# Breastfeeding

Grassley, Ernst oppose big spending bill but back some provisions

The U.S. Senate completed its work for the year on December 22, when senators approved an omnibus bill to fund the federal government through the end of the current fiscal year on September 30, 2023.

The bill allocates $1.7 trillion in federal government spending ($858 billion for the military, and $772 billion in non-defense spending). The Washington Post broke down the funding by appropriations area.

The legislation also provides $44.9 billion more in aid to Ukraine, and $40.6 billion for disaster aid. It changes some Medicaid rules, which will preserve coverage for many new mothers and children. It also includes some policies not related to federal spending, such as reforms to the Electoral Count Act, workplace protections for pregnant or breastfeeding employees, and a ban on installing TikTok on government-owned devices.

Eighteen Republicans joined the whole Democratic caucus to pass the omnibus bill. Iowa’s Senators Chuck Grassley and Joni Ernst were among the 29 Republicans who opposed the bill on final passage (roll call). But they supported some amendments added to the bill on December 22, as well as several GOP proposals that failed to pass.

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Iowa women may breastfeed their children in any public place

An unfortunate incident at a public pool in Dubuque prompted that city to update its written policies this week to permit “breastfeeding in a public swimming pool or deck area at the mother’s discretion.” On Monday, KCRG’s Katie Wiedemann interviewed the woman whom lifeguards asked to retreat to a private place to nurse her baby. Thanks in part to advocacy by the non-profit Family Friendly Business Initiative, Dubuque officials quickly brought their policies into compliance with state law, Wiedemann reported today.

Whether or not other Iowa cities have similar written policies, breastfeeding mothers should know that they need no special permission to nurse their babies in public parks or recreation areas. Since 2000, Iowa Code 135.30A has stated, “Notwithstanding any other provision of law to the contrary, a woman may breast-feed the woman’s own child in any public place where the woman’s presence is otherwise authorized.” During my breastfeeding years, I nursed in public hundreds of times–including at least once in the rotunda at the Capitol–and was hardly ever hassled. My impression from acquaintances with babies and young toddlers is that it’s increasingly rare for employees in stores, restaurants, or other public places to ask nursing mothers to find an out-of-the-way spot.  

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More Iowa women are breastfeeding their newborns

More than three-quarters of Iowa mothers are breastfeeding their newborns at the time of discharge from the hospital, according to the latest figures released by the Iowa Department of Public Health. A chart near the bottom of this page shows data compiled through the Iowa Newborn Metabolic Screening Profile Feeding Report since 2000. Statewide, about 63 percent of newborns were receiving some breast milk in the year 2000, but by 2013 the rate had risen to 77.7 percent. This chart shows the breastfeeding incidence for about two-thirds of Iowa counties between 2006 and 2013. (Counties with fewer than 20 recorded births per year were not included in the analysis.) Almost every county saw the breastfeeding rate increase during that period, but there was wide variation among counties. Howard County in northern Iowa started out above the statewide average in 2006 and had the highest breastfeeding rate in 2013 at 95.2 percent. Nearby Chickasaw County had the lowest rate at 54.5 percent and is one of the few Iowa counties where the newborn breastfeeding rate has declined in recent years.

Small changes in hospital policies can make a big difference in breastfeeding rates. This slide show created by Dr. Nils Bergman discusses how skin to skin contact in the first hours after birth promotes more breastfeeding. Toward the middle of the presentation, he discusses a study at one California hospital, where an hour of skin to skin time for babies in the first three hours of life dramatically increased the percentage of mothers who were breastfeeding at the time of hospital discharge.

The new Iowa statistics only reflect the percentage of babies receiving some breast milk in the hospital. For many women, the most difficult period for breastfeeding is the week or two after bringing baby home. (That was my experience.) In-person help from certified lactation consultants or accredited volunteer breastfeeding educators can be crucial. Sometimes a small change in how a woman holds her baby or her breast can make a huge difference in baby's ability to transfer milk. Free breastfeeding support is available through Iowa chapters of La Leche League and Breastfeeding USA. After the jump I've posted information about other free breastfeeding resources for Iowa mothers.

Knowing what to expect during the early weeks of breastfeeding is critical. It's typical for newborns to nurse every hour or two around the clock, or to go through a period of "cluster feeding" for a few hours each day. In our culture, many women wrongly interpret those and other normal behaviors as a sign that they are not making enough milk. Again, seeking advice in person or over the phone can be helpful. Good online sources for breastfeeding information, including trouble-shooting, include Kellymom, La Leche League, and Breastfeeding, Inc. Among the many good books that have been published about breastfeeding, the best short read in my opinion is Breastfeeding Made Simple by Nancy Mohrbacher and Kathleen Kendall-Tackett. The best book for trouble-shooting is The Ultimate Breastfeeding Book of Answers by Dr. Jack Newman and Teresa Pitman. The best overview of typical breastfeeding behavior is The Womanly Art of Breastfeeding, published by La Leche League International.  

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CDC birth control guidelines could reduce breastfeeding

The Academy of Breastfeeding Medicine warns that recently updated “birth control guidelines released by the U.S. Centers for Disease Control and Prevention (CDC) could undermine mothers who want to breastfeed,” I learned from the ByMomsForMoms blog, sponsored by Lansinoh. From the Academy of Breastfeeding Medicine’s news release:

“The new guidelines ignore basic facts about how breastfeeding works,” says Dr. Gerald Calnen, President of the Academy of Breastfeeding Medicine (ABM). “Mothers start making milk due to the natural fall in progesterone after birth. An injection of artificial progesterone could completely derail this process.”

The CDC report, “U.S. Medical Eligibility Criteria for Contraceptive Use, 2010,” released in the May 28 issue of Morbidity & Mortality Weekly Report (MMWR), contains important changes in what constitutes acceptable contraceptive use by breastfeeding women. The criteria advise that by 1 month postpartum the benefits of progesterone contraception (in the form of progestin-only pills, depot medroxyprogesterone acetate (DPMA) injection, or implants), as well as the use of combined (progestin-estrogen) oral contraceptives outweigh the risk of reducing breastfeeding rates. Previously, progesterone birth control was not recommended for nursing mothers until at least 6 weeks after giving birth, and combined hormonal methods were not recommended before 6 months.

Based on clinical experience, breastfeeding support providers report a negative impact on breastfeeding when contraceptive methods are introduced too early. One preliminary study demonstrated dramatically lower breastfeeding rates at 6 months among mothers who underwent early insertion of progesterone-containing IUDs, compared with breastfeeding rates of mothers who underwent insertion at 6-8 weeks postpartum.

I have met women whose milk supply collapsed after they received a progesterone shot. One acquaintance had successfully nursed previous babies and was never informed by her health care provider that a birth control shot could impede her ability to produce enough milk for her infant.

It’s illogical for the CDC to give its blessing to early postpartum use of hormonal birth control when the federal government has supposedly been trying to promote breastfeeding for more than a decade. Earlier this year, the White House Task Force on Childhood Obesity set a goal of having half of U.S. babies breastfed for at least nine months by 2015, and recommended a number of specific policies to help reach that goal. But breastfeeding without a full milk supply is quite difficult no matter how educated the mother is or how supportive her environment. I hope the CDC will revise its guidelines and recommend non-hormonal forms of birth control for women in the early months of breastfeeding.  

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