>>> good morning and welcome tothe 2013 of breastfeeding grand round.produced by the university of albany school of public health.i'm dr. mary applegate the associate dean and host of thethis morning's broadcast. it's a pleasure to welcome youtoday. this year's breastfeeding grandrounds is called it takes a village.with me is dr. ruth warren, author of breastfeeding andguide. also joining us for this year'sbroadcast is chair of the
mid-hudson lactation consortiumand deputy director of allster counties.stephanie has been leading communitywide breastfeedingpromotional efforts for the past 20 years.we have hoped to have a fourth person here today, mrs. kim bug,founding director of rose, reaching our sisters everywhere,a nonprofit organization that promotes and supportsbreastfeeding among african-american mothers.kim was recently elected to the board of u.s. breastfeedingcommittee and had to be in
washington today for her firstboard meeting. she gave us permission toinclude clips in the broadcast reclaiming an african-americantradition. so even though she isn't here inperson in the studio, she'll be part of the brought cast.as always there will be time in the second half of the broadbroadcast for your questions. while we're talking, please jotdown questions so we'll be ready when you open the phone lines.or e-mail us at any point at bfgr.ny, 1-800-452-6062.and fax number is 518-426-0696.
if you do send a fax, pleaseright legibly. at the end of the broadcast,please don't forget to fill out your evaluation post test.those are both online. the focus of today, as i said,is how to support breastfeeding at the community level.the first question, why focus on the community level?and the major reason is that in the u.s. there is still hugedisparities in breastfeeding rates among different racialsubgroups in the population, particularly disparities in raceand ethnicities and income
level.whenever we see these big disparities, you need to lookreally broadly at what are the reasons behind them and how canyou address them. before we really get started,let's hear from a couple of real experts on that subject.kim, herself, as well as dr. david satcher, the formersurgeon general. >> rose is at the forefront ofthe movement to encourage african-american mothers toembrace breastfeeding. >> it's important for the healthof mothers and babies.
and we know thatafrican-american women breastfeed less and because ofthat, our babies do suffer more of many ailments that couldpossibly be prevented if moms would breastfeed their babies.and also, moms have significant health benefits when they chooseto breast freed. rose is an acronym for reachingour sisters everywhere. >> it's important that everychild have a opportunity for a healthy start in life.and we know that breast feeding is an important part of that.we know it reduces infections in
children, it reduces childhoodobesity, it also benefits the mother.and over time, it actually decreases the risk of breastcancer and uterine cancer in women.>> by 2010, 75% of all women in this country were breastfeeding,and 58% of african-american were breast feeding.and by six months only about 28% are still breastfeeding.we have a major problem. >> as dr. satcher said,breastfeeding rates among african-american mothers aremuch lower than rates among
caucasian and other mothers.let's look at what are the national goals forbreastfeeding. for decades from the start ofthe healthy people program setting national objectives forhealth measures, the rates were the same.575% breastfeeding initiation, 50% at six months and 25% at ayear. they stayed the same because wenever reached those goals. in the past ten years, just afew years ago, actually, we finally reached that 75%initiation rate, which means
that it was time to reset thegoals so we have a new target to aim for.you can't just aim for something that's lower than where youalready are or you don't make progress.here are the new breastfeeding goals for 2020.they're not as memorable as the old ones, but i'm doing my best.the new breast feeding initiation goal is 81.9%, sixmonths, 60.6%, and at 12 months, 34 point 1%.i think it was an formula increase from where we were atthat time to get us to these new
goals.any way, there is still a major stretch, especially in theduration ones where we reach the initiation goal, but we stillfairly far away from the old duration at six and 12-monthgoals. so we've got a ways to go.>>> next we have data from the cdc showing how the rates havelooked over the past 20 years. here's a graph showing theprogress that has been made since 1993.these are initiation rates for the u.s. population as a whole.but when we look at population
subgroups, the picture isn'tquite so encouraging. you can see before that lastbar, we did reach the 75% target and have gone a bit beyond it.but when we look at the next slide, we can see that eventhough in all of the population subgroups that the cdc lookedat, there has been upward progress during that time, theprogress among african-americans has been lower than among theothers and the disparity continues.fortunately the disparities are narrowing a bit, but they'restill pretty significant.
as you can see, rates amonglatino mothers are higher, and in fact, they've been at thenational targets for longer than rates among white women.but the rates among african-americans arepersistently lower, and that's why our main focus this morningis going to be on promoting breast feeding inafrican-american communities. when we look at progress at thesix-month mark, we see a similar picture.continuing upward progress, but still major disparities amongthe racial subgroups.
so let's talk a little bit aboutwhether the causes of some of these disparities are.poverty and maternal age are two of the common suspects.you know, lower income women and younger mothers having higherrates of unfavorable outcomes. we've got more cdc data lookingat the combination of breastfeeding rates and race andpoverty and maternal age. and you can see on this onelooking at race and poverty, in each of the racial groups, thelow income women have lower rates of breastfeeding than theupper income women.
but the disparities among racialgroups persist even within the income groups.so the low income women in the blue bars, the black low incomewomen are significantly less likely than white and latino lowincome women to breastfeed. so the disparities can't be justexplained by the poverty effect. and in fact, among latino womenthere's almost no disparity between the poor and middleincome women. so we can't point to poverty asthe reason why black women breastfeed less.by the same token, if you look
at different maternal agegroups, among young mothers they have the low event breastfeedingrates, but if you look among the other races, blacks have lowerthan latino and clearly the latino community has got itright in a way that the others of us need to learn from andespecially we need to figure out how to help the african-americanachieve the same kinds of goals as the latino women.so dr. lawrence, i know this is an issue that you've taught agreat deal about over the years. could you talk a bit about whatwe should be thinking about as
the contributing factors here?>> well, we have a tendency to think that african-americanwomen don't know how to breastfeed.and that is so far from the truth.historically, they have always breast-fed.and i had the privilege of training in new haven whobrought breastfeeding back to this country along withchildbirth without fear and rooming in and all of thosethings were there in new haven while i was trained.all of the african-american
mothers were breastfeeding allof my clinical mothers were breastfeeding, and i would say,how do you do that? and they look at me and theysay, well, you just put the baby there.>> and the baby figures it out. >> that's right.so what's happened is our cultural changes and forces kindof working against them because then in clinic, some of thedoctors were saying, oh, you shouldn't bother to breastfeed.let me give you a formula. >> scientific.>> let me set you free.
and this caught on in theafrican-american community because they prescribed formulaand sort of told that's old-fashioned.so there are a lot of external forces quite apart from povertyand quite apart from race. these mothers were led downanother path. >> uh-huh.so any time we've got these patterns that have becomeestablished over decades, we really need to look deeply atwhat are culturally appropriate role models and messages andresources to be available to
communities.people need support from their community, from their familiesfrom their peers. even though it was thepredecessors fault as doctors that we got into this mess inthe first place, it isn't good enough just to say we're fromthe government, we're here to help, this is what you shoulddo. >> right.>> it's much too patronizing and isn't going to work.>> there's nobody in the community to act as a model.>> and yet, birthing practices
have changed over the years.we've also seen the way that mothers were allowed to birthhave a big impact on the ability to breastfeed.we know now how the first hours of skin to skin contact.my mother's generation, there were knocked out.there was no way they could have breast-fed.so in addition to supporting breastfeeding in the community,we really need to focus on reaching women before they havetheir babies, hopefully in their teens when they're thinkingabout it, maybe, but really
vital that breastfeeding is muchmore successful. >> and that's why a lot of thesesessions have focused on what can be done at the institutionallevelled to help make breastfeeding more possible.this is kind of a complement to that, what can be done at thecommunity level as well to help them†-- the documentary fromrose says to reclaim a breastfeeding tradition, reclaiman african-american tradition in this case.>> so, we came across as we were getting ready for this a sloganthat i think was first developed
in south africa by a group ofdisabilities right activists, nothing without us without us.we don't want us as a bunch of white professionals coming intothe community saying we know what's best for you and this ishow you should do it. it needs to really come from thecommunity itself. so why don't we go back to thedocumentary from rose and hear from kim herself again.>> i met with a few young women at my house a few weeks ago, hadmet these young women over the years many different times.i want you to see this
two-minute video.\m\m \m\m\m\m \m\m>> i'm not really sure why more african-american don'tbreastfeed. it's certainly the best thingfor your baby and it's 100% free.\m\m >> maybe it's education, maybethere's a stigma there. maybe a lot of african-americanwomen believe that breastfeeding is for mothers back in the dayand now people just use formula.
\m\m>> people don't like for you to do it in public.some people don't think that it's healthier than formula.i'm still kind of nervous about it.because most mothers who breast-fed, they told me thatthey had had a hard time doing it.i'm worried about that. i think it will be a goodexperience. >> i think once they geteducated enough on breastfeeding that they'll be more susceptibleto actually doing it.
basically it's about gettingeducated on doing it and why it's important to do versususing similac and like that. >> a lot of the teen mothers,they're not really educated as to how and where†-- didn't havethe support of the family to cater to those decisions.>> people would say because he's a little taller than other kidsand then he had teeth, you know, from the time i can probablyremember, so they would say the same things, like do youbreastfeed him and he has all of those teeth?he doesn't bite you?
you get the stereo typicalstuff. and it's like, that's nasty.why is it nasty? i'm nurturing my child.>> like not feeding as often as she should have.her breasts were sore and how it hurt and was painful.>> if they gave them information in the community aboutbreastfeeding and plus they don't see it a lot.>> i think african-american women need the chance to meetand talk one on one with other african-american mothers whobreastfeed and really get the
facts and decide for themselvesthat that is something that they would be willing to do.\m\m >> technical difficulties.>> looking farther back in history, as dr. lawrence wassaying, african-americans almost all breast-fed.but during the last half of the 1900s in the efforts to recoverfrom the real dip in breastfeeding that was caused bythe move toward scientific formula, a lot of those effortsinvolved middle class white women.peer support efforts like
nursing mother's counselorslargely involved anglo moms. in recent years, leaders havebeen working hard to reclaim that african-american tradition.one of those leaders has been dr. michael young who was ourguest in 2004. it's available on the archives.but we have a clip from her from the recent documentary.let's go and listen to what she had to say there.>> breastfeeding is the first food, it's the firstimmunization, it's the best thing next to a mother's lovethat a mother can give her baby.
this was our tradition tobreastfeed for many years. when the war came along, womenwent to work and more women in the work force, and formulascame in as a supplement and then they took over.>> we spent $850 million a year for wic for mothers who could bebreastfeeding. >> it initially was not on thebreastfeeding ban wagon. a lot of women got that withoutbreastfeeding education. then we have work to do in thatregard as far as promoting it. >> in public health when wethink about the public
engagement, we work with thesocio ecological framework which recognizes that health isinfluenced by all kinds of different factors.we have a graphic that shows what the socio ecologicalframework looks like. it's a tiered approach startingat the individual and going out to interpersonal interactionsthat people have to interact with, live in, the communitiesand values of a whole community and then public policy issuesmuch today we're not going to talk about so much about thepublic policy issues, but we're
going to look at those communityorganizational and or personal layers.when we look at the individual level of that framework, that'sthe area where most health care providers are usuallyinteracting. pediatricians less so, becausethey've also recognized that children don't occur inisolation, they are part of a family and you've got to dealwith the whole family. even though, most health carefocuses on that individual level.what are the major issues that
we deal with at that individuallevel? >> well, we always think abouteducation. as health care providers, wealways want to educate everybody.derek jealous said something years ago, he said breastfeedingis a confidence game. and probably our most importantresponsibility is to instill confidence in the mother thatthey can do it because the baby knows what to do.>> it's not just a step by step, do this, do this and this andyou will be fine.
if you do it right, it's amatter of believing that you will do it right and your babywill do it right. >> you can do this.>> that's a big piece of the community education that we doat our agency. we always believed very much sothat women had the power to make these decisions but they needthe information. we try not to make it toocomplicated, really the baby knows what to do.>> moms and babies would be doing this for a long time.and hopefully will continue for
for a very long time and wewon't be arrogant enough to think that we can figure out abetter way than what mother nature invented over the years.>> corporate america is trying to take that away, but we cantake it back. >> yes.so when we move away from that individual level and move to theinterpersonal level, there are tons of influences at that levelfor better and wore worse. one of the most important is therole of the father in helping to promote and support his partnerin breastfeeding.
what are some of the examplesthat you two have seen over the years of fathers having atremendously positive impact on the mom's ability to breastfeed?>> in my experience in working at the community level, we knowthat if we can get a father to be present at the breastfeedingclass or childbirth class, we know that that baby is reallyoff to a good start. because the mother needs so muchsupport coming home from the hospital.the fathers really makes a big difference.the partner in her life really
makes a big difference inhelping her in other ways. and we spend a lot of timestalking to the fathers about it's not your only job to feedthe baby a bottle. there's so many other things.but the baby on your chest. >> and it's not a matter of if iget to feed the baby or change the diapers.>> there's a chore that's very important and that's[†inaudible†]. babies need quieting and calmingand that sort of thing from somebody who doesn't smell ofmilk, and that's dad's role.
>> in our prenatal classes wetalk to the father about how important it is to make theconnection during the pregnancy. when that baby is born, he orshe is going to recognize the father's voice and be comfortedon the father's chest. >> and in the hospital, thefather is not considered a visitor, he's part of family.he can come and go at his leisure, he can be there.>> they're no longer segregated out in the dad's waiting roomthat are the subject of so many new yorker cartoons over theyears.
>> and it is, if we look at themedia way of presenting birth, we are seeing some changes,which is really nice. the mother screaming duringlabor. we're seeing more natural birthand things like that on sitcoms which makes a big differences.>> that's where the title child birth without fear came from.was understand what's happening. >> because it becomes a viciouscycle. if you are afraid of it youtense up and it just gets worse. i think with the growingpopularity in the general public
of things like yoga andrecognition that calming and centering can have a positiveinfluence on all kinds of aspects of our life, i thinkthis is a really key place for that to happen too.>> hour agency offers yoga for birthing which is education partof childbirth. it's very successful.>> the magic of the lamaze breathing technique.>> not at all. >> it's having a approach togetting that focus and calm? >> right.as a childbirth educator, lamaze
has been one of the leadingorganizations and leading the change.they have come away from the breathing to being the onlything you learn to really promoting natural and normalbirthing normal. which is a worm concept.>> and we were talking about dads a minute ago.and we have another clip from the documentary thatspecifically is about dads. the beginning of it is prettyfunny, actually. let's take a look at that.\m\m
>> the mom that's delivering thenewborn, she's the quarterback, she's the head coach, widereceiver, she's in charge. >> at least once a month, wegather, men who are going to be new dads or expecting fatherstogether and we answer any questions that they may have.>> another key group in that interpersonal level of thelevel, the grandmothers, aunts, sisters and friends, people whohave had successful breastfeeding in the past andthey can create support for the breastfeeding mom.when a community loses its
breastfeeding tradition, thatgroup of role models is one of the first interpersonalconnections to disappear and one of the hardest to rebuild.we can reeducate health professionals as long as wewant. but until you've had enough timefor there to be members of the community available to serve inthat role model kind of interaction, it's an uphillclimb. how have you seen awful thatkind of thing play out in your communities?>> again, we do community level
prenatal breastfeeding classesand birth education. and i know that if i find outthat the mother herself has been breast-fed, we've got agrandmother that is going to support her.and she's going to support her instead of fighting with hersaying you sleep and we have a free case of formula, let's usethat. >> or you think those makeenough milk for that baby? >> and we have great toolsshowing the grandmother and the mother and the father really howtiny the newborn's belly is.
they don't need two ounces offormula. >> not a football player whoneeds to drink gallons of stuff. >> yeah.so reaching the community is really important.we've been doing that for a long time.just having places in the community where moms can feelcomfortable breastfeeding their baby.if they come into our agency, we have breastfeeding friendlysigns up. and it makes a big differencethat they're supportive.
we have role models that womentend to look at celebrities. we have some now that havechosen to breastfeed and going public.it's a really great thing. i know that the kelloggfoundation just reported†-- i don't think it's news to thoseof us in the field information. but i think it raises a level ofawareness among the general population that most peoplebelieve in breastfeeding. but when it comes to being ableto continue breastfeeding, sometimes that's difficult.that's why we're here today
because mothers and familiesneed that support in the community.when they leave the hospital, they need somebody to say, it'sokay and we're here to make it easier for you.>> the kellogg produced a wonderful graphic, but thekellogg's foundation's website is wkkf.org.and it would have been perfect for this.because it talks about the percent of people who believethat hospitals should adopt breastfeeding friendlypractices.
they talk about the number ofpeople who believe that work sites ought to adopt them.what are the other things that they†-- you have a copy there.>> i do. 68% of their polled groupbelieve that there should be baby friendly or breastfeedingfriendly hospitals. 66% of the people polled feltthere should be more support in the workplace.we know that's a real issue. we have federal department oflabor laws as well as here in new york state.but we know that women have a
lot of difficulties when they goback to work in trying to have their employer reallyaccommodate them. 71% said that they would like tosee public spaces for breastfeeding and nursing.and not be told if you're in a grocery store that you have togo find a bathroom. >> or go out to your car.>> yeah. >> i think we need to have acheer for the kellogg foundation.they joined us five years ago supporting the first summit.now they're using all of their
resources to support breastfeeding. >> and doing a lot of work atthe community level. >> exactly.they're offering grants, they've funded over 100 places who aretrying to support breastfeeding. so eat your corn flakes.>> that's what breastfeeding has needed is some financialbacking. we've never had that.because breastfeeding doesn't cost anything and nobody earns aprofit. >> yes.yes.
and there are major profits tobe earned by the formula companies who are trying to yourhonor mined efforts to breastfeed while put on a glossof, oh, yes, we're very breastfeeding friendly.looking at that graph, it's encouraging that such highnumbers are supportive. but i also think to myself thatwe've got to get to the 30 plus percent who don't thinkemployers have a role or that hospitals have a role.so the numbers are good, but they're not where we need themto be.
and that's part of this whole†-->> right. >>†-- looking at it at acommunity level. so getting back to theinterpersonal peer support role model thing.while we're waiting for the next generation to pass and get tothe point that we've got a whole bunch of grandmothers who havehad positive breastfeeding experiences themselves, wic inparticular has done a lot to try to make up for that bydeveloping a huge peer counselor program.and stephanie, that's a lot of
what you do at work.>> yes. it's absolutely wonderful.at least in new york state, every wic agency is mandated tohave a peer program. and i've had the privilege ofstarting the one in orange county with our localdepartment. they're women who were or arewic participants themselves who have breast-fed their ownbabies, experience with it. we've had tremendous increasesin breastfeeding rates. when we first started, less thanhalf of the mothers that came to
wic even thought aboutbreastfeeding and now we've almost doubled that.we have almost†-- it's really remarkable that the wholefeeling in the wic clinic has changed.we started with three peer counsellors, we have twowonderful peer counsellors now, moms that do incredible work insupporting their peers. it makes such a difference whenyou have a wic mom come in and you have another wic mom to comein and talk about it. our peer counsellors have 24/7phones.
they can call any time.we're working on getting them into the hospitals so thatthey're there†-- >> meet the moms right away.>> yes. because we know that a lot oftimes in that first week when moms are not supportive, whenthey come back to wic, what happened?we thought you were going to breastfeed?this, that, and the other thing. and there are wic agencies thatalready have peer counsellors in hospitals.it really is a great model.
and i know wic is really tryingto get away from being the formula people and they're doinga wonderful job at becoming the breastfeeding people.>> and dr. michael young on that video clip that we saw mentionedthat in its early years, w. ic was inadvertently doing a lotto undermine breastfeeding. but over the past 10, 20 yearshave done a huge turn around. >> and we hope at the federallevel the funding continues for the peer counselling program.it's such an effective program. and increasing and improvingtheir health, improving the
mother's health as well.it makes no sense at all to rid of a wonderful program for that.>> well, the original model for that was†-- they were peercounsellors. and they continued to work andmodel that concept. >> and we have our peercounselors go to the la leche meetings.we work with them. it really is wonderful.the hospital in about our community has a mom's supportgroup. it makes a nice community levelof support.
>> kim bug has done a lot withpeer counsellors with rose. let's take a look at the clipfrom documentary that has some of her peer counsellors talkingabout their experiences in that role.>> as someone who works in an area where there aren't a lot ofafrican-americans in general, the ones that i do meet in thewic offices i really want to target they will and help themsee that it's not taboo in our culture and community, it'ssomething that's beautiful and we want to embrace it.that's really my†--
>> sometimes moms just don'twant to do it and i hear it all the time in my clinic.i can't do because i want to go back to work and school.every friday i have to get my hair done.and when they see a counselor going to school and we're goingthrough everything that they're going through and we're stillable to breastfeed, and they ask you, how do you do it?especially my dads when they come in class.do you know that michael jordan was breast-fed for three years.>> i had a mom actually a week
ago, she's 39 and this is herthird child. oldest is in the military,19-year-old. she had flat nipples and didn'tthink that she could do it. >> you can see those women havemuch more credibility with the population that we're trying toreach than any of us would really.and they look at us, you've got all kind of advantages.how am i supposed to do it in my life?but having peer counsellors are†-->> they understand all of those
things that part of their lives.and they've done a marvelous job as educators and mothers beinggreat role models for the moms that come into the wic program.>> and it gives them positive reinforcement and empowermentfor themselves. it has advances on all kinds oflevels. >> that's one of the beauties ofthe program, we encourage them to continue with their educationand opportunities to go to conferences and breastfeedingconferences. we have regular meetings.it really is a very successful
program.it's going to make a big difference.>> add more and more hospitals and other organizations getinterested in improving their breastfeeding rates, there's apotential career ladder even for people who start out as pe.r counsellors to become lactation counsellors andlactation experts in two or three years.>> right. and we know, for hospitals thatare working on baby-friendly or ten stepped or whatever they'redoing, that a big piece of it is
having that connection to thecommunity. the pe.r counsellors really make that easy for them to do.they have to connect with the local wic agency.>> and now we move on the to next level to the wholeorganizational environment. this is the level that we'vetalked about in lots of past breastfeeding grand rounds.the hospital and workplace environment.all of those past broadcasts are available on the website if youwant a full recap of what we
talked about then.let's do a brief overview of what the major organization atthat level are that we need to be thinking about.the most obvious one is the health karen environment.as we've talked already a bit before, the birthing environmentitself has a major impact on the success of breastfeedinginitiation. and if breastfeeding doesn't getoff to a good start, it can't get off to a good continuation.so really, even though the amount of time people spend inthe birthing environment is
shrinking, what happens in thatenvironment has a huge impact. >> we can usually help them.but it's unnecessary. if things would have gone betterin the hospital, we wouldn't have these issues a week or twoweeks later. >> on surveys like the maternitychildbirth connections, they did a survey that showed thattrouble getting breastfeeding going was the number one causefor early weaning in the first couple of weeks of thebreastfeeding experience. so really getting that goodstart is key to success through
the rest of the breastfeedingyear or two or three. with the african-americancommunity, another important part of the health karenenvironment that we need to think about is the nicu.african-americans have higher rates of premature babies andlow birth weight babies. so higher numbers of babies whospend time in the knee owe natal intensive care unit.conveniently enough, kim's husband is the director inatlanta, and he and their daughter, who is a futuredoctor, both and on the
documentary.why don't we hear from them next.>> breastfeeding is a very important topic to us.because the infants need the nourishment that they get fromthe mother's milk am. the artificial statute does notprovide the protection that the babies need in their first fewmonths of life. it increases their risk ofinfections if they don't get mother's milk.of so for our babies it can be a matter of life and death.>> i'm thinking about becoming a
ob-gyn and i feel like mypractice is important. because i do want my mothers tobreastfeed. it's a benefit for the babiesand the mother. >> so that's it for the bugfamily hour on the breastfeeding grand rounds.it's cool to see their daughter following their parents' footsteps into this world. >> my agency has been working inthe middle and high school region for a long time reallytalking to young people about their futures as potentialparents.
when you bring up breastfeeding, they're like sponges. they've never had anybody talkto them about it and they all get it.hopefully the next generation will†-- we won't have to fightso much with them to get them to understand how great it is.>> that job will have been done. check mark.>>> another key organizational environment that women have todeal with in terms of the continuation part ofbreastfeeding is the work environment.codified in lots of state laws,
including one in new york stateand now in the federal affordable care act, there aresome requirements on workplaces that they need to provide timefor breastfeeding mothers to either breastfeed or pump duringthe workday and they need to provide spaces for them thataren't just the bathroom down the hall to do the pumping.so unfortunately in the past, a lot of employers, even if theyhave accommodated the, okay, you can have a space to pump, it'sreally not much more than a bathroom and it may be abathroom.
so our next humorous clip fromthe documentary is what if we all had to eat in the bathroom?from a group called table for two.>> table for two is a community organization that speaks toestablished public lactation rooms for breastfeeding moms.>> so what did you eat in the bathroom?>> we went to the university just right around a corner andwe took over a bathroom. we said, hey, we'll feed youguys if we can put you in a bathroom and take photos.and now they are ambassadors for
breastfeeding.how about that? >> so stephanie, tell us aboutwhat the new york state coalition has been doing.>> the new york statewide breastfeeding coalition back in2008, i believe, we received a grant through the united statesbreastfeeding committee to provide training of the businesscase or breastfeeding toolkit which is a wonderful documentthat's available online now at our womens health.gov website.but we were able to train over 350 people to help them reachout to businesses to educate
them on why it was so importantfor their business, the bottom line would be improved if theywere able to support their nursing mothers at theworkplace. and fortunately, we had thepassage in 200 of the new york state nursing mothers in the newyork state law. so it gave us teeth to go outand reach out to organizations. and the best and easiest thingthat happened was because so many people that attended thetrainings already worked in agencies.we said start there.
look there and see what you cando to make changes. and we did see a lot of positivechanges. the statewide coalition was ableto offer mini granted. even if it was something toprovide a refrigerator for the business so the mother could puther pumped milk in the refrigerator during the day.it didn't have to be much. but we were able to reach out tomany businesses. and since then the wic programhas come out with a new tool called make it work.which is aimed at employers and
employees of low income wageearners. where the business toolkit wasreally sort of corporate america.but if you're working at mcdonald's, it's not the samething. >> big challenges.>> the new york state wic program, the department, wentout and through a grant they put together this wonderful toolkitwith lots of really great ideas on how small businesses canaccommodate nursing mothers. it might be something in newyork city where one of the
networks opened up a lactationroom that all of businesses and all the women that work withintheir block can come in and use. simple ideas like that.even in upstate where there were women that work on the like thetelephone line. you know, they could go in theirtruck. but they look add the portableat the present times like you take to a beach and you pop itopen and she was able to pump. you can plug your pump in.>> and telephone line workers? >> yes.>> at first i thought you meant
a telephone call center.>> out in the line, in their trucks, climbing the poles anddoing what they do up in the air.>> moms do all kinds of jobs. >> and the toolkits have a lotof information that you should access.and if you come to the new york state breastfeeding coalition'swebsite, we have a lot of links to all that stuff on there.and our facebook page is always giving information and linksthere as well. but the fact that here in newyork state, we have the support
of the health department, wehave the support of the statewide coalition, we have thesupport of in very†-- in the new york state health department hasfunded pare natal networks for the past 20 years and those areone of the great community level places where we find that womencan be supportive in breastfeeding.>> we're lucky in this state to have lots of layers of supportavailable. and even in other states, manystates have developed statewide and regional networks as well aslots of national level resources
from the cdc from the women'shealth.gov. >> and following that frameworkthat you mentioned earlier, it ''s a great tool to help youfocus on what you need to do. >> figure out which level youneed to operate on and whatever you can do.one of the sort of cornerstones of workplace support has alwaysbeen the lactation room. and the university of rochesterhas a fabulous lactation room with rocking chairs and pumpedin music and privacy screens. >> the elite pumping room.>> it's like the gold standard
of gold standards for lactationrooms. but they don't†-- i mean, as yousaid, the pop-up tent can be an extremely simple lactation room.we have a photograph of something in between those twoextremes. an employer can provide alactation room without going to a huge expense and still havewhat you need to have. you know comfortable chair, arefrigerator to store the milk, a pump to plug in an electricpump. >> and some place to wash up.>> a sink.
that's one†-- the sink was oneof the reason people got moved into the bathrooms.you can have it next to the bathroom so there's a sinknearby. >> as little and four feet byfive feet. look for that unused closetsomewhere and you can revamp it. there are organizations that canhelp you do that. and we can get you the link tothose too. it doesn't have to be elaborate.>> yeah. yeah.>> well, this is on the first
floor of the hospital.it's accessible to everybody. >> everyone.>> and we agonized over the name.it's called "the pump place". >> seems appropriate.>> you can see an engineer running in there with a clampingdevices. >> that's a different kind ofpump. >> in one of the counties that iwork in, one of the first places that made changes for thebusiness case of breastfeeding was the hospital.and yet, if you were a nurse you
knew that you could go up to thematernity floor and use their office.but if you were a custodian or worked some place else, you hadno idea. just putting that into their hrpolicy to let them know that anybody can come up here.but it's really nice and clean and comfortable.and there is a public one now down by the emergency room.so the families that are coming in have a place to go to.>> we have a pumping places all across the university.so it's permeating.
>> model programs.>> not surprisingly. >> one of the organizations thatreceived a mini grant from us was cornell university.we know that they went to make changes in their campus as well.>> you can have the greatest lactation room but it's only thepeople in the know or it's not much good.making changes in the human resources office wheneversomebody inquires about maternity leave, that should bea trigger to provide information about the breastfeeding supportthat's available.
>> and that's why even when weare working with a mom who is pregnant, we talk to her abouther plan for going back to work and how important it is for herto reach out to her hr department now and let them knowthat these are the things that she's going to need.and you don't want her to come back and go, where is my pumproom? and one of the great tips isthat you should go back with your baby and let everybody seehow beautiful and this is why you're doing this during yoursix to eight weeks or whatever
limited maternity leave youhave. let everyone see how wonderfulyour baby is. >> and how they're flourishingbecause they're breast-fed and you're not going to be home sickall the time with the baby because the baby is beingbreast-fed and not getting ear infections all the time, etcetera, et cetera, et cetera. we talked about lactation rooms,but that isn't absolutely necessary.sometimes the major adjustment that an employer needs anattitude adjustment.
and being supportive and helpingfigure out even if it's a small place and they can't set up awhole lactation room, what can they do short of sending you tothe bathroom or your car that would accommodate your need topump dug the workday and take breaks and that kind of thing?so having a positive supportive, let's figure it out kind ofattitude can go a huge amount of the way toward findingsolutions. >> and as we see in the photoshere, we have a mom who has her baby with her.what better place.
you've solved a lot of issues.until the baby is actual mobile, mom can wear the baby andaccomplish a lot of things at work.>> and the baby spends a fair amount of time sleeping.as long as the baby isn't too cute and a distraction toeverybody else, it can work out really while.after a while, even the cutest babies are sorts of part of thebackground and people stop fussing over them.>> and getting your colleagues to not feel like you're gettingsomething you're not.
for years people took cigarettebreaks and they were gone two hours probably out of the wholeday and known complained about them.but a nursing mom pumping for ten minutes, what is she gettingthat i'm not? having the education office-wideis really important too. >> so often with the workplaceenvironment, the other environment that really needs tobe accommodating is the child care setting.>> yeah. >> not everybody has thewherewithal to have a nanny at
home to support thebreastfeeding mom when she goes back to work.and not everybody has a grandma who can retire right at themoment the first grandbaby is born and become that stay athome nanny for the baby. so having supportive child karenenvironments is also a key part of the whole thing.what are some successful models of that that you guys are seen.>> i would like to say thanks to dr. mary applegate.when you were there, it's been a great tool to have.the new york statewide breast
feeding coalition, we takeemails and get calls and things from mothers who have issues andwe're able to send them to the website and say here's a list ofbreastfeeding friendly child care centers and here is a listof what they should be doing. it's not a toxic substance.>> you don't need to wear rubber gloves or put on a mask.>> yeah. and those children arehealthier. why not support that?in my agencies one of the things i've done is gone to any childcare center that will have me
and come in and talk to themabout how easy it is to support breastfeeding mothers.all even if they just have a place where the mother can getmy pamphlet and say, call this agency and they can help you.or a list of lactation consultants.a book, anything at all. but to not chastise the motherbecause she wants to come to the day care center to breastfeedher baby. she has an hour for lunch, she'scoming in. and we had that recently with achild care center on long island
who didn't want the mother tocome in and breastfeed. you have to go out in your carwith your baby. it was ridiculous.>> crazy. and that's a setting where anattitude adjust is really the biggest thing that needs tohappen. >> yes.and you know, for some of the head starts that i've workedwith, they've been wonderful. they're federally fundedagencies, so they have a lot of rules to follow.but they've been wonderful.
they've accommodated motherswith working places, and because they have it there, their staffcan use it. so it's really perfect.>> dr. lawrence, do you have anything you wanted to commenton about child care centers? >> well, i could give you a listof ones that cooperated and are wonderful.we have to get rid of that term brett feeding†-- and have peoplerealize it's normal and best thing that could happen.>> and i think as an advocate myself, i think one of the realimportant messages is that we're
not trying to force people tobreastfeed. >> we're trying to help themreach their own goals. >> exactly.exactly. exactly.>> that's the sad part. we're often portrayed as peoplewho are forcing women to do what they don't want to do.but in fact, as the website, best for babes, they point outwhat's really out there in the community is not people beingforced to breastfeed it's the bobby traps that underminewomen's group goals that they
set for themselves.and this is about helping people avoid those traps and able toreach their own goals. >> i think close to 90% of thewomen that were giving birth said they wanted to breastfeed.but within a week or so they're not breastfeeding because of allthe issues that they encounter. >> because of all the potholesin the road. our goal here is to pave overthe potholes. so beyond their role asemployers, businesses can†-- and we've mentioned a couple oftimes, lactation rooms that were
set up for employers that thenwere open to the general public. that's an excellent example ofhow a business, as a key part of a community, can really go along way to making a community breastfeeding friendly.what are other examples that you can think of breastfeedingfriendly thing that a business can do?>> even if it's a restaurant to not throw a mother out forbreastfeeding her baby. or thinking they're terrorists.absolutely not making a big fuss.we did, i think that was a
couple of weeks ago, it made thenews, national news that somebody actually paid for theirpizza because they were happy that she was breastfeeding herbaby. we need more people to pat momson the back when they see them breastfeeding.and say yes, that's really great.that's wonderful that you're breastfeeding.we're happy and proud that you've made that choice for yourbaby. in a county where one of mycounties that i work in, working
with the businesses there togive them a little sticker for their window, this is abreastfeeding friendly business. in orange county, we havestickers, this is a breastfeeding friendlyworkplace. a little recognition.>> a patton the back for the business.and it changes the environment for the breastfeeding moms outthere if they see stickers all over the place and think, oh, icould go there. they're supportive of what i'mdoing.
it just changes the environment,in subtle but important ways. >> until the day we don't haveto do that anymore when everybody thinks it's normal.>> of course it's breastfeeding friendly like most the rest ofthe world is. >> yeah.and in our region and actually lots of places in new yorkstate, breastfeeding caves, baby caves in my neck of the woods wedo our baby talk. places for mothers to come, chatwith other mothers. no entrance fees or anythinglike that.
you don't have to be a member.and really, mother to mother support is crucial.they can commiserate with each other about what they're goingthrough and what their baby is doing.sometimes it gets a little out of hand, we have to kind ofbring the conversation about what's appropriate.>> let's be solution-oriented here and not just be a gripesession. >> yeah.which is really nice for the baby caves.they have a nice for matt and
they're licensed organizations.breast feeding cafe, we do baby talk.just to drop in weekly. it's a weekly chatting.>> a place where you can come and bring your baby orpresumably not bring your baby if baby's having quality time, awalk in the park with dad or whatever.just a comfortable place to come and talk about stuff.great models. so we have a couple of picturesof other kinds of community organizations and what they do.and one is from your county,
stephanie, health departments.>> there's our†-- our pe. r counsellors decorate ourbulletin board from the season, that was from the ball season.>> we guessed. >> yeah.one of the nice things in educating is that we share theclinic space with the public health clinic.there's breastfeeding stuff every place.even though they're not wic participants, they have to sitand look at awful that stuff. raising the awareness thatbreastfeeding is normal.
>> if somebody comes in for aflu shot, they can see all of these posters.>> and a lot of times we have something on the dvd playerthat's appropriate. and the other picture is thecounty fairs in the region. and not that it was my idea, igot it probably 15 years ago from down south.but going to the could you be fairs where you can breastfeedanywhere you want. but to make a comfortable spot,shade, we rent a tent. it's really simple.there's a table, rocking chair
in the back.we had bottled water, a fan. a changing table for the moms.and it's just wonderful. we have people who are notbreastfeeding come in and say, what are you doing in here?and look around, oh this is a great thing.>> and you can sit here too as long as there's not a mom†-->> we have them at sullivan county fair, dutchess countyfair. and it's grown now that we haveother organizations helping. not just me running around toset everything up.
it's really been great.mothers, fathers, grandmothers, they all come back.>> and this is county fair season.if your county does not have a rockin' rest tent, this is thetime to implement one. >> easy to do.>> an easy way of again making it part of the normal atmospherefor the community. >> and the county fair peopleare happy to have places that mommies can go.you're doing a service for them. we're not a business and we'renot, you know, going†--
>> not everybody is comfortablejust sitting at a table at the concession area breastfeeding inthat much in public. so having a quieter space can begood for them too. >> and we have the volunteersthat come in are from local agencies and organizations.they bring their information and able to reach out to familiesthat otherwise may not know that they're around.>> as long as they don't have formula ads on the front page.>> that's in my rules in participating there are noformula promotional items ever.
no pacifiers or anything at all.>> a center for an older child who is being breast-fed, becausethey're so distractible. i mean they like to nurse andlook around. >> yes.>>†-- at the same time. >> and at a county fair, thereis so much to see that it's time to keep the focus.>> especially from the older ones, it's nice to get them awayfrom the cotton candy. >> and just have a little downtime so they aren't as high-strung whether they'reeating tons of cotton candy or
not.>> crayons and coloring books for the older kids.diapers, wipes. >> you have family friendlyoasis. excellent.>>> another key part of communities are faithcommunities and whether it's christian, muslim, jewish,hindu, unitarian universalist, there's a major role in settingfor faith communities in setting community values and being partof the atmosphere that families are surrounded by.dr. lawrence, you have had
special relationship with thishaving met with, was it pope john paul the ii on the secondof breastfeeding? so why don't you lead ourdiscussion about the faith communities.>> well, as a matter of fact, we did look at this back in the'90s and realized that the core ran, for instance, hasinformation about breastfeeding and suggested that youbreastfeed for at least two years.the old testament says the same thing, a mother shouldbreastfeed her infant for at
least two years and thechristian religion had nothing. and at that time pope john paulii was touring the world particularly underdevelopedcountries, and we thought, what a spokesperson.so a small group of us, 16 in total, we had a few catholics,butting a no, sir ticks and atheists, we all went to seepope john paul ii. we spent three days at thevatican preparing a statement for him.and we were taken to his private quarters and represented thestatement.
we presented the statement tothe pope. and we sat there in this roomwith him. and pope john paul ii didpontiff indicate that†-- literally pontiff indicated.>> yes, he did. and he published this and all ofthis sort of thing. and then he greeted each one ofus as well. it was a very awe-inspiringevent. but the most important thing wasthat he spoke out and suggested that the women of the worldshould assume their role of
breastfeeding their infants.it's a beautiful piece, if you like†-- wanted to read that.>> yeah. and after all, you know, all ofthose bracelets, what would jesus do?what would jesus eat? there were not alternatives atthe time. >> right.>> and we've seen wonderful initiatives in new york city.he they had a wonderful faith-based initiative thatworked with the churches to help them understand how to supportbreastfeeding women.
if you go to their website, youcan click on the clink for the information.at the conference that i went to several years ago, went to awonderful workshop presented by faith-based organizations.and the tremendous work, the changes that they were able todo when they got behind them. there's a lot of faith-basedorganizations out there. if you can get them behind youin supporting this, it's wonderful.we always look to the churches, a religious organization.they usually have a nice, big
space and not going to charge ustoo much money and have a kitchen.>> and they tend to be family friendly.>> exactly. and a big parts of the educationthat we're doing at the community baby shower isbreastfeeding. we involve the church members,usually they're there helping us out for the day.and again it's raising the left of awareness of everybody.>> getting the grandmothers in the congregation to be a wearthat this is a important thing.
>> grandmother's tea curricula.it's really a great way to involve generations of motherswho may not have breast-fed their babies.>> when we were prepare for this i found a quote from apediatrician from washington, d.c., i wrote it down so iwouldn't forget what she said. she said, i had one mother sharewith me that her decision to breastfeed in church was metwith remarks that it should be a sin.this was from a child who clearly had not been taught thatit was the normal way to feed
your baby.my response would have been it can't be a sin because jesus wasbreast-fed. women who take their newbornsinto church with them and sitting there for quite a while,the baby is likely to get hungry.and nobody want as screaming baby in the middle of areligious service at the quietest time especially.of course you're going to want to breastfeed the baby.and then to be met with a congregational reaction, likethat should be considered a sin,
is going to totally underminethe mom's confidence and the feeling that she's welcome inthat place. and congregations don't want toconvey the message that you aren't welcome here.so i think they're receptive to the whole idea that they have arole to play in the breastfeeding community.>> they want them to come there, so they need to accommodatethem. >> and with hinduism, when i waspreparing the slide, any religion whose most iconic temphas that looks like that has got
to be pro-breastfeeding.look at that. >>> we've alluded over and overagain to things happening in the community as a whole, sort of ageneral ambiance that influence the breastfeeding friendlinessof an area w stephanie, could you comment a little more onthat kind of stuff. >> we know that breasts are sexyin our society. so any time there's a picture ofa breastfeeding baby on a poster or billboard, it always elicitsinteresting comment or feedback. we know that some of theprograms that have been run, the
wic program got a grant awardand had wonderful breastfeeding campaigns and we saw them onsides of buses and billboards and things like that, and thereaction was not as good as we expected.it really is very controversial. and it's sad that mothers andbabies belong together. and women can have barelyanything on on a car ad. huge standup statutes ofvictoria's secret models in hardly anything.but the mom sitting there nursing their baby, the guardcomes over and throws her out.
the more we see breastfeeding,the better off we'll be. some of the things we saw on theslide, putting the pictures out there are very important.you can go to a lot of the websites and download thesepictures. get them out there.>> and that little breastfeeding welcome here symbol,breastfeeding mom and baby. >> it's an international symbolthat is designed and it is free for everybody to use.make your own poster. there's a lot of stuff that'sout there already.
and we know that it will becontroversial. but the more we see it, thebetter off. this year the statewidecoalition offered mini grants. and one of the applications thatwe received was to help them purchase life-size statutes ofbreastfeeding mothers and plant them around in the city.and i do believe that new york city is going to be doing that.>> source of like the horse sculptures†-->> mommy is breastfeeding in public places and they can movethe poster board i guess it
is†-- life-size, get yourpicture taken next to president clinton and he's atwo-dimensional cutout. i think the next campaign shouldbe for a city to adopt†-- a lot of cities have these horsestatutes all over the place or†-- it's different for eachcity. but we could have, you know,competitions for statutes sprinkled around a city ofbreastfeeding mother-baby pairs. >> and if you look at artwork,there's so much artwork out there that mothers and babiesare breastfeeding.
get more of that stuff outthere. >> and then we have the negativeapproach that and on "time" magazine that had so manyinappropriate innuendos associated with it.>> they sold a lot of magazines and that was their purpose.those are the kind of issues that we have to deal with.it's just sexualized and it shouldn't be at all.>> and in europe, i had a breastfeeding talk that i gavefor a number of years that i had found a great bus placard fromrome that was a picture of this
smiling baby with his other herhead nestled in between his mother's ample breasts.and these buses driving through the streets of rome, i could notimagine this happening in albany.but maybe we'll get there. people will think of breasts ofmore of the mother dash baby†-- >> in london, there is a statuteof a mother breastfeeding what would probably be a 2-year-old.and of course, you're not supposed to take pictures inwestminster abby. and the guard was standingthere.
and my husband went over to himand said we need a picture of the statute.he said, i can't give you permission, but i'm going to belooking the other way. >> good for him.good for him. isn't it downtown oslo that hasa huge statute of a mother with lots of babies sort of millingaround and she's leaning over with breasts.in other countries this is much more part of the public space.>> it's just human. >> human art form.>> right.
stephanie, at the beginning youalluded to the public figures going public with the fact thatthey were breastfeeding. >> it has been nice to see thatwe have, you know, over in england a certain mommy theregave birth, we were all waiting for her.and thank goodness she is breastfeeding the baby.and not giving them dummies, which is what they callpacifiers in england. >> that's encouraging.and if kate doesn't have support, i don't know who will.>> exactly.
exactly.>> there's really no reason for her not be able to breastfeedthat baby. but i think it's a great†-- shecan be a great role model. i don't know if it's true ornot, that she doesn't want to be that, but she is.she knew that when they got into the family.>> she can be a new mom privately and not be on postersbeing the face of a breastfeeding mom.but still just the fact that she†-->> here in american we tend to
idolize the rock stars and moviestars, but fortunately we have notable celebrities who arechoosing to breastfeed. and the more african-americancelebrities that we have that are showing breastfeeding likebeyonce and other new moms. >> and michele obama wasn't abreastfeeding mom when she became first lady.but she was one when her children were little.and she's been very supportive and included lots of message ofbreastfeeding in her white paper about childhood obesity.she and beyonce are two very
prominent african-american facesfor breastfeeding being the way to go.>> well, she lived in chicago at the time.and the local community helped her breastfeed.>> good for them. >> but, you know, the media isreally very important to people these days.and with facebook banning pictures of breastfeeding, itmakes it interesting to read facebook.but i think it's really such a great†-->> it's one thing to moderate a
new york statewide breastfeedingcoalition group. that needs to change.>> it really is a great tool to get out of the information thatmothers need. so they feel supportive.at least electrically they know there's a place for them to goand get tweets from people talking about the breastfeedingexperiences. i think we're going to continueto see our breastfeeding rates, at least initiation, increase.the cdc just released their maternity practice scores justyesterday.
we still need improvement.even though mothers going to the hospital choosing to breastfeed,they're very often given formula for whatever reason.but we need to continue to work on that and help them breastfeedtheir babies and help them continue.and the 2020 goals are including exclusive breastfeeding.but we need to work towards that.and in order to work towards that, all of the community stuffneeds to get better. >> yes.especially for the duration
goals.>>> we have another clip from the documentary about this issueof getting comfortable with breastfeeding in the publicmarketplace. why don't we take a look at thatnext. >> we all need to become morecomfortable with nursing. this is the president ofvenezuela talking to a young woman who is nursing.we can't go to a restaurant and cover up and be comfortablenursing our babies without someone saying something to us.i try to tell the young ladies
that i work with, when i try totalk to them about breastfeeding, they're like, i'mgoing to try. and i'm like, no, i don't wantto hear that. this is the new mantra.yes, i can, and i will, and watch me.i'm going to do this. >> i take it, dr. lawrence, youwere the origin of yes, i can, i will, and watch me.and kim learned that from you? >> well, i wouldn't take creditfor that. >> it's certainly your attitude.>> it's such an important
attitude to have.and we need to support mothers. >> build that confidence.breastfeeding is a confidence racket.>> some of the mommies that come to my breastfeeding classes,they're so confidence in everything else they do.they're business women and they've got it all together,they're schedules and blackberries and everything.and they come to the breastfeeding class and they'resort of like a deer in the headlights.their friends haven't breast-fed
or maybe they have†-->> and the mother-in-law. >> i'm not anti-mother-in-law,but very often that's a real sticky thing.is that the mother-in-law wanted her grand or granddaughter togain enough weight and there's no way you have enough milk inthose breasted. but whatever the issue is, thefamily system very important. but i think that we need toreally continue with prenatal breastfeeding education.and it's very difficult. because women don't know whatthey don't know.
and childbirth classes ingeneral are less attended than they ever were.back in my day, you looked for your lamaze class or whateverclass you were taking. >> you had to take it to havethe baby. >> you had to take the class.and nowadays you can go on facebook or the internet andlook something up and watch things on television that youthink are†-- >> childbirth move on tv.>> and say, oh that's fine. so the education is really key.and we know, at least in my
organization, that it makes adifference. the women who come through ourclasses, we keep records on them.they have better success and more likely to get what theywant our of their birth and breastfeeding experience.and even going back to the wic participants, we have themnursing their babies at a year and beyond.which was not happening. not at all happening.>> not a generation ago. >> yeah.yeah.
>> yeah.so progress is being made. >> yes, it is.>> before we wrap up, i wanted to mention the u.s.breastfeeding committee has a wonderful section of theirwebsite with lots of stories about success stories about howwomen were supported in their breastfeeding by members oftheir families, by their work site, by their faith community,by their employer, by all different part of the community.so if you're looking for inspiration for something thatyou or your group can do in your
community to help raise thelevel of support in your area for breastfeeding, it's a greatresource to go and read some of those stories and see how thingscan change for the better to make a more pro-breastfeedingenvironment. >> and if you go to the usbcwebsite you can go to your local and stay coalition.they're all listed on the website.if you ever see my car in the parking lot, i have a bumpersticker. you can make a donation andprobably get a bumper sticker
for your car too.>> that is the message. just like there are manyopportunities to undermine breastfeeding, there are alsoopportunities for all of us in making it more prevalent andsuccessful and all those things. >> everyone plays a part.>> all of those things working together form what an editorialin the lancet from what, 20 years ago, 1994, it was referredto as a warm change for breastfeeding.in the world of public health, in the immunization world.it's a system of government and
community organizations workingtogether to get vaccines to the farthest corners of the planet,still cold and still effective. dobing and colleagues weremaking the point that breastfeeding doesn't need acold chain, especially 20 years ago, breastfeeding often got thecold shoulder. what it needs is a warm chain.people at every level support in the hospital and then peoplethat the hospital folks can turn the mother over to when sheleaves the hospital so that she knows that she'll get the nextlevel of support in her
breastfeeding.so altogether, it actually should instead of being a warmchain, it's more like a warm web for breastfeeding.and as you said, all of us have a role to play in supportingbreastfeeding. >> and there's a wonderful newnational initiative called best fed beginnings that's workingwith 90 hospitals across the united states to help them makethat connection with the community.we've finished up doing community assessments to seewhat are the gaps.
is there no referral to asupport group? or maybe there isn't a supportgroup and maybe the hospital needs to start a mommy group sowe have more support in the community.but breastfeeding really is something that we all need to beinvolved with to help those mommies.>> even john dashing said it's a confidence game.and that's so important as a thread to all we do.>> new york city is talking about developing breastfeedingempowerment zones.
i'm dying to see what those looklike when they're all up and running.that's such a great idea, a breastfeeding empowerment zone.that's the same kind of thing, yes, i can, i will, and watchme. >> yes.>> so with that, why don't we turn back to kim and let herhave the last word in the show today.and then we do have time for questions.we already have some that have been phoned and faxed in.let's go to kim and then your
questions.>> we feel that we can make a major difference.it's about images and being positive and one of the mainthings we like to say is instead of hearing people say, well,i'll try, that yes, i can, i will, watch me do it.\m\m \m\m>> so, thank you kim. even though you aren't here inperson we've missed you and thinking about you this wholetime. >>> let's go to some of thequestions from the audience
next.here is one that we touched on a little bit.a challenge for many moms is having a job in gas station orsmall store where they are the only employee.also wait staff have a hard time with busy tables or environment.please comment or give ideas about how that can be solved.this is from jessica in vermont. >> i would say that one of thethings is of course talking to the business owner to see whatarrangements could be made. maybe you could work shortershifts so that you're not
expected to be there at thetime. but having the opportunity to goto your car, possibly to pump. women have used that withportable pumps. but it really needs to be aconversation. there are solutions, but youneed to have a conversation with your employer to see what worksfor them as well. maybe you can go into the boss'soffice for 20 minutes two or three times a day, whatever isneeded. >> i think one of the key thingsabout that question was that
this was the only employee onthe premises at that time. and i think until our communityis comfortable with the†-- >> with a pump†-->> right. >> if president chavez can standthere talking with that mom breastfeeding right out therewith the cameras rolling, then if he could do it, then thecustomer at the gas station can do it too, eventually, maybe,hopefully. >> i would equate the wait staffwith the same as nurses. long shifts and busy on theirfeet all the time.
if you make it a priority andyou work with your employer to see how we can†-- we're notgoing to be doing it for the next ten years.it may just be the next three or four months that you need topump three times a day. and eventually your child isgoing to have solid foods. we can actually do the reversenursing thing so that the baby doesn't need as much pumpedmilk. >> babied adapt to that and theysleep while mothers are working. and they wake up and want to eatall the time she's home.
but the baby adapts too.that's part of this picture. we're expecting†-->> mother-baby. >> right.right. >> but we can adapt the baby.>> can the child care provider bring her baby to her once a dayso she can just nurse. and really a customer seeing amom nursing should be more comfortable than seeing a mompumping. >> right.yes. that's more overturned to thedairy industry.
>> but that is a challenge.>> yes. it's definitely a challengingsituation. and starting early to talk itthrough and come up with solutions.>> solution prior to that moment.>> yeah. yeah.>> yes. >> okay.next question from the audience, i'm heading the breastfeedinginitiative in warwick at saint anthony's community hospital.they didn't say what warwick.
there's one in rhode island.there's probably warwicks in many states.of wherever you are. i'm trying to get a tent goingtore the apple fest. any tipped?>> call me. the whoever you are.that's in my community. and apple fest is a huge huge.>> so it is warwick, new york? >> yes.it's a huge event. >> you have local suppliers.>> yeah, we can help out with that.>> excellent.
okay.another question. are any efforts being made totry to work with the service sector to make the workplacesmore breastfeeding friendly? for example, fast foodrestaurants. >> it's a work in progress, it'san absolute work in progress. as i mentioned before, the newyork state wic program does have their making it work toolkitwhich is available on their website and online.lots of good tips and handouts for both employees andemployers.
this is going to take a lot ofwork. nationally it's going to be ahuge uphill climb. without having better paidmaternity leave, something has to give.and we are asking businesses to make these accommodations.but really if we could let mommy stay home longer and make somemoney, we would probably eliminate those issues.>> this is why we haven't talked about milk dash banks oranything like that. there was a new cooperative milli can bank in michigan which is
operating around the countrywith the idea that here are these mothers with this milk andthey need to earn money and so forth.and a co-op is very different than an industry.you can't belong to the co-op unless you're lactating.i think it's a beautiful concept.>> it is. >> and with all of this need formother's milk and that sort, to have something that women canbelong to and control and contribute to and earn somemoney so they can stay home and
breastfeed their own babies.so it's a little action to watch.>> very interesting. >> yes.>> okay. we got a call from cheryl fromthe madison county health department.where will the rockin' lactation be at the end of august?she would like to promote it. >> i'm not from that area, so idon't know. >> there's a whole hugestatewide fair in syracuse every year.you're from the finger lakes,
you're from the mid-hudson, i'mfrom the capital region. >> i would suggest if you're notassociated or fail waited with your local breastfeedingcoalition, go on the usb website and find your coalition and seeif they have something that they're setting up there.>> and syracuse does have a lot of activities throughout theregion. >> and it would be on thedoggett county website. >> we're on the map on some ofthe other ones since we've been there a long time.but the state fair is like ten
days, i think.>> it's a huge event. >> that's a lot of volunteereffort. and that's one of the reasons wenever did the orange county fair because it was ten days long andoverwhelming to organize awful that.the other fairs are five days, six days or a week.>> we have a local one that's about four days.>> yeah. >> they could recruit.i could see a group of volunteers coming from rochesterto help them out.
>> when i was at the statehealth department, they always recruited people to go staff thehealth department booth at the state fair.so, you know, maybe that's a project for the statewidebreastfeeding coalition, launch a rocket and recitation at thestate fair and get people to chip in half a day each.>> i think that's a great idea. >> as if the coalition doesn'thave enough to do already. we'll add that to the list.one more question. do you have any good successstories or tips relating to
addressing a workplace that wasreluctant to encourage breastfeeding but then camearound? >> hmm.you know, the one thing that just pops into my head, the†--in orange county, we're in a county department building.and one of the sheriffs who drives her car around with abullet proof vest on and everything needed a place topump. and they†-- they gave her a hardtime at first. you know, because they wantedher to use the locker room or
bathroom.and we ended up making a great change in the county.so in every county building she would come into, there was aspace for her to go in and pump. >> a floating lactation.>> a floating, yeah. >> and i think the health carefacilities have to be the model. if we don't have such facilitiesin the hospital and health department and so forth, how canwe ask somebody else? >> and that's why we did thebreastfeeding training, we said start with your own organizationyou'll be the model for your
community about what you've doneand changes you've made. >> but in this particularsituation where somebody has just converted the religion andthey need support and comp minute and thank you very muchand everybody rising up and recognizing that they have takena great leap of faith. >> yeah.and it's one of the things at the coalition level that we'llbe talking about tomorrow is how to do a little more recognitionof the businesses that have made these great strides andaccomplish something for the
nursing mothers in their employ.>> that would be this afternoon. >> oh.>> we got†-- >> the rest of the day.>> the coalition meeting is today.what are the best strategies that you've found for gettinggrandmothers onto the breastfeeding band wagon?>> just talking to them. at the wic clinic at baby talk,we have grandmothers bringing their daughters in.and just starting the conversations with them aboutit, it makes a difference.
they really want to know.they really want to know. they want the informationbecause a lot of timed the first thing they teal me is, icouldn't. you probably weren't supportive.>> it wasn't your fault. >> it wasn't their fault.tell me about your birth experience.and women remember everything that happened during theirbirth. >> decades later.>> it's a real ice-breaker to meet with the women in thewaiting rooms and just having
that plain, old simpleconversation with her really gets her†-- we have pamphletsdesigned for the grandmother of the breast-fed babies.we give them our phone number, you can call us.one of the things that we want to do is a grandmother's tea.we just haven't gotten to do a formal setting but we do meetwith them on a one on one base. >> kind of like thebreastfeeding cafe, but for grandmoms?>> yeah. >> i think your approach to tellme what happened when you had
your children.because they pass down these midsts.well, you aren't going to be able to breastfeed because icouldn't. and that kind of thing.nobody in my family could ever breastfeed, so you won't be ableto do that. >> i didn't have enough milk.well, tell me what happened. >> and it wasn't them, it wasthe environment that they were working and living in.>> and many people interpret the fact that, you know, initiallyyou're kind of engorged and so
forth.but when that goes away including physicians who don'trealize that that†-- it's a milk machine.>> and that the engorgement dissipation is normal.>> many women stop breastfeeding because they don't think theyhave milk because they're not engorged like they used to be.>> right. if these†-- these are moms thatcome back to us at the wic clinic with the same sentiment,they don't have any milk and they can't do this.and i put the baby to breast and
the baby is right there, andthey're like, oh, i didn't know. >> you hear that swallow,swallow, swallow, the baby is swallowing milk.>> baby wanted to breastfeed. >> and you weigh them and youtake a history of wet diapers and all that sort of thing.that's such an important part of diagnosis.>> so let's get more of our questions.what can community coalitions do to make sure that lactationsupport is available to women who don't qualify for wic?>> the model of the baby cafe,
you can actually go to theirwebsite and look how they've done that.baby cafe is really for all moms.work with your local hospital and see if they will allow youto run a mommy group there. some of the hospitals are veryhappy if somebody else will come in and do it.there's†-- there's ways to do things, it's just to get a groupof people together and go for it.just do it. build it and they would come.they'll be there.
and with social media, it's easyto reach out to all the mommies that are out there.>> we're talking about like we just invented this.but the league has been here for over 50 years and that's wheremothers went. >> and the wic program is tryingto compensate for the fact that the league wasn't active in†-->> yeah. yeah.>> a generation ago, i was part of the a group in harrisburg,pennsylvania, of nursing mothers counsellors and we were based atthe harrisburg hospital.
and there were 30 of us.and every month we would take a day, go into the hospital, meetall of the new moms who had said they were planning tobreastfeed. we didn't get to talk the oneswho weren't planning to breastfeed.and then we would make followup phone calls and go visit them ifthey wanted to somebody to help them that way.so there are lots of mechanisms for sort of re-creating all ofthe wonderful stuff that wic has done.>> and breastfeeding usa is out
there.look them up too. >> and there's a new lactationconsultant, a whole new specialty, if you will.and we ought to be working with lactation consultants.we're very fortunate. we have six on our normal birthcenter, we have three more in the nicu.and so†-- >> ideal situation.>> exactly. it all comes.>> uh-huh. >> another question.please comment on how coalitions
can impact formula marketing andthe distribution in physician's offices.>> there's the challenge. >> wow.it's definitely something that we always talk about.we know that in new york city, they†-- you probably all heardabout the latch on campaign†-- i think it was last year or maybethe year before then. >> time flies.>> but the fact that the health department down there realizedthat hospitals were marketing agents for the formula companiesand they asked for voluntary
hospitals to not marketformulas. it was a big bash lash.of course the media latched on to that and called mayorbloomberg the nanny state, et cetera.but really the idea is that hospitals are offering healthcare. they shouldn't be sellingproducts or giving products away.>> free advertising. >> yeah.and we know that now many hospitals are going after babyfriendly status or working on
the ten steps to improve theirbreastfeeding at the hospitals that the formula companies needto go elsewhere to market their stuff.and they're going after pediatric offices, ob-gyn'soffices. >> pediatricians as a group donot take dash them. they've gone to the ob-gynoffices. >> we still hear in ourcommunity that they're getting information from health careproviders about the formulas because we signed up for babypictures or whatever it is in a
magazine.and they have their home address and they have a case on theirdoorstep. >> and we're all up in armsabout what the nsa is finding out about us.but the formula companies have their surveillance teams outthere. >> and the fact that the unitedstates has not signed on to the who code, world healthorganization code of marketing of breast milk statutes, make itreally difficult to have any say in getting rid of thatmarketing.
but there is an organizationwaba.org and there's a national organization that's run by ithink marcia walker. and she takes all these reports.you can look that up online and report the violations of thecode. even though the united states isnot the†-- >> still a national standardthat we're aiming for. >> still educating mothers isone of the tools that i use in my class.we take out a baby magazine and i say, show me the pictures ofbreastfeeding.
every other page is formulas.this is how good they are at getting you to believe thatformula is the norm. >> unfortunately in the unitedstates it's the only large country that did not sign on.>> exactly. >> and the who code says youshall not advertises breast milk substituted much so themagazines that take their ads are breaking the code.>> absolutely. they're on television now.it really is very disheartening. >> here's another kind ofrelated issue.
i'm interested in what you thinkabout the language we use as health care professionals to tryto normalize breastfeeding. talking about it in terms ofbenefits, ideal or optimum, sets the stage that it's somethinghigher than normal. what about your thought, whatabout using the term infant feeding to mean breastfeedingassuming that it's just the way to feed your baby.how can we use language to normalize this.>> i say that's key to what we do, we expect that you willbreastfeed your babies.
and we continue to use thatlanguage, at least in the work that i do.>> i think this is referring to the various written materialsabout the benefits of breastfeeding.there also is the verbiage, what are the risks of notbreastfeeding? and that does change the wholeconcept. >> turns the tables.>> so the cost of not breastfeeding, work out ofharvard have shown that we've safe billions of health caredollars.
but the risk of increasedillness, asthma. >> and iq as the baby grows up.>> turning that message around is so important.when i first started and i did my community resource brochureand we listed some of the benefits.but i also put down that formula use increases the risk of suchand such. i got phone calls from thenurses and hospitals, like, you can can't say that.well, you show me otherwise. it's still in there.now they've come around.
as a matter of fact, thehospital in my community has a wonderful brochure, in englishand spanish, the 14 risks of formula.>> so you actually can do this without saying the word formula,the risk of not breastfeeding. >> >> yes.>> and you haven't insulted anybody.>> or hopefully you haven't. i mean people get so caught upin this or that increases the risk of breastfeeding likeknowing exactly what type of plastic is in the cups you'redrinking water out of.
and, you know, but notbreastfeeding your baby increases the mother's own riskof breast cancer much more than these subtle differences inplastic types. not to dismiss those, by anymeans, because we are exposed to all kinds of chemicals.but one thing that we have control over ourselves isdecisions we make about feeding our babies.and if we choose not to breastfeed our babies, we'reputting ourselves at all kinds of increase the risks as well asputting our babies at higher
risk.>> and there's an article that just came out two days ago, avery definitive article on thousands of children showingthe independent electric wall impact of breastfeeding.>> and that's one of those intergenerational things thatyou can really break the intergenerational cycles ofdisadvantage by giving the babies the best possible startin their†-- >> we're getting more questionsin all the time. we don't have all that manyminutes to go.
any pointer on how to work ondads to become breastfeeding supporters.>> well, actually the fathers that have been in the classesreally bond with each other. there are videos out there thatare specifically aimed at dads and breastfeeding.>> michael jordan was breast-fed for three years.i thought that was a good one. >> well, bill cosby wasbreast-fed also. we tried to get him on one ofour ads about ten years ago when he was dr. huh that by.and he demured.
>> and i think just engaging thefathers and there are models out there, dad's boot camp is one ofthe models. the classes, informationsessions are run by fathers. so they're able to talk to eachother. i've had lots of the fathers whohave said, if you want to me to come back i'll talk about it.and again, it's like peer to peer type of model that worksvery well. and the new york city departmentof mental health as hygiene has published a article that'savailable on their website and
download it.>> i think we only have time for one more question.so apologize†-- apologies to the people who we aren't getting totheir question. how can we improve our†-- andfollow through on becoming breastfeeding friendly?>> if you are the local ibvlc in the area, knock on their doorand offer yourself to do an inservice training for yourstaff. but by the end of it, they getit. they really get it.but they didn't have the
information before.they didn't see the value of it. so it's up to everybody outthere to do that education. >> well, and also to publicizeand congratulate the child care center who do supportbreastfeeding. >> and here the cacfp actuallyhave an award that they designate breastfeedingpractices. >> and on the internet, i thinkyou can find ratings of child care centers so.so the more women realize that and vote with their feet byswitching child care providers
if they have one who is notsupporting breastfeeding, the more people will get themessage. also, from the child carecenters' point of view, emphasizing the huge value interms of keeping babies from getting infectious diseases thatwill spread throughout the center, you would think thatthey would be strong advocates just on that ground alone.>>> so i think that we've reached the end of time.as usual, we're leaving more questions on the line.but i think we got to most of
the important ones.so thank you, stephanie, and ruth warrens for a wonderfulmorning. and thank you in the audiencefor tuning in to this morning's broadcast.we hope you learned a lot about community wide efforts topromote breastfeeding. we know that many of you areinterested in having all of your staff watch this archivedbroadcast at some point. fortunately it's now worldbreastfeeding month. so the broadcast it takes acouple of weeks.
but it will be there in a coupleof weeks. keep your eye on it.and by the end of august, all of your staff ought to be able tosee it. our website iswww.albany.edu/sph.coned. all of our past broadcasts areavailable on the website as well.if if you want more about the workplace or more about familymaternity and parental leaves that we did last year, etcetera, et cetera. we really encourage you to go to that siteto see more of the work we've
done over the years.we hope you'll join us next year.next year i think is the 17 edition of breastfeeding grandrounds. i think we're up to more thanthat, but for the first year it was a live small thing ratherthan this big broadcast. i think we're up to the 17thbroadcast next year. but we're getting close to our20th anniversary. as usual, we will bebroadcasting on the thursday morning for breastfeeding week.next we're that's going to be
august 7th.mark your calendars. we'll start at 8:30 a.m. again.thank you for joining us. and we will see you next year.happy world breastfeeding week. thank you both for being hereand†-- >> thank you.>>†-- and enjoy the rest of the week.\m\m
