Starting rural parents on their breastfeeding journey
Becky MannelWhen welcoming a new baby into the world, most first-time parents feel a wide range of emotions: excited, overwhelmed, proud – and more than a little terrified. That anxiety often extends to breastfeeding, with new moms frequently unsure how to begin. About 84 percent of women start out breastfeeding in the United States, but only 27 percent are exclusively breastfeeding at six months, which can lead to negative health outcomes for mothers and babies.
In Oklahoma, rates are lower: breastfeeding initiation averages 78 percent, and exclusive breastfeeding drops to 20 percent at six months. Percentages are even lower in many rural parts of the state, where access to resources and information can be limited. Oklahoma’s infant mortality rate is also higher than the national average, at 7.1 per 1,000 live births in 2021. That’s why Becky Mannel says hospital providers need to be able to help parents get started on their breastfeeding journey – especially when these nervous new moms have no previous experience.
“Have they ever seen anybody breastfeed? Has anyone in their family ever breastfed? If they’re not exposed to that and don’t have access to unbiased information, they go with what they know,” says Mannel, who is the director of Oklahoma Breastfeeding Resource Center (OBRC) and a clinical associate professor of obstetrics and gynecology in the University of Oklahoma College of Medicine. “We see the lowest breastfeeding initiation rates in our rural communities.”
Founded in 2009 with funding from the Oklahoma State Department of Health, the nonprofit OBRC helps parents access evidence-based education and resources to promote exclusive breastfeeding. The center has four main initiatives: a hotline for common breastfeeding questions and concerns; inperson and virtual trainings for health care professionals including physicians, nurses, dietitians, and home visiting staff; assistance for hospitals around the state to achieve Baby-Friendly status through Baby-Friendly USA’s Baby-Friendly Hospital Initiative; and the Oklahoma Mothers’ Milk Bank, which provides donor milk to families in need.
"Oklahoma has 77 counties and more than half of those are maternity care deserts, so that means they have no birthing hospital or OB providers." – Becky Mannel |
“Everything we do has a statewide focus, especially looking at the fact that we are a very rural state with lots of access-to-care issues and a lack of resources,” Mannel says. “Oklahoma has 77 counties and more than half of those are maternity care deserts, so that means they have no birthing hospital or OB providers. We’re trying to help make a dent in some of those disparities.”
Recently OBRC received a three-year grant from the Oklahoma Tobacco Settlement Endowment Trust to extend services to 10 rural Oklahoma hospitals next year. The initiative aims to improve the state’s high rates of maternal and infant mortality through the health benefits of breastfeeding, which include a reduced risk of obesity, diabetes, cancer, and infections for the baby and a lower chance of hypertension, heart disease, obesity, diabetes, and cancer for the mother.
 Becky Mannel, Oklahoma Breastfeeding Resource Center director, and board-certified lactation consultant Jaclyn Huxford conduct a training. |
To provide this support, Mannel and her staff will work to help these rural facilities achieve Baby-Friendly designation, which was developed more than 30 years ago by the World Health Organization and United Nations Children’s Fund and has been adopted by more than 20,000 health care facilities in more than 150 countries around the world. The designation aims to give mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies and gives special recognition to hospitals that have done so. Since 2012, OBRC has helped 12 Oklahoma hospitals achieve Baby-Friendly status.
“Baby-friendly practices are important so everybody is on the same page about how breastfeeding works and how to answer common questions,” Mannel says. “That way when the baby is born, parents are getting consistent, evidence-based information about breastfeeding, and nursing staff can help them with this new little human being that they’re terrified of and responsible for. Being unsure is such a normal response from new parents, especially if they’ve never been exposed to breastfeeding.”
"Baby-friendly practices are important so everybody is on the same page about how breastfeeding works and how to answer common questions." – Becky Mannel |
Most of all, Mannel wants more families to have access to the latest evidence-based information and resources so they can make informed decisions regarding how to feed their baby. She believes that through widespread and consistent communication and education, hospitals and health care providers can encourage more families to choose breastfeeding and help more babies get the best possible start in life.
“I’m most proud of the ability to educate so many different players about breastfeeding, from hospital staff to medical students to OBGYN residents,” Mannel says. “I appreciate having the opportunity to normalize breastfeeding and help more health care professionals feel confident that they can help so we have a bigger team out there to help families.”
Baby-Friendly USA’s 10 steps to successful breastfeeding
Critical management procedures
1 a. Comply fully with the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly resolutions.
1 b. Have a written infant feeding policy that is routinely communicated to staff and parents.
1 c. Establish ongoing monitoring and data-management systems.
2. Ensure that staff have sufficient knowledge, competence, and skills to support breastfeeding.
Key clinical practices
3. Discuss the importance and management of breastfeeding with pregnant women and their families.
4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth.
5. Support mothers to initiate and maintain breastfeeding and manage common difficulties.
6. Do not provide breastfed newborns any food or fluids other than breastmilk unless medically indicated.
7. Enable mothers and their infants to remain together and to practice rooming-in 24 hours a day.
8. Support mothers to recognize and respond to their infants’ cues for feeding.
9. Counsel mothers on the use and risks of feeding bottles, artificial nipples and pacifiers.
10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.