While Texas hospitals and birthing centers adopt baby-friendly policies to encourage breastfeeding, community support is still lacking.

A new report from the CDC outlines how the nation and individual states are progressing toward the Healthy People 2020 breastfeeding objectives. Texas has met the CDC target of 81.9 percent of mothers ever having breastfed, but still falls behind in other key metrics.

Texas medical facilities lag behind the national average in the percentage of live births taking place at baby-friendly facilities, as well as in implementation of procedures that can help encourage breastfeeding. These procedures are outlined by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) as the optimal level of care for breastfeeding and mother-child bonding.

According to WHO and UNICEF, adoption of these evidence-based policies, like initiating breastfeeding within one hour of birth, or encouraging breastfeeding on demand, have been demonstrated to increase initiation and duration of breastfeeding.

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The Texas Department of State Health Services (DSHS) established the Texas Ten Step program to encourage these policies’ adoption in Texas hospitals and birthing facilities. According to Julie Stagg, the state breastfeeding coordinator with DSHS, Texas Ten Step is really a continuum of initiatives.

"Texas Ten Step program is a recognition program for birthing facilities to provide recognition for hospitals and birthing facilities that have written policies of breastfeeding support,” she said. "The program also includes technical assistance and support with guidance on policy implementation.”

While facilities are encouraged to seek baby-friendly designation, Stagg says the Texas Ten Step program is not focused on such designations. “We’re focused on building capacity and support for hospitals to adopt recommended practices,” she said.

Alongside monitoring key measures of breastfeeding practices within hospitals and birthing facilities, Stagg says DSHS also pays close attention to whether moms are meeting their personal breastfeeding goals. Currently, approximately 50 percent of women polled by DSHS at a Women, Infants and Children (WIC) infancy class answered “no” to whether they are meeting their individual breastfeeding goal.

Stagg said, “There's so much evidence to suggest that if we improve practices and get women to start with breastfeeding, confident in having problems addressed, with early breastfeeding and the continued support in the community, along with the prenatal preparation, women are much more likely to meet their breastfeeding goals.”

Some mothers are not so fortunate, like Julie Almendral, whose early success in breastfeeding did not last. “Initially we had no trouble at all,” she said. “I didn't need any help from the lactation consultant in the hospital. My son latched on right away, we breastfed right away, and it seemed fine. As time went on, as he grew, and things changed, his latch changed and I ended up having a lot of trouble.”

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While her personal goal was to breastfeed for the first full year, she was only able to continue for the first four months. “It was not maintainable for me anymore,” she said, "I was getting too stressed out, which wasn't helping.”  

For Almendral, she had difficulty finding community support.

“I don't have family members I could really count on for information and support, and there’s not really the built-in community that can help someone through these things," she said. "You don't grow up seeing it, learning about it, understanding it, knowing the challenges, knowing what to expect.” Though she found some help through her doulas and their group, the Breastfeeding Cafe, Almendral felt she largely took on the challenge on her own.

“Something like this requires a community. You've never done this before, some of us might not do it again. Even the amount of knowledge and everything you gain through the process. I felt like I learned so much about all of this, and then it's gone afterwards. I don't have anyone to share that with after that experience. That knowledge just sort of goes latent,” Almendral said.

New mom Randan Steinhauser echoed the need for moms to share their experiences and knowledge.

“Now that I've gone through some of the struggles of nursing, especially at the beginning, whenever I see someone who is pregnant, I definitely make it my priority to just talk about nursing, and make it clear that yeah, it's hard at the beginning, but it's totally worth it," she said. “I've found that everyone I talk to is desperate for more information. There's so many questions. I would encourage moms who have nursed to reach out to expecting or new moms to make sure they feel empowered to nurse.”

As a working mother, Steinhauser has a supportive staff that helps by scheduling pumping into her day, but finding a place to actually do so is a challenge. Her work often takes her to the Texas Capitol building, where she is entirely unable to pump.

“Where I lack support is in spaces to pump,” she said. "I have to go back to my car and pump in my car, and then walk back to the capitol. I would love to see more public spaces for nursing mothers.”

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Steinhauser added, “For me, it comes down to creating those spaces, having an open conversation about the reality of being a working mom and pumping. And just the difficulties with that. First, you're not with your baby, so you're already having that emotional pull, and it's already challenging enough to find a clean space for you to sit and pump in comfort, that doesn't include a toilet that you're sitting on.”

Jessica Shortall, author of "Work. Pump. Repeat: The New Mom's Survival Guide to Breastfeeding and Going Back to Work", says the connection between paid leave and successful breastfeeding should not be overlooked.

“Women make up 47 percent of the workforce, so returning to work after having a baby is not a niche activity,” she said. "And it's the very early return to work that can have massive negative impacts on breastfeeding duration, and therefore on public health and the mental health of the mother.”

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