Whether a mother breast-feeds exclusively during the first two days of her baby's life largely depends on the hospital in which she gives birth.
A review by this newspaper of data from the California Department of Public Health's newborn-screening program shows that in some hospitals -- such as Kaiser Oakland -- more than 90 percent of new moms breast-feed without giving their infants any baby formula. In some California hospitals, however, that figure is less than 10 percent -- despite decades of evidence showing the benefits of feeding newborns only breast milk.
"We would like to think that all hospitals should function exactly the same way and provide exactly the same care no matter where they are in California," said Diana Mahar, the Northern California breast-feeding coordinator for the American Academy of Pediatrics. "However, our hospitals are unique, just like our communities."
In an attempt to close the gaps between hospitals, a new state law will take effect in January requiring hospitals to have an infant feeding policy in place that encourages exclusive breast-feeding. The bill, SB502, authored by Sens. Fran Pavley, D-Santa Monica, and Kevin de León, D-Los Angeles, was signed by Gov. Jerry Brown in 2011.
Breast-feeding supporters agree that hospitals with the highest rates have strong policies that extend beyond lactation consultants to nurses and doctors, often treating women with a "tough love" approach. Those with more average rates seem to apply their breast-feeding messages less consistently, with some nurses opting to pacify tired mothers and infants rather than sticking firmly to a breast-feeding plan.
A few others are stuck decades in the past, feeding formula to more than 90 percent of the infants in their care. The state average for exclusive breast-feeding rates in hospitals is 60 percent, although the average in most Bay Area counties exceeds 70 percent.
One major hurdle is that breast-feeding doesn't come easy for many women, especially during the first couple of days after birth, when women produce small amounts of colostrum, rather than full-fledged milk. A golden elixir packed with factors that prime the infant digestive tract and boost immunity to germs, colostrum comes out in a few precious drops per feeding. So infants who don't receive a supplement lose an average of 6 percent of their birth weight during the first few days of life.
The weight loss is normal, but it's easy for mothers to worry that their babies aren't getting enough milk. To make matters worse, a "poor latch" can lead to scabby, raw nipples and excruciating pain. Combine all of these factors with the exhaustion from labor or a C-section, and the challenges can often seem daunting.
"Sometimes in the first few days it is very difficult for moms," Mahar said. "They're tired; they may have difficulty with the baby latching on well and getting milk. But we know that if we can provide them with support and let them know how normal that is, often things get better within the first week or so."
Studies also show that the more in-hospital support a new woman gets, the greater the chance a mother will exclusively breast-feed after she brings her baby home.
So far, 59 California hospitals have earned the World Health Organization's "Baby-Friendly" designation, which means the hospital follows 10 important steps to support exclusive breast-feeding. These include the promotion of skin-to-skin contact between mother and baby, allowing the mother and baby to room together, and having a highly trained breast-feeding support staff.
El Camino Hospital in Mountain View is listed as having a 97.4 percent exclusive breast-feeding rate in 2011 -- the last year for which statistics were available. But according to nurse Kim Forsberg, who manages the mother-baby care program at El Camino, the actual number is 62 percent. The hospital had erroneously entered the number of women who intended to exclusively breast-feed, rather than those who actually did.
The blooper, however, provided an interesting new statistic: About a third of moms who planned to exclusively breast-feed ended up feeding their infants formula before leaving the hospital.
Forsberg said exhausted moms stressed by screaming infants often ask for formula. "And the answer will sometimes be, 'Yes, you can give the baby a bottle if it will not settle down,'" she said.
She said she sees the value of exclusive breast-feeding, but she also values the autonomy that mothers, nurses and doctors have to decide when a baby should receive formula.
She voiced concern about the lack of available formula at Baby-Friendly hospitals, where it's kept "under lock and key" and only accessible by pediatricians when it's deemed medically necessary. "We have a little more latitude for the nursing staff to decide," she said.
But Melisa Nuñez, a Santa Clara computer engineer who recently gave birth to her second child at El Camino, thinks that kind of flexibility can confuse new mothers, especially those who don't have education or experience with breast-feeding.
"Most of the mother-baby nurses are great, but they don't give all the same advice for breast-feeding," said Nuñez, who volunteers as a breast-feeding counselor. "One nurse will tell you this; the other will tell you that. And they're all well-meaning. But by the time you come home, you're not sure what to do."
Kaiser Permanente hospitals take up three of the top 10 spots for rates of exclusive breast-feeding in California, and all Kaiser hospitals are above average. At Kaiser Oakland, 95 percent of new moms breast-fed exclusively in 2011. According to Dr. Amanda Calhoun, director of maternity services for Kaiser Permanente East Bay, the key to their success is educating all doctors and nurses in breast-feeding support, so that even if a lactation consultant isn't around, new mothers can always get help.
Although Kaiser Oakland isn't officially Baby-Friendly because of the administrative costs associated with the review process, Calhoun said they adhere to all of the initiative's criteria. One of these criteria -- keeping formula out of the reach of nurses without a doctor's permission -- has worked wonders for promoting breast-feeding, said Calhoun, who doesn't share Forsberg's concerns about restricting the latitude of nurses.
"I'm a big believer in autonomy," Calhoun said. "But I think that the need for success in breast-feeding supersedes that."