certain illnesses in babies. It is. Asthma, obesity, and even certain cancers are significantly reduced in breastfed babies. The numbers just speak for themselves. Whether breastfeeding exclusively to the six month mark is feasible for everyone is not so straight-forward, though, as many of us know from experience. The report mentions allergic conditions among those breastfeeding helps reduce, and this is—numbers-wise—accurate, but of course I have a baby who suffered allergic reactions to my breast milk, because he was allergic to what I was eating. Kaspar was most likely born with allergies, and then his GI track and immune system took some early blows that worsened his condition (which, by the way, is now improving—hooray!). Since we didn’t know what was going on, but our kid was clearly suffering, I was extra tired and extra stressed, and struggled to keep my milk supply up. I wanted Kaspar to reap the immuno-rewards of breast milk, though, so I did my best and managed to feed him first mine, and then a friend’s, in decreasing ratios to organic formula for about six months (counting my friend’s milk). It wasn’t an ideal situation, or what I’d imagined, by any means, and I really empathize with moms who struggle with breastfeeding for any reason, as a result (so don’t condemn them in the comments here. That’s sh*tty). That being said, as unusual as our situation was-- and actually, it’s not that unusual anymore-- I could have breastfed for a lot longer had our pediatrician recognized what was up, instead of just treating Kaspar’s symptoms (eczema). Had we found out about Kaspar’s allergies sooner, I could have modified my diet, and probably helped Kaspar’s GI system out as a result of continuing to breastfeed. (I learned that last part in the report; baby gastro-tracks love breastmilk. No surprise there.) It would have been a dramatic modification, on my part, but I felt committed to breastfeeding and would have been game. I could have survived on steamed chicken, broccoli and sweet potatoes for six months. And Kaspar may have been much better off for it.

Our ped was trained in babies, though, not mamas (she told me that when I asked a breastfeeding question early on, albeit apologetically). But when it comes to breastfeeding, the pros are most helpful when they support both. As compelling as I find the AAP report’s data, I’m really impressed by their use of this data to preface (and justify—the report even makes an economic case for breastfeeding) its suggestions that follow. The AAP not only suggests babies drink breast milk (and only breast milk) for six months after birth, but identifies the entities that can best support this—which are, not coincidentally, the same entities that often get in the way— from hospitals to pediatricians and, finally, places of work. The section on hospital practices is fascinating (really, read it), but, since we’ve recently discussed pediatrician-parent relationships on this blog, the report’s section on pediatrician’s roles in supporting breastfeeding, in particular, caught my attention. This role, according to the report, is “critical,” and extends beyond individual doctors’ offices and into the community at large; the AAP contends that pediatricians are truly breastfeeding advocates, and offers resources for them to use in addressing breastfeeding concerns-- including specific problems-- and for helping busy physicians’ offices promote breastfeeding in general. Of course, breastfeeding (especially for moms who are struggling with it) can be a touchy subject, and I can appreciate that a pediatrician might not want to make an already-stressed and tired mom feel that she’s failing her child if she takes the formula route. No one should feel forced to breastfeed. But as a mom who wanted to breastfeed and faced obstacles in doing so, I really wish I’d had more support from our pediatrician in making it work. Hopefully the resources and guidelines provided by the AAP will aid pediatricians in looking for, and addressing, underlying causes behind their patients’ breastfeeding challenges, thereby enabling more babies—and moms-- to reach the six month mark.

Lastly, the report’s section titled “Business Case for Breastfeeding” is kinda awesome. It references the Patient Protection and Affordable Care Act passed by Congress in March of 2010, which requires employers to provide “reasonable break time” for nursing mothers, and private, non-bathroom areas for pumping (I pumped in an in-office “phone booth,” one of two in three floors of company space, so there was often a line outside the door… and no lock), as well as resources businesses can utilize in setting up adequate nursing-mama spaces and systems. Thinking ahead of skeptical CEOs, the report includes a return on investment breakdown (shazam!) on providing adequate accommodations for breastfeeding working moms: “for every $1 invested in creating and supporting a lactation support program (including a designated pump site that guarantees privacy, availability of refrigeration and a handwashing facility, and appropriate mother break time) there is a $2 to $3 dollar return.” Take that, this lady’s boss!

I think we all know that breastfeeding doesn’t always work for everyone—I mean, really, it just plain doesn’t—but rather than get caught up in mom-against-mom mudslinging regarding whether it should (which leaves the rest of society to think the issue is simply ours, not theirs, to consider), I think we can take this AAP report and its recommendations as a major positive for babies and mamas, across the board. Much like Indonesia’s breastfeeding law, this report is clearly intended not to pressure moms to breastfeed, but to make a strong case for it… and to pressure the hospitals babies are born in, the pediatricians their moms bring them to a few days later (and call when anything’s wrong for months to come), and the workplaces to which those moms ultimately return. It’s a call for these entities to at least stop getting in the way of moms’ breastfeeding success, and ultimately to aid in it. Whether hospitals, docs or employers most prize the economy (from the report: “If 90% of US mothers would comply with the recommendation to breastfeed exclusively for 6 months, there would be a savings of $13 billion per year”), their own bottom lines, or the babies themselves, it serves everyone’s best interest for them to support the milk-makin’ mamas.

What do you think of the new guidelines? Do you think the AAP is pressuring moms to breastfeed? Do you think this will have a positive impact for breastfeeding moms? Any positive hospital, pediatrician or workplace breastfeeding experiences out there? Negative? How long do you think babies should ideally drink breast milk? What do you think about options like milk sharing for moms who can’t breastfeed their babies themselves?

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