Accompany Doula Care recognizes National Breastfeeding Month this August

Doulas play a unique role in breast/chestfeeding advocacy

This week concludes the month of August as National Breastfeeding Month, recognized each year to promote the benefits of breastfeeding and chestfeeding, to support parents who breastfeed and chestfeed, and to raise awareness of barriers faced by lactating parents across the country. This year, 2024, is the 14th annual National Breastfeeding Month, first recognized in 2011 by the United States Breastfeeding Committee (USBC). 

The Benefits of Breastfeeding

The World Health Organization and UNICEF recommend that lactating parents initiate breastfeeding within the first hour of birth to protect the infant from infection and to reduce the risk of infant mortality. The WHO reports that breastfeeding within the first hour of birth also encourages emotional bonding between the birthing person and infant and stimulates the production of breast milk. The breast milk produced in the days following an infant’s birth, called colostrum, provides key nutrients and immune protection. 

WHO and UNICEF also recommend that infants be exclusively breastfed for the first six months of life. Breast milk supports infant development and contains antibodies and healthy nutrients that help to protect growing infants from common childhood illnesses, infections, and allergies. Infants who are breastfed have a lower risk of developing SIDS (sudden infant death syndrome), asthma, diabetes, diarrhea, and more. Breastfeeding can also reduce the risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure in the birthing person. 

Breastfeeding Statistics in the United States

For parents who can breast and chestfeed, exclusively feeding breast milk is almost always recommended by practitioners. Additionally, a 2023 Scorecard published by UNICEF, WHO, and the Global Breastfeeding Collective reported that global rates of exclusive breastfeeding in the first six months of life have increased by 10% since 2013, reaching 48% for 2023. However, far too many lactating parents face barriers to breast and chestfeeding initiation and continuation. 

Breastfeeding rates in the United States are low compared to international standards. The Centers for Disease Control and Prevention reports that in 2021, 84.1% of children in the United States were “ever breastfed,” or the proportion of infants born in the last 24 months who were ever breastfed, whether exclusively or for a short period. In the same year, 59.8% of children were breastfed at six months, and 39.5% were breastfed at 12 months. About 47% of children were exclusively breastfed through three months, and 27.5% of children were exclusively breastfed through six months. Comparatively, countries such as Rwanda (86.9%), Sri Lanka (82%), and the Solomon Islands (76.2%) have the highest rates of exclusive breastfeeding in the first six months of life. North America has the lowest exclusive breastfeeding rate in the first six months of life compared to any other region in the world. 

The data for breastfeeding in the United States is characterized by significant racial, educational, and socioeconomic inequities. Fewer non-Hispanic Black infants are ever breastfed as compared to non-Hispanic White infants. Fewer infants who are eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are ever breastfed as compared to infants not receiving and/or ineligible for WIC. Families in rural areas are less likely to initiate breastfeeding than families who live in urban areas. Birthing people with a high school or less education are less likely to report breastfeeding at three months than birthing people with college degrees. 

Factors Influencing Breastfeeding Cessation

There are many factors that influence breastfeeding cessation. A study by Odom et al. (2013) reports that reasons include concerns about infant nutrition, issues with latching and milk pumping, and concerns about maternal illness. Additionally, unsupportive work policies, lack of parental leave, lack of familial support, and unsupportive hospital-based policies can influence a birthing person’s decision to breastfeed or chestfeed, or to stop breast or chest feeding early. The United States has also not yet signed the WHO International Code of Marketing of Breastmilk Substitutes, which regulates the marketing of breastmilk substitutes to promote and protect breastfeeding. 

Allergy issues are a common barrier to breastfeeding for lactating parents. While allergy issues in breastfeeding infants are unlikely, some infants who may be allergic to something that the parent is eating or drinking and passing to their child via breast milk. In this case, infants may demonstrate colic, abdominal pain, diarrhea, skin rashes or hives, vomiting, and/or difficulty breathing. The infant’s pediatrician can assess and monitor symptoms and provide guidance on how best to avoid allergic reactions in the future. After identifying the cause of the reactions, a healthcare professional may recommend a lacatating parent eliminate certain foods or drinks – such as cow’s milk, eggs, and nuts – from their diet for a time and continue to monitor symptoms before reintroducing the allergen. Lactation specialists can support lactating parents who are modifying their diet due to ongoing concerns related to allergies. In some cases, a special formula that is free of several allergens may be the best course of action. 

Additionally, milk banks provide donor milk to infants when a birthing person is unable to produce and provide enough milk for their infant. In Massachusetts, Mothers’ Milk Bank Northeast provides donor milk to all level III NICUs in the state. Mothers’ Milk Bank Northeast is a nonprofit organization that also provides donor milk to mother-baby units and outpatients by prescription. Lactating parents can even donate their surplus of milk to their local milk bank to help families who wish to feed their infants human milk but may circumstantially be unable to. 

Policies for Feeding

Several federal policies have been enacted which protect lactating parents’ right to nurse. The PUMP Act, signed into law in 2022, requires businesses to provide a private, non-bathroom space and reasonable break time for workers to pump breast milk. Workers can sue non-compliant employers in the absence of such accommodation. Signed into law in 2023, the Pregnant Workers Fairness Act (PWFA), gives workers the right to reasonable accommodation for pregnancy, childbirth recovery, lactation, and other related medical conditions. The 2019 Fairness for Breastfeeding Mothers Act requires that some public buildings with public restrooms also include a lactation room that is available for use for any member of the public. 

However, much more needs to be done to ensure that all birthing people are supported in their journey to breast or chestfeeding. Many organizations across the country, including here in Massachusetts, are doing work to make this support a reality. Accompany Doula Care recognizes the importance of supporting breastfeeding and chestfeeding parents. Our mission toward ensuring that all families have the pregnancy, birthing and postpartum experience they desire is deeply intertwined with advocacy for lactating parents. 

The Role of Doulas in Supporting Breastfeeding

It is essential that all birthing people have access to doula care and lactation consulting, paid for by insurance, as well as that lactation consultants and doulas of color have adequate support and training. Doulas offer prenatal, labor and postpartum support that helps expecting families prepare transition to parenthood. In the prenatal period, doulas can facilitate discussions on caring for a newborn, including the birthing person’s intentions for infant feeding. In the immediate postpartum period, doulas stay with the birthing person and can help to initiate infant feeding. During postpartum visits, doulas support the birthing person in their new journey, providing further education and supporting infant feeding. 

Doulas play a unique and critical role in supporting infant feeding, which is well documented in the literature. Including doulas as part of a birth care team is associated with a significant increase in breastfeeding initiation. Access to culturally-appropriate doula care, particularly for minoritized and/or lower socioeconomic status birthing people, leads to a greater likelihood in experiencing the positive health outcomes that come from breastfeeding and chestfeeding. As  National Breastfeeding Month concludes, let’s continue to support breastfeeding and chestfeeding parents, as well as policy and community advocacy that allows all families the choice as to how they feed their infants.