Christina Stevens wanted to breastfeed her first child, but well-meaning hospital nurses threw those plans into disarray.

“I had my first daughter in a hospital in Florida,” she said. “I thought I’d take advantage of putting her in the nursery, so I could get some sleep.”

But nurses let Stevens sleep through the night and gave her baby a bottle. It then became difficult to get the baby to breastfeed. After a couple of weeks, she gave up and fed her only formula.

The 31-year-old from the Sicklerville section of Winslow Township  recently had her second daughter at AtlantiCare Regional Medical Center in Galloway Township, where she has gotten support for exclusive breastfeeding, and it’s going well.

But that isn’t the case for many New Jersey moms. Despite studies showing the health benefits for babies — including a decrease in childhood obesity, allergies and some cancers — the percentage of New Jersey moms who leave hospitals exclusively breastfeeding has decreased." target="_blank">Related story: South Jersey Healthcare champions breastfeeding

In 1997 the rate was 42 percent, and by 2009 it had fallen to 35 percent, according to the state’s “Breastfeeding and New Jersey Maternity Hospitals: A Comparative Report,” released in August.

At the same time, the percentage of new moms who have chosen to both breastfeed and formula feed prior to discharge from New Jersey hospitals has increased from 15 percent to 38 percent. Combination feeding while still in the hospital greatly lowers the chance that women will breastfeed at all just eight weeks after birth, the state report says.

Hospitals in southeastern New Jersey are seeing similar drops in exclusive breastfeeding rates. Only one hospital system — South Jersey Healthcare in Cumberland and Salem counties — has seen significant increases.

Exclusive breastfeeding

Researchers say hospitals need to take a more active role in convincing new moms to shun formula.

“The choice to breastfeed is personal, but that choice can either be supported or undermined by what happens in the hospital in the first few days after delivery,” the study said.

Exclusive breastfeeding for at least six months is recommended by the U.S. Centers for Disease Control and Prevention, the American Academy of Pediatrics and other medical groups. The state Health Department’s Healthy New Jersey 2010 goal was to increase exclusive breastfeeding rates to about 68 percent of births.

Sometimes women have multiple reasons for formula feeding, and it would take more than a casual conversation to help them figure out how to get over the hurdles they see ahead.

Stephanie Hannum, 20, of the Villas section of Lower Township, had her second child — a boy she named Jesse — about three weeks ago at Cape Regional Medical Center. She had a list of reasons for not breastfeeding.

“I have a 4-year-old daughter. I didn't breastfeed with her. I decided to do the same with my son as with daughter,” she said of her decision to formula feed. “I'm a smoker, and I know the nicotine goes into the breastmilk. I would not want it to pass through into the breast milk.”

Hannum’s mom told her breastfeeding was painful.

“For some reason it made her bleed,” she said. “I was afraid to (try).”

She acknowledged that she was told by physicians and nurses that breastfeeding was better for the baby, but she still saw it as a personal choice and wasn’t convinced breastfeeding was better.

“I guess it's a personal preference,” she said. “He's very alert. With either the breast or bottle, I think he would be developing just the same.”

To top it off, in a few weeks she must return to work. That’s two part-time jobs, for a total of 48 hours a week.

Answering questions

While each of the above challenges can be worked with — for example the CDC still recommends that smokers breastfeed — women such as Hannum have reasonable concerns about breastfeeding. They need those concerns to be taken seriously and addressed in a supportive way, through peer networks and by health care providers, according to the CDC Guide to Breastfeeding Interventions.

Lactation consultants are trained to answer questions and help women find their way to successful breastfeeding. But most women won’t meet one until they go to the hospital to deliver, which is often too late in the process. And not every hospital has them on staff.

Most hospitals who have consultants on staff are hesitant about actively discouraging formula feeding, fearing they will antagonize parents.

“When women come into delivery, the nurses ask what is their feeding choice,” said Jodi Wetzel, the single lactation consultant working at AtlantiCare Regional Medical Center’s Childbirth Center at the Galloway Township campus, where all ARMC births now take place. It discharged 1,949 newborns in 2009, 34 percent of whom were exclusively breastfed. That was down from 36 percent in 2007.

“I make my rounds here in hospital every morning to meet all those moms who choose breastfeeding.” There is no attempt to change the minds of women who choose formula feeding, said Wetzel, who has worked in maternal/child health as a nurse for close to three decades and has been a lactation consultant for more than 10 years.

South Jersey Healthcare in Cumberland and Salem counties, the one hospital in southeastern New Jersey to see an increase in exclusive breastfeeding, has found a way to take the pro-breastfeeding message to pregnant women from early in pregnancy through delivery and after.

SJH’s exclusive breastfeeding rates went up from 2007 to 2009 from 37 percent to 46 percent in its Vineland hospital, and from 68 percent to 81 percent in its Elmer hospital.

“You have to reach out early in the pregnancy to get the message across that it’s not as difficult as you’ve heard, that it doesn’t hurt, and it’s not ‘gross’ — which is a mindset we’re seeing here among younger moms,” said Marge Pollock, administrative director of women's and children's services, who has been central in getting the administration of the hospital to make exclusive breastfeeding a priority.

Half of the hospitals’ deliveries are to women who have used its Women’s Centers for prenatal care. The centers are clinics designed to serve uninsured or underinsured women. That means the hospital controls the message women receive about breastfeeding throughout their pregnancies, Pollock said.

“When (the moms) get to the hospital they are hearing the same message” from SJH’s three lactation consultants and a staff of nurses that have all had specific training in the benefits of breastfeeding, she said.

To reach the other 50 percent of women early, the hospital works closely with private prenatal care providers and the Women, Infants and Children (WIC) program, the state program that provides nutritional assistance to pregnant women and mothers of young children. WIC has enthusiastically embraced breastfeeding as a more affordable and healthy way to feed babies. It gives more food aid to nursing women, understanding they need more calories while nursing.

SJH’s lactation centers can provide affordable breast pumps for women, such as working moms, who need to pump for babysitters or other caregivers.

Different hospitals, different approaches

At Cape Regional Medical Center, where Hannum delivered, there is no staff lactation consultant. But one is called in on a per-diem basis as needed, said Lisa Nichols, R.N., and director of maternal and children’s health at CRMC. It discharged home 523 newborns in 2009, 28 percent of whom were exclusively breastfed. While that number was up from 27 percent in 2007, it was still fewer than a third of babies born at the hospital.

Cape Regional also serves a large population of women who are uninsured or underinsured, but most of them get prenatal care in a clinic that is not hospital run, so the hospital has no control over breastfeeding education there, Nichols said.

She and Wendy Baldwin, perinatal project manager at CRMC, are both strong advocates of breastfeeding.

“My children had notes on them, ‘Don’t give them anything (but breastmilk),’” Baldwin said of her childbirth experience years ago. “I learned over the years that I was right. My whole family came from that place.

“But you don’t see that (in Cape May County) at all. More likely there is a voice saying, ‘Don’t do it,’” Baldwin said.

Even though breastfeeding is much less expensive, most of the poorer patients Baldwin sees opt for formula, she said. Usually they don’t have family members who can give them positive information about breastfeeding.

So the women who deliver at CRMC, like Hannum, are coming in with lists of concerns that no hospital staff — regardless of how dedicated it may be — can effectively deal with in the tight time frame between delivery and choosing a feeding method.

At South Jersey Healthcare, patients from similar socio-economic backgrounds who also must work long hours, make different decisions after longer exposure to the information, and more opportunity to ask questions and get support.

“Some of the new immigrants come to the U.S. and formula is so available, they develop the mindset it must be better,” said Donna Lilla, a nurse and lactation consultant at SJRMC’s Vineland facility. “They want to become ‘Americanized.’”

“But once we talk to them, and just give the benefits of breastfeeding, they’ll say, ‘I’m going to think about this now,’” said Vivien Bates, the nurse and lactation consultant at SJRMC’s Elmer location.

She said nurses are trained to ask — in a nonharassing way — why a woman has chosen formula feeding.

“The mom might say, ‘I've always heard that (breastfeeding) hurts.’ Now we know we can work on this,” with information about how to nurse properly to avoid soreness, Bates said.

She said first-time moms especially need a lot of support and information, but sometimes a woman comes in who has had a frustrating first experience with breastfeeding. “We talk about what happened the first time, and what we can work on differently this time.”

The challenges

As natural as breastfeeding is, it is something that must be learned. Like anything new, it is a challenge, said Wetzel, the ARMC lactation consultant.

“It’s a learning curve pretty much,” Wetzel said. “It’s like riding a bike — you’ve got to keep practicing until you get good at it.”

She knows firsthand about challenges to breastfeeding. When her baby was born prematurely, Wetzel had to pump milk to feed him. Because of the effort, she was later able to successfully breastfeed her son after his release from neonatal intensive care.

In spite of her own dedication to promoting breast feeding, Wetzel isn’t the only influence on new moms. Many other health care professionals and family members have an effect.

“We definitely want (the percentage of exclusive breastfeeding moms) to be higher than it is,” Wetzel said. “We have to get the staff educated and on the same page as far as breastfeeding goes.”

ARMC is also planning to apply for Baby Friendly status, which indicates the hospital has met World Health Organization and UNICEF standards on a variety of practices related to childbearing and breastfeeding. But it is at the beginning of the process, she said.

“We’re trying to get everybody onboard so we’re all doing the same thing and practicing the same way. It’s a big undertaking . We’re working on it one step at a time,“ Wetzel said.

And sometimes it’s all about attitude, said Nicole Toci, 26, of Little Egg Harbor Township. She has a 13-month-old daughter and just had a son two months ago at Community Medical Center in Toms River, which has an exclusive breastfeeding rate of 36 percent, down from 38 percent in 2007.

“I tried with my first, but only lasted three weeks,” Toci said. “I think I was just too cocky about it. I didn’t ask for any help. I thought if my baby and I got into a rhythm, it would just happen. But it didn’t, and I got so frustrated,” she said. So she began formula feeding.

Now, with her son, she is much more relaxed and having no problems after some breast soreness the first week. “It’s very mental. I’d say it’s 80 percent mental and 20 percent physical,” she said. “After about a week, the physical discomfort goes away, but the mental part doesn’t. Some moms think, ‘The baby’s here, but still controlling my body.’ You need help to get through that part. You need your husband to rock the baby to sleep after feeding, to give you a break.”

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The benefits

Breastfeeding is proven to protect babies by fighting disease and aiding digestion. It decreases the incidence of: infant mortality, SIDS, diarrhea, ear infections, respiratory infections, otitis media, bacteremia, urinary tract infection, juvenile diabetes, childhood obesity, asthma, eczema, Crohn’s disease and ulcerative colitis, some forms of cancer and cavities. It also enhances cognitive development.

Health benefits to the mother include a decrease in: ovarian and premenopausal breast cancers, osteoporosis, postpartum bleeding, type 2 diabetes and long-term obesity.

Source: The Centers for Disease Control and Prevention

Getting information

LaLeche League provides free education and support through phone consultations and meetings.

LaLeche League Brigantine, meets the first Tuesday of the month at 10 a.m. Call for location, Susan 748-0872 or Renee 748-3452.

LaLeche League Linwood, meets third Wednesday of the month at 7 pm at the Linwood Library. Call Kelly at 412-3623.

LaLeche League Bridgeton meets the second Monday of the month at 10 am at the Friends meeting house on Ye Greate St. in Greenwich. Call Susan at 856-455-7815, or Sharon at 856-453-5633.  

LaLeche League Vineland meets the third Tuesday of the month at 10 a.m. at South Vineland Methodist Church at S. Main Rd. and Sherman Ave., and on the second Monday of the month at 7 p.m. Call for location of the evening meeting, Patty at 856-691-9569 or Judy at 856-692-4953. 

The New Jersey Womens, Infants and Children Program provides staff to help WIC mothers breastfeed, breastfeeding classes at WIC agencies, breast pumps and other aids when needed, a telephone warm line to answer breastfeeding questions and concerns, and a breastfeeding food package that includes more food for breastfeeding women whose babies do not use formula.

South Jersey Regional Medical Center, Vineland

Births discharged home 2009: 2,099

Exclusive breastfeeding rate 2009: 46 percent

Exclusive breastfeeding rate 2007: 37 percent

South Jersey Regional

Medical Center Elmer

Births discharged home 2009: 258

Exclusive rate 2009: 81 percent

Exclusive rate 2007: 68 percent

Shore Memorial Hospital

Births discharged home 2009: 1,215

Exclusive rate 2009: 46 percent

Exclusive rate 2007: 48 percenet

AtlantiCare Regional Medical Center

Births discharged home 2009: 1,949

Exclusive rate 2009: 34 percent

Exclusive rate 2007: 36 percent

Community Medical Center in Toms River

Births discharged home in 2009: 1,611

Exclusive rate 2009: 36 percent

Exclusive rate 2007: 38 percent

Cape Regional Medical Center

Births discharged home 2009: 523

Exclusive rate 2009: 28 percent

Exclusive rate 2007: 27 percent

Southern Ocean County Hospital

Births discharged home 2009: 289

Exclusive rate 2009: 26 percent

Exclusive rate 2007: 20 percent

Memorial Hospital of Salem County

Births discharged home 2009: 266

Exclusive rate 2009:11 percent

Exclusive rate 2007: 13 percent

Source: Breastfeeding and New Jersey Maternity Hospitals: A Comparative Report