Sammy Yolanda Miranda wanted to breast-feed her children because she remembered her mother breast-feeding her younger brother.
That makes her unique in Letcher County, where approximately one-third of new mothers begin breast-feeding in the hospital and many have never seen another woman breast-feed.
August is World Breastfeeding Month, and Kentucky Public Health officials are calling on health professionals, employers, families and others to encourage mothers to breast-feed.
Study after study has shown the advantages of breast-feeding over bottle-feeding, from mitigating babies' colds and diarrhea to more serious diseases such as diabetes, asthma, obesity and even childhood cancers.
Studies have shown that the longer women breast-feed, the more they realize those advantages for their babies and other advantages for themselves.
But Kentucky has a long way to go. According to the Centers for Disease Control and Prevention, less than half of Kentucky mothers ever breast-fed, even once, in 2005.
Of the 50 states and the District of Columbia, only Louisiana has a lower rate of breast-feeding initiation.
Nationally, 74 percent of women ever breast-fed their babies in 2005.
Kentucky falls at the bottom of the list for other measures, too. After six months, the minimum amount of time that health professionals recommend breast-feeding exclusively, less than a quarter of Kentucky moms breast-fed at all. Even fewer — 5.9 percent, according to the CDC's 2008 report card on breast-feeding — breast-fed exclusively.
Rural areas worse
Breast-feeding initiation rates are higher in Kentucky's metro areas. In 2006, Fayette County had an initiation rate of 72 percent, the highest in Kentucky, according to the Kentucky Department of Public Health.
Eastern Kentucky, where Miranda lives, has some of the lowest breast-feeding initiation rates in the state. In Knott County, less than 20 percent of women initiated in the hospital.
The area doesn't have a La Leche League chapter, a group that supports nursing mothers, and the hospitals don't have certified lactation consultants, said Alice Caudill, director of nutrition services for the Kentucky River District Health Department.
In addition, it's harder to find breast-feeding supplies.
The one resource for nursing women is a health department program aimed at participants in the government's Women, Infants and Children program.
Melody Claussen is a peer-to-peer counselor, a woman who breast-fed her children while on WIC and now helps other moms. She talks to expectant moms about the benefits of breast-feeding. Many are unfamiliar with it.
”I feel like I am selling a new product that people have never heard of,“ Claussen said.
When Miranda, the Letcher County mom, first came to the support group that Claussen runs, she didn't breast-feed in public, even in front of other women.
Miranda crouched in bathroom stalls to nurse or surrounded herself with receiving blankets in her truck.
The group helped her continue breast-feeding when she had difficulties from an infection, and it also helped her become comfortable in public.
She now breast-feeds wherever she needs to and especially in front of other women.
”I've nursed on TV,“ Miranda said. ”The preacher, everybody's seen me.“
Usually within a week of birth, more than half of the women who begin breast-feeding introduce some formula, said Jacqueline Wolf, a professor of social medicine at Ohio University.
”We really are a formula-feeding culture,“ she said.
That culture dates back to the late 1800s, when large numbers of women began supplementing their own milk with cow's milk in order to wean their children by three months.
Today women have an array of formula choices. But despite the advances in its production, it isn't the same as breast milk, Wolf said.
Wolf argues that formula-fed babies have changed society's view of what a normal, healthy baby is — because formula-fed babies get sick more often and have more serious illnesses than breast-fed babies.
”Formula is not the normal way to feed babies but really a very inferior way,“ Wolf said.
But breast-feeding is not always easy, especially at the beginning. New moms need encouragement, said Doraine Bailey, the breast-feeding support services coordinator for the Lexington-Fayette County Health Department.
”If they're not breast-feeding in the hospital, it's highly unlikely they're going to go home and start breast-feeding,“ Bailey said.
Nurses and doctors should encourage breast-feeding, and hospitals should have policies to keep babies in the room with new mothers and to prevent breast-fed babies from being giving formula, sugar water or even a pacifier, Bailey said.
At St. Joseph East, the hospital with the highest rates of breast-feeding initiation in the state, nurses and lactation consultants help new moms through the first few days, when a sleepy baby can make nursing difficult.
”You have to help mom not to get frustrated with what is normal,“ said Joan Morrin, the nursing supervisor there.
All of Lexington's birthing hospitals have high rates of initiation. At St. Joseph East, 72 percent of women initiated breast-feeding in 2006, according to the Kentucky Department for Public Health. At the University of Kentucky Hospital, 70 percent of women initiated, making it fourth in the state. At Central Baptist Hospital, 67 percent initiated, placing it fifth.
Once they get home, women need the support of their families and other breast-feeding women.
If the grandmother bottle-fed, then she has to be convinced of the benefits of breast-feeding, said Susan Stapleton, director of the midwifery faculty practice at the Frontier Nursing Service in Leslie County.
The grandmother and other relatives have the most impact once the mother goes home, Stapleton said.
The work challenge
If women make it through the first few weeks of breast-feeding, the next drop-off is when they return to work or school.
As part of the WIC program, Bailey gives away breast pumps. But she often has to talk to employers to convince them to give women time and a place to pump.
Employers often don't understand how important breast milk is for babies, said Becky Derifield, breast-feeding promotion coordinator for the Cabinet for Health and Family Services.
”They think it's just a fluff rather than an important part of a baby's life and a mom's life,“ Derifield said.