Investigate This! Investigative Journalism With Alex Roslin: Finding the Right Formula for Nursing

Just three per cent of Quebec mothers breastfeed exclusively until their babies are 6 months old, statistics show. A big part of the problem, says one mom, is the difficulty and cost of finding medical professionals who offer support.

Alex Roslin

The Montreal Gazette, Saturday, October 4, 2008

When Marie-Andrée Bossé had her first baby in 2005, she was all set to breastfeed. She knew breastmilk was the best food for her child.

But she soon started to feel pain and burning sensations during breastfeeding sessions. She consulted a long list of medical professionals—CLSC and hospital nurses and several private lactation consultants—but the problems only got worse.

Soon, there was intense pain in her breasts even when she wasn’t breastfeeding. She was advised to change how the baby latched onto her breast, but the changes helped only a little.

Adding to the pain, she learned she had contracted a host of breastfeeding-related illnesses with strange names she had never heard of before: candidiasis of the nipple, vasospasms and something called bleb—painful blisters around the nipples.

Still, Bossé, a sexology instructor at the University of Quebec in Montreal, insisted on breastfeeding. It was three months before the pain and ailments finally went away with the help of lactation consultants, who showed her how to improve her baby’s latch, and a sympathetic doctor who prescribed medications.

A big part of the problem, she said, was the difficulty in finding medical professionals specialized in breastfeeding issues and the cost of the help. She estimates her expenses for the consultations and drugs at $400 to $500.

“My problems required specialized expertise, and it’s very hard to find those services. That’s why most mothers stop breastfeeding when they encounter problems,” she said.

Breastfeeding experts say Bossé’s story is common and a key reason why, according to a 2006 study by the Quebec government’s statistics institute, just three percent of Quebec moms breastfeed their babies exclusively until they’re six months old. That’s the period of time recommended by Health Canada and the World Health Organization.

Seven years after Quebec adopted one of Canada’s most ambitious policies to promote breastfeeding, the province still has one of the lowest rates of sustained breastfeeding in the country.

For comparison, 19 percent of mothers Canada-wide breastfeed exclusively until six months; in Sweden, the rate is 70 percent.

Now, health officials are reviewing the province’s breastfeeding policy and trying to figure out the reasons for the glacial progress.

The problem, say breastfeeding experts, is that while most Quebec women start out breastfeeding their babies, health professionals are failing to provide proper support and advice when women encounter problems like a bad latch, soreness or poor milk supply.

That, coupled with abundant supplies of infant formula that companies give for free to most Quebec hospitals, makes it hard for women to keep breastfeeding when they encounter problems, said Howard Mitnick, a family doctor at the Jewish General Hospital’s Goldfarb Breast-Feeding Clinic.

“We live in a world where people don’t see breastfeeding and don’t know what it looks like. They have a baby and are suddenly expected to be experts, and people are not around to help them,” he said.

The stakes in the battle over the breast are huge. Research shows breastfed babies have fewer ear and respiratory infections, reduced allergies and diarrhea, a stronger immune system, higher IQ, less risk of diabetes later in life, better development of speech, jaw muscles and baby teeth, and better bonding with mom.

Mothers also benefit by losing weight quicker, experiencing faster contraction of the uterus and having lower risk of osteoporosis and ovarian and breast cancers.

In some cases, research shows breastfeeding is literally a life-and-death issue. A May 2004 U.S. study of 9,900 infants published in the journal Pediatrics found a 27-percent higher chance of death among kids who had never been breastfed compared to those who had, including a 19-percent greater risk of sudden infant death syndrome and 69 percent more chance of death by injury.

“Promoting breastfeeding has the potential to save or delay approximately 720 post-neonatal deaths in the United States each year,” the study said.

The poor situation in Quebec is especially ironic because it was the first Canadian province to officially mandate in 2001 that its hospitals and CLSCs get certified under an international pro-breastfeeding program called the Baby Friendly Initiative.

The initiative, created by the World Health Organization, sets out 10 measures for hospitals to adopt to encourage breastfeeding.

They include training for maternity-ward nurses and doctors, better education on breastfeeding techniques for moms and reduced reliance on formula.

The Quebec government set a target of having 20 hospitals and 40 CLSCs certified as Baby Friendly by 2007, as well as 75 percent of moms breastfeeding exclusively at birth—meaning no infant formula, water or other food—and 10 percent doing so at six months.

Quebec has fallen well short of those goals. Just 13 Quebec hospitals and CLSCs are now Baby Friendly, while only half of moms breastfeed exclusively at birth and just three percent do so at six months.

The failed targets don’t come as a big surprise to Mitnick. He said the province has devoted few funds to train medical staff on breastfeeding techniques, provide more breastfeeding education to parents, create more free lactation clinics or reduce reliance of formula in hospitals.

“The more money the health system puts into breastfeeding, the more money it saves through reduced hospital re-admissions, infections and malnutrition,” he said.

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Why do so many moms stop breastfeeding early on? A study of Quebec moms in August found the main reasons for giving up are latching problems, pain and poor milk supply.

Most of these problems can be resolved with some expert help, said Louisa Ciofani, a lactation consultant at Royal Victoria Hospital.

Just three percent of moms actually can’t produce enough milk to breastfeed their babies exclusively, usually due to damage to the breast from cancer, burns or surgery, Ciofani said. But even these women can still usually breastfeed to some extent. Less than one percent of women can’t breastfeed at all, she said.

Long ago, it used to be that new moms got help for breastfeeding problems from their mothers, aunts and grandmothers. But after infant formula companies started touting their product as being as good as breastmilk in the 1950s—a belief that numerous studies have since discredited—several generations of women lost that knowledge.

Today, most women must rely on doctors and nurses for help. But few of those professionals have taken the 20-hour training course on breastfeeding that the WHO recommends for maternity-ward staff, Mitnick said.

“People (in hospitals) don’t have the skill set,” he said.

Without help from experts, many breastfeeding moms end up giving up, said Carole Dobrich, a lactation consultant at Mitnick’s clinic and president of the Quebec Association of Lactation Consultants.

“Mothers who are well-supported can get through it, but you have to have that support,” she said.

Tammy Sawyer, a registered massage therapist in Montreal, said she encountered unhelpful hospital staff when she gave birth to her daughter Sophie in August. Her daughter was born with a cleft lip and palate, and medical staff told her to avoid breastfeeding because they believed her baby wouldn’t be able to suck well.

“They said my baby was pretty much going to starve if I breastfed,” Sawyer said.

She said hospital staff advised her use to a pump to manually extract breastmilk, but didn’t show her how to use one.

She later discovered Mitnick’s clinic, where she learned how to breastfeed her baby successfully. She said Sophie is now growing nicely.

Dobrich said hospital staff are often too overworked to teach moms breastfeeding techniques. The result: infant formula is often seen as a quick-fix to feeding problems, she said.

“The quick answer is, ‘Let’s give mom formula because we don’t have time to teach her,’” she said.

Provincial government statistics show half of moms who breastfeed while in hospital are not doing so exclusively and are being given formula to supplement their babies.

The problem is early use of formula can disrupt the establishment of breastfeeding and, later, make it harder for moms to stick with it when they encounter problems or one too many sleepless night, Dobrich said.

The high rate of formula supplementation in hospitals runs counter to WHO guidelines on breastfeeding. The WHO says formula should be used only in cases of dire medical necessity, such as when babies or their mothers are severely ill or the baby has birth weight under 1.5 kilos.

Dobrich said the WHO guidelines are routinely flouted. Mitnick said Quebec hospitals also accept free formula from companies in violation of the WHO guidelines, which call on hospitals to pay at least 80 percent of the market price.

What’s wrong with hospitals accepting free formula? If it’s free, staff hand it out too readily, Mitnick said. “The more formula that’s around, the more it’s going to leak into the maternity rooms.”

And the province’s support for breastfeeding may soon actually diminish, said Isabelle Cloutier, president of the Nourri-Source Federation, a group of volunteers who help moms with breastfeeding problems. She said proposed government cuts to prenatal education classes will make it even harder for mothers to get breastfeeding information.

“We need the will and the cash to change practices,” she said.

Oct. 1 to 7 is breastfeeding week in North America and will be marked with a world-wide "breastfeeding challenge" on Saturday, Oct. 11, when organizers are trying to get the most women possible to come together to breastfeed at one time. In Montreal, last year's winning city with the most moms participating, there are 10 locations this year, including the Palais des Congrès, where the breast-in starts at 11 a.m. For more information and registration, visit Babyfriendly.ca.