The Medical Minute: Helping moms, babies with breastfeeding takes families, communities

When she was a medical student, Dr. Madie Hartman had to take a crash course in hiding in plain sight.

Hartman was seven months pregnant with her first child when she started medical school. Eight days after she had her daughter, she returned to class, where she had to keep herself covered while she “literally nursed her with one arm and took notes with the other.”

She’d seen her mom nurse her little brother and knew it was important.

Eventually, she needed to pump her breast milk, and for that she needed a private room with a power outlet. After an embarrassing moment with a professor who found her taking care of it in the only room available ― the professor’s vacant office ― she wound up in a supply room, surrounded by cardboard boxes.

Hartman’s story is one of millions of combat tales in a war over accommodations. Businesses don’t always offer new moms enough time off after they have their babies or space for them to breastfeed. Many mothers are faced with economic and social hardships that make those crucial first moments difficult if not impossible.

And these are battles with broad implications. Today, Hartman is a family physician focusing on women’s health at Penn State Heath Medical Group ― Middletown and a member of the Department of Family and Community Medicine’s obstetrics core faculty at Penn State College of Medicine. Every day, she tells her patients and students why breastfeeding is worth protecting. It can transmit immunity from disease between mother and child, provides optimal nutrition and lowers the risk of infant mortality. Studies have shown it can lower cancer rates, blood pressure and the risk of diabetes in new mothers, said Amy Wagner, lead lactation consultant in the Women and Babies Center at Penn State Health Milton S. Hershey Medical Center.

However, a significant portion of Black women in the U.S. don’t breastfeed their newborns. A 2021 study from the U.S. Centers for Disease Control and Prevention determined that 84% of all mothers in the nation breastfeed their babies. But among Black mothers, the number falls to 74.5%, which was the lowest of any racial group. The discrepancy can be linked to higher mortality rates among Black babies and higher rates of upper respiratory illnesses and other diseases.

That’s why nine years ago a group of women designated one week each year ― in 2024 it’s Aug. 25 to 31 ― Black Breastfeeding Week. For the thousands of women opting not to breastfeed their child, advocates want to be sure they know what they’re missing.

Why is breastfeeding so important?

Along with the nutrients an infant needs after birth, a mother can transmit antibodies to the baby through her milk, Wagner said. “It helps the baby fight disease,” she said. “A lot of people call it the baby’s first immunization.”

Through breastfeeding and touch, “The mother synchronizes her immune system to whatever bacteria is colonizing in the baby,” Wagner said. “She will build antibodies to the bacteria on that baby, and those antibodies or immune cells then pass through her milk to protect the baby.”

Wagner said breastfeeding leads to long-term benefits for the baby, too, and can result in fewer cases of:

• Asthma
• Obesity
• Diabetes
• Respiratory infections
• Sudden infant death syndrome
• Gastrointestinal disorders

That’s a lot of benefit for no cost, Hartman said. “Breast milk is the best we’ve got,” Hartman said. “It’s not just perfect nutrition for baby, it’s readily available. I always joke with my patients and say, ‘It’s always on tap.’ And you don’t have to warm it up.”

Who shouldn’t nurse their child? Is there anyone for whom breastfeeding is dangerous?

“It’s very, very rare” for someone not to be able to breastfeed for medical reasons, Wagner said.

The National Institutes of Health lists illnesses, drugs and conditions you should discuss with a provider before breastfeeding. But for most people, dangers are few.

Hartman usually recommends it for everyone who doesn’t fit one of the criteria. On occasion, she has a patient who is so opposed to breastfeeding she suggests formula.

So, why doesn’t every woman breastfeed? And why do fewer Black women opt to?

Just after World War II, several businesses launched aggressive marketing campaigns pushing lab-created formulas as a safer alternative to breastfeeding.

Today, experts generally agree the benefits of breast milk make it far and away the healthier alternative to formula. Still, the old marketing messages have a hold on some people’s preferences, Wagner said.

Some experts suggest that abandoning breast milk for formula can be linked to childhood obesity epidemics and other surges in health problems, Wagner said. But the use of formula has become a time-honored tradition for some families ― mothers following daughters down through the years, Hartman said.

Other reasons formula persists:

• Misconceptions. Some women are convinced breastfeeding hurts. It doesn’t, Wagner said. If it’s painful, often the problem is the position of the baby. Some women are convinced that if they have small breasts, they won’t have enough milk for their baby. Also, not true.
• Socioeconomic disadvantages. Access to care is of concern for many, particularly in the Black community, Hartman said. “They’re thinking breastfeeding is going to be super easy, when it’s a process,” she said. You need to learn breastfeed properly, and learning often requires help from a lactation expert or a doctor to talk about how it works. Similarly, many lower-income jobs don’t offer enough time off or the right accommodations to wet-nurse.
• Perceptions. “Unfortunately, a lot of my moms are dealing with the sexualization of breasts,” Hartman said. “They feel like they’re for Victoria’s Secret. I have to remind them that’s kind of what breasts are for.”

Where can I turn for help with breastfeeding?

Hospitals and lactation consultants offer a variety of resources to help new and expectant mothers. Penn State Health, for example, offers a warm line – 717-531-MILK. Lactation consultants have access to translation assistance so they can speak with people in a variety of languages, Wagner said.

Consultants like Wagner are specially trained to advise mothers about how to breastfeed. They meet with patients via one-on-one appointments. Mothers can also take classes or meet in support groups.

“We’re trying to be more readily accessible,” she said.

Addressing the problem of health disparities for the Black community, “does not start and end with breastfeeding,” Hartman said. “It starts and ends with equity in health care.”

A community approach is needed, Hartman said, a support system for mothers that emphasizes the importance of creating the healthiest of situations for them and their babies.

As a first-time mom, Hartman understood the importance of breastfeeding her own children because it was important to her mother. And feeding her baby was hard, but eventually the college began to make accommodations for her after understanding firsthand what was needed.

“We need to be getting families and communities involved and realize that they are huge parts of the decision-making process when it comes to how a woman chooses to feed her baby,” she said. “That’s where we start. And that’s where we should continue, and that’s where it should end.”

Related content:

• The Medical Minute: A new or expectant mother’s guide to breastfeeding
• The Medical Minute: Want to breastfeed successfully? Turn to a lactation consultant

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.