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Stanford Report, January 29, 2003

Packard program addresses science of breast-feeding

By KRISTA CONGER

How many of us avert our eyes and stumble in our conversations when a new mom lifts her shirt to feed her baby? A confident mother convinced of the benefits of breast milk may overlook embarrassed reactions from her peers. But when awkwardness sidles into a woman’s interaction with her health-care team, it can have devastating results.

Without adequate support immediately after birth, most women forgo breast-feeding altogether or quit within days of leaving the hospital.

"Breast-feeding can be very difficult," said Jane Morton, MD. "In our country we have skipped generations of breast-feeding, and most of us have never gotten our noses 6 inches away and watched. It’s so much easier to see the milk in a bottle and give it to the baby."

Jane Morton will promote the benefits of breast-feeding to health-care providers in her new role leading Lucile Packard Children’s Hospital’s Johnson Center’s Breastfeeding Medicine Program. PHOTO: KRISTA CONGER

Morton, newly arrived from the Palo Alto Medical Foundation, is spearheading Lucile Packard Children’s Hospital’s Johnson Center’s Breastfeeding Medicine Program — a unique effort to increase rates of breast-feeding in full-term and premature infants delivered at Packard and its satellite nurseries. The effort requires bridging obstetric and pediatric care, pre- and postnatal care, and maternal and infant care.

"Issues of breast-feeding fall into several different specialties, and advice and care can be confusing and inconsistent," said Morton. "It’s easy for everyone to assume it is someone else’s responsibility."

Morton’s plan to garner more support for breast-feeding among obstetrics and pediatric staff will complement the efforts of the hospital’s seven lactation consultants, who are dedicated to helping new mothers learn to breast-feed effectively.

"This is an important part of the range of services that we provide for moms and their babies," said David Stevenson, MD, the Harold K. Faber Professor of Pediatrics and professor, by courtesy, of obstetrics and gynecology. "We’ve had a lactation program, but we’ve not had a complementary piece on the physician side that would further facilitate their efforts."

Morton plans ongoing in-service education about the benefits of breast-feeding, the physiology of breast-feeding and the composition of breast milk. She’ll also address how to manage breast-feeding in infants or mothers with special medical concerns. Common problems such as impaired milk production or problems with latching on will also be reviewed.

The benefits of breast-feeding are legion, including speeding mom’s recovery after birth, boosting the newborn’s immunity and enhancing the bond between mother and child. But many mothers who attempt breast-feeding are discouraged by a real or perceived inadequacy in their milk supply or the sore nipples that often plague first-timers.

The stakes are higher and the challenges greater for premature babies. Breast milk is more effective than formula at protecting a tiny baby from life-threatening necrotizing enterocolitis, or sepsis. Studies have also shown improved neurocognitive development and decreased length of hospitalization for babies who receive human milk.

But the bulky equipment that keeps these tiny babies alive, along with physical problems linked to prematurity, may hinder traditional breast-feeding. Mothers must depend on breast pumps to express milk, which is then fed to their infants through small tubes leading from their nose to their stomach. Transitioning from tube feedings to the breast can be difficult yet critical to the infant’s long-term health.

"We want to help mothers do what’s natural and best for babies," said Stevenson. "Jane is probably one of the best people in the world in helping women establish breast-feeding in circumstances that would almost certainly lead to failure"

Morton established her reputation as a breast-feeding expert during her 20 years as a community pediatrician at the Palo Alto Medical Foundation, teaching Stanford students and consulting with physicians on breast-feeding support issues. She’s enthusiastic about the opportunities of her new position.

"It is unique of Packard to be so visionary," said Morton, pointing out that her physician colleagues in the Academy of Breastfeeding Medicine invariably juggle other jobs in addition to their efforts to promote and aid lactation. "My primary responsibility here is to develop a successful program. I’ve been sort of a nut case about breast-feeding for a long time, but previously I was primarily a general pediatrician with a passionate interest in breast-feeding. Now I feel like Henry Higgins in ‘My Fair Lady,’ who said, ‘It’s a rare fellow who is lucky enough to have his passion as his profession.’ "




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Lucile Packard Children’s Hospital