Despite the important health benefits of breast-feeding, many new mothers are intimidated. "The number one concern among new mothers is, 'do I have enough milk?'" reports Christine Bedgood, a lactation consultant at Washington Hospital in Fremont.

That worry is usually based on misunderstanding, says Kathy Hesser, head of the hospital's Maternal and Child Health Education Program. "People think that after babies eat, they shouldn't be hungry for three or four hours because that's how it works with us."

Hesser tells new moms that frequent nursing-babies wanting more after an hour or even after five minutes-is not only normal, but it's the way nature ensures milk production. The baby's sucking stimulates the hormones that tell a mother's body to make milk.

That kind of information can make a big difference in the number of women who breast-feed their infants. And for the babies, the stakes are high -breast milk protects infants from a range of health problems (see below: Breast-feeding benefits).

But U.S. women have a low rate of breast-feeding compared to other countries, according to the federal Department of Health and Human Services. That's why, in 2000, the department released a Blueprint for Action on breast-feeding, calling for more programs like the one at Washington Hospital.

From the start

After a woman gives birth in Washington Hospital, she gets a visit from one of the hospital's three lacatation consultants every day she's there.

The consultants advise the moms on the signs of successful breast-feeding-is the baby alert during feeding? Does the baby swallow every one to three seconds? And they urge the mothers to feed their babies frequently. "The more she feeds, the quicker the milk comes in," Bedgood says.

For those few moms who start off without much milk, says consultant Rita Meekma, they provide extra coaching and herbal supplements. Consultants also help in "getting a mom and baby together in the right position."

All the attention pays off: More than 90 percent of Washington Hospital's new mothers are breast-feeding their children when they are discharged, and Hesser is confident that many continue to breast-feed.

That's partly because "we advertise to our patients, when they leave, not to hesitate to call if they have a question," says Hesser. Three days a week, a lactation consultant is on hand to take phone calls and meet with outpatients. Instead of loading down moms with free formula samples, Washington Hospital sends them home with literature on breast-feeding-and on breast pumps.

Milk at work

Since many women must return to work shortly after the birth of their babies, breast pumps have become increasingly important. Women can pump breast milk at work, then leave it for caregivers to feed their babies the next day. That's a real benefit, says Hesser-babies who drink only breast milk get fewer infections and allergies.

Washington Hospital runs a popular breast-pump rental station. "We're now up to 100 pumps," Hesser notes, "and we may need to go up again!" But ironically, at Washington Hospital, "We really don't have a spot yet for our own employees to pump." She adds, "I think that's our next step."

Model program

Washington Hospital might look for inspiration to the Los Angeles Department of Water and Power (DWP), whose breast-feeding program was recently recognized as a model by the National Healthy Mothers, Healthy Babies Coalition.

Rona Cohen, who administers the program, is a certified lactation consultant; she teaches classes about breast-feeding "as part of a whole series of pregnancy classes. This is an equal benefit for both male and female employees, so men can come to class," says Cohen. "Sometimes if I have a lot of men, I'll have what we call a 'coaching class' for successful breast-feeding." She also works one-on-one with parents who might have breast-feeding issues or concerns, "mainly on the phone, but occasionally on-site."

The DWP provides lactation rooms for its employees; women schedule a time to come in, express their milk, and save it. Each gets a cooler case and a free breast pump. Every male employee whose partner works somewhere else can also take a breast pump home at no cost. "It's probably the only company in the country that goes to this extent," Cohen notes.

Benefits for the DWP, Cohen says, include "35 percent lower health care claims and 27 percent lower female employee absenteeism, for those who were providing breast milk to their babies."

Supportive dads

For a company that's 80 percent male, "It's unusual to have this kind of program," Cohen says. "We have extremely high usage by our male employees." Cohen coaches new fathers in their role of supporting their breast-feeding partners. "They can support eating healthy by helping with meals. Or maybe they can comfort the baby if it's fussing. " And, Cohen adds, "of course, he would be the one picking up the breast pump. It's now very common here to watch these big, macho men walk out with their little breast pump," Cohen says. "We've started a little society of new dads. These men play a major role in the success of the breast-feeding experience."

Washington Hospital and the DWP have extensive programs to support breast-feeding, but even small steps make a difference. Washington Hospital's program, Hesser points out, began with informal individual consultations between nurses and moms. Many workplace programs begin with a room and a comfortable chair set aside for lactation.

Breast-feeding benefits

• Increased resistance of infants to infectious diseases including diarrhea and pneumonia. Ear infections are three times more common in formula-fed infants.
  
  
• Reduced risk of chronic diseases. Breast-feeding may reduce the risk of a child developing diabetes, allergies, and asthma.
  
  
• A stronger immune system. Children who were breast-fed have fewer illnesses on average than those who were bottle-fed.
  
  
• Better nutrition. Human milk is more digestible, less stressful on the kidneys, and has the ideal balance of proteins and vitamins to promote infant growth.
  
  
• Better maternal health. There is evidence that breast-feeding reduces the risk of breast and ovarian cancer in the mother. It might also reduce the likelihood of osteoporosis later in life.
  
  

Breast-feeding is also cost-effective: Formula is expensive; breast milk is free. Formula-fed infants also average $200 more in medical expenses per year than breast-fed infants.

Resources on breast-feeding

• La Leche League International, 800-LA-LECHE, www.lalecheleague.org.
  
  LLLI is an independent organization, with local chapters across the country, devoted to supporting breast-feeding mothers.
  
  
• California Women, Infants, and Children (WIC) Supplemental Nutrition Program, 888-WIC-WORKS, www.wicworks.ca.gov
  
  WIC provides support and information for low-income pregnant, breast-feeding, and post-partum women.
  
  
• The African-American Breast-feeding Alliance, 877-532-8535
  
  AABA's mission is to create a breast-feeding-friendly culture within the African-American community; they provide a hotline, plus publications and videos.
  
  
• San Diego County Breast-feeding Coalition, c/o Children's Hospital and Health Center, 3020 Children's Way MC5073, San Diego, CA 92123-4282
  
  SDCBC is a private nonprofit association of health professionals providing community outreach and education.
  
  
• The Breast-feeding Task Force for Greater Los Angeles, 626-856-6650, www.breastfeedingtaskforla.org
  
  The BFTLA provides resources and information including an annual directory of area resources.