Breastfeeding for Two Years? Updates!

The June 2022 AAP policy about breastfeeding sure made some headlines. The issue was the AAP recommendation that babies receive breast milk for two years. Two years? Is this putting pressure on mothers/women to do more?

The current policy statement titled “Breastfeeding and the Use of Human Milk” promotes breastfeeding, pumping and providing donor human milk. Research continues to confirm the benefits of micronutrients for the gut microbiome, brain and body growth. It is beneficial for preterm, full term, medically fragile babies and for toddlers. That is not in dispute.

Providing human breast milk influences long term health. The longer a child receives breast milk, the longer the benefits last. That is why the AAP recommends providing breast milk for six months, even two years (“as is mutually comfortable for mother and child.” ) It’s the issue of two years. That’s a lot to recommend, or ask, if there is little support for lactation. When we recognize how important this is, the real question is:

How do we help families to start and continue to provide breast milk?

At all points in their care, families need accurate, consistent information. To be honest, there are plenty of gaps when families receive little or incorrect guidance. When giving birth, some hospital policies may interfere with early breastfeeding. Back at home, getting follow up support is often difficult. When a parent returns to work there are challenges to continuing to pump. We need to enact proactive policies so families get what they need to start and continue. Fortunately, there are some strategies that do work and are in place, at least, in a few places. Here are some guidelines:

More hospitals designated ‘Baby Friendly’ . These are hospitals that follow specific protocols, the Ten Steps to Baby Friendly. That begins with providing prenatal education, immediate skin-to-skin contact, rooming in,  informed support for breastfeeding at the hospital and resources within the community. This is a  necessary approach that,  hopefully, avoid gaps in education and care.

• UPDATE: Paid Family Leave  makes a significant difference to the whole family, not just for breastfeeding. Families need time to care and to adjust to changes (illness birth, adoption, etc. ) Thankfully, here in Maine, Governor Mills signed Paid Family and Medical Leave into law in 2023.  This will start in 2026. It provides for 12 weeks of paid time off.  For eligible workers in the private and public sector, this includes a new baby as well as illness, caring for a relative and other family and medical concerns. Check out the maine.gov site for specific, current information.

• UPDATE: The P.U.M.P Act (Providing Urgent Maternal Protections) was signed into law and went into effect on December 29, 2022.This requires employers across the nation to provide clean, private non-bathroom pumping spaces and reasonable break time for pumping during the work day. The Maine State Breastfeeding Coalition has a helpful ToolKit for parents returning to work and continuing to pump.

• Insurance coverage of IBCLC visits for all subscribers. Many private insurance will cover IBCLC consultations. Check with your insurance. All families, high, medium and low income, need to have IBCLC care covered.*  Coverage means there is no out-of-pocket cost for the family. Reimbursement is a barrier to care. It means a family has to pay first then wait for reimbursement.

For IBCLC office visits with me at Anchored Women’s Health, there are several insurance plans that are accepted. Families with MaineCare can have unlimited office visits for IBCLC support.

The question has been, does this recommendation of two years put the pressure on women and mothers? The AAP policy states that Pediatricians can play an important role in leading and advocating for the societal changes that permit continued exclusive and direct breastfeeding”  The pressure should be on our health care providers, legislators, insurance companies, administrators and employers. Each of us, in our varied roles, can promote better support families. Paid Family Leave and the Pump Act are two good foundations for building family support.

Breastfeeding, providing human milk for human babies, is safe, nutritious, economical and sustainable. And with proactive policy changes, it is more possible. That’s the issue worthy of headlines and more discussion.

 

* The Affordable Care Act stipulated that families receive lactation support with no co-pay, no added cost. However, there have been loopholes which, hopefully, are changing for the better.