Editor's note: This is the second in a three-part series. Here's part one and here's part three.
Joining us for more on the disparities between breast-feeding rates between rich and poor women is Robin Kaplan, president, San Diego Breastfeeding Center Foundation . Robin, welcome to the program. You run a business that provides lactation consultation services but you also started a nonprofit what was the reason for starting a nonprofit. So I've had my business for about seven years now, which is the Sunday goat breast-feeding center. What I've noticed over the past years is that many women have been calling. We get about 60 to 100 women a month and what I was finding is that about 10 to 15 a month would call and they would not see consultation that they needed because they could not afford it. They heard that the affordable care act was supposed to cover these types of consultation so that meant that their OB/GYN and pediatricians were all telling them that they could get these consultations but unfortunately when they called, they found that their insurance or their benefits would it be covered and they were not able to get the support that they needed because of financial barriers. So that was one of the reasons that after a couple of years my heart was going out to them. I could not imagine that they were all being able to meet their personal breast-feeding goals because of financial restraints. So this year in March, we started the San Diego breast-feeding Center foundation and what it does is it subsidizes the consultations for low income women so that way they can receive the support that they need, but if it's well within their price range to be able to get that support. Robin, tell us the things that lactation consultants do. There are lots of free groups out there and what they work on is the more general. So latching, positioning and basic questions. A consultant they look at the more medical side of it. So we are dealing with mothers with low milk supply and babies who have some suck dysfunction or babies who have tethered oral tissue and their tongues are not able to remove milk from the mother's breast. So these women while they do benefit from the free support and the mother to mother support that we are getting from these groups and they need someone to take a look at their personal situation and craft a personalized plan of care for them as well as followed them along until we are able to figure out what is going on. So that is the difference between -- and what we provide as lactation consultants. Besides what you just talked about do the mothers you consult with talk about sort of external problems they encounter with breast-feeding like perhaps lack of sleep? Sure. Although honestly any parent that has a new baby whether they are breast-feeding or bottlefeeding are going to have a lack of sleep. The women that we work with especially are low income women they do have additional barriers. Sometimes it depends on they have to return to work more quickly because they cannot live on their unpaid maternity leave. There are additional challenges with returning to work especially if bosses are not supportive. Those are some things that Dasha depends on family support, community support, how much education they have. Those can also be barriers when trying to meet breast-feeding goals. What advice to get to try to lessen those pressures that those women are feeling? Well, I think if anything getting breast-feeding off to the best start possible and getting all of the wonderful support that they can get from consultants in the hospital and then following up with these free breast-feeding support groups and also with following up with us if it is something where they really do need a personalized plan of care to really overcome their breast-feeding challenges because transitioning back to work and dealing with family members who may not be super supportive or employers is a lot easier to deal with when breast-feeding is going easily so it's much easier to keep up and there's a lot less stress around it and so really getting the most assistance and the most support possible in that first month or so can really change the trajectory of how long a woman will breast-feed for. There are women who say they kind of feel bullied about breast-feeding. Some studies indicate the benefits of breast-feeding might be overrated. I'm wondering to work with your clients no matter what their income to discover actually what's right for them and their babies? Our main motto at the center is that we provide nonjudgmental breast-feeding support. So from others who come in and they want to exclusively breast-feed, we are here to help. For mothers that come in and they want to combo feed, we are here from them. For moms who want to just exclusively pump and not put baby to breast, we are here for them. There is enough judgment that we get as moms and to add breast-feeding into the makes -- makes there so much judgment and mommy wards test wars going on. Asked the mom what their goal is and help her meet that personal goal. We are not trying to make her do what we think or what society thinks, it is what she want to do and then help her reach that. I've been speaking with Robin Kaplan, president, San Diego Breastfeeding Center Foundation . Robin, thank you. Think you so much for having me. -- Thank you so much for having me.
At a prenatal yoga class in San Marcos, Lisa Bandong takes her students through their poses.
“Good! I see shoulders trying to relax down, beautiful," she said.
As Bandong walks around the room, she glances at each student, and offers some corrections. Then she addresses the whole class.
"One more full breath like this, sending in love, love, love into your baby, baby’s receiving it, and he’s saying ‘Mama, I want peace in the world,’ sending out peace with the exhale.”
Some of these women are ready to give birth any day.
It's harder than it looks
Pricila Marquez had her son, Axel, a couple of months ago. She likes staying connected with her yoga friends. Marquez has been telling them about her challenges with breastfeeding.
“It’s a lot more difficult than what it looks like," she said. "I mean, you see women just breastfeeding everywhere. I have more respect for them now, because it takes a lot from your body, your mind, physically and emotionally as well, too.”
Before the advent of formula, virtually all girls grew up seeing mothers breastfeed their babies.
No longer a breast-feeding culture
Lactation consultant Vicki Wolfrum, who died in October, said we no longer live in a breastfeeding culture.
“Most young women giving birth today have only seen bottle-feeding," she said. "And they only know about schedules, and they really don’t know what normal, natural, instinctual breast-feeding looks like.”
That’s why many new moms need help with breast-feeding.
Carolina Alban-Stoughton, who gave birth to her son, Kai, earlier this year, said she couldn’t have breastfed her baby without it.
“You really need guidance. You really need someone to walk you through it, and there’s really a science behind it,” she said.
Hospital staff typically provide the kind of hands-on assistance that new moms need.
Stephanie Jardin, who recently gave birth to her second child, remembered learning some techniques, but they just didn’t take.
“They give you all the basics, right from the get go, but you’re just kind of overwhelmed that just you just brought life into the world, that it’s kind of in one ear, and out the other," she said.
For new moms who still need help with breast-feeding after they go home, there are support groups and lactation consultants.
Socioeconomic barriers
Those resources are easier to find in affluent parts of the county like La Jolla and Encinitas. They’re much harder to come by in poorer areas like Barrio Logan and Southeast San Diego.
Women who live in these areas face other barriers to breastfeeding, said Dr. Yelennia Palacios, a medical resident at the San Ysidro Health Center.
“Here, in our community, the women may be more likely to be single mothers, they may not have family as readily available to help. And they may have to go (back) to work earlier than others, too," Palacios said.
At their main clinic in Chula Vista, Palacios and other staff have created a support group for new moms.
Creating supports to encourage breastfeeding
On a weekday morning, Mayra Moreno comes in with her three-month-old daughter, Ambar. She tells Palacios how things are going.
“At first, I had to combine breast-feeding with formula," she said. "Lately, when I’m on the run, I’ll give her a couple of ounces of formula. But other than that, I’m breastfeeding exclusively now.”
When Moreno came home from the hospital, she wasn’t totally comfortable with breastfeeding. Luckily, she got some help from Layla Fitzhugh, the Health Center’s in-house lactation consultant.
Fitzhugh uses a puppet and a mock breast to show new moms how to position their babies.
“You want the baby to latch well onto the nipple, and have the bottom lip out," she said, as she worked with the puppet. "And so, I just have some visual aids so that people can understand that it may be uncomfortable for them. But you’ll work out the kinks, and be on your way.”
Palacios said not all women are familiar with the health benefits of breastfeeding. And for new moms who are feeling overwhelmed and uncomfortable with breastfeeding, the ease of formula can be hard to resist.
Even so, Palacios said it’s important to keep a couple of things in mind.
“Every woman wants the best for their child. And it’s not that Latina women don’t want to breast-feed, it’s just there are barriers," she said. "We need to help, and alleviate those barriers, so that we can be up to par with the other communities.”
