Breastfeeding was an ordeal for Sarah Montano that ended three months after her first child was born — when her milk supply dried up.

“He would get enough milk at first and then he would get unlatched and I would have blisters,” Montano said.“I didn’t have a pump and I couldn’t afford a good one.”

And she didn’t have much support or information to guide her. Now eight months pregnant with her second child, Montano has since gotten better educated about breastfeeding — and a borrowed pump — and feels a lot more confident.

“If it doesn’t go right, I can still maintain my milk,” Montano said. “I was 20 when I had my son and I didn’t really know ... it was a supply- and demand-type issue.”

Montano’s quest to breastfeed is something local health workers want to replicate throughout Kern County, which has some of the lowest breastfeeding rates in the state, according to the California Department of Public Health.

Kern ranked 44th out of 50 counties for exclusive breastfeeding, according to newborn screening data crunched by the California WIC Association and the UC Davis Human Lactation Center. In 2010, the San Joaquin Valley ranked last among the state’s regions for exclusive breastfeeding three months after birth, according to the state’s Maternal and Infant Health Assessment Survey.

Lactation advocates say there are positive signs, though. Several local hospitals are working to achieve “Baby-Friendly” status, a designation awarded after a lengthy process that includes training staff and crafting policies that promote breastfeeding. And a local breastfeeding coalition rebooted in 2010 after falling dormant.

“Our vision really is to make breastfeeding the norm so that instead of seeing bottles everywhere, you will see moms feeding babies from their breasts and that’s OK,” said Juli Coulthurst, chair of the Kern County Breastfeeding Coalition.

Breast benefits

Exactly why valley breastfeeding rates are so low is hard to pinpoint but experts suspect a higher rate of teenage pregnancies and a lack of support for breastfeeding, especially once women return to the workplace, contribute to the lag.

Breastfeeding is widely considered the best way to feed babies and experts said it provides immediate and long-term health benefits. The American Academy of Pediatrics recommends exclusive breastfeeding for about six months and continued breast feeding for at least one year, while the World Health Organization recommends  breastfeeding along with providing other foods for two years or longer.

Dr. Poornima Kunani, a Kaiser Permanente pediatrician in Bakersfield, said breastfeeding helps mothers get back in shape after pregnancy and decreases rates of postpartum depression. Breast-fed babies have fewer childhood illnesses such as ear infections, diarrhea and colic, she said. Fewer sick babies means fewer doctor visits and less time off work for parents.

Laura Jason, breastfeeding and training coordinator at Clinica Sierra Vista, said breast-fed babies are leaner and receive antibodies from their mothers. Breastfeeding also decreases obesity rates, experts said.

“It’s a win-win situation for everyone,” Kunani said.

But breastfeeding’s not always easy.

Mothers may not have the community support or positive examples to encourage them, Clinica staff said. New moms may become dismayed that their baby doesn’t catch on to breastfeeding right away and reach for the bottle at the urging of a family member.

“(Many women) don’t know someone who’s successfully breastfed. They really don’t know what to expect, they hear a lot of horror stories, they don’t think that there’s any help out there,” Jason said.

Education levels also appear to influence how women feed their children. Women with higher levels of education are more likely to breastfeed, said Lynn Johnson, coordinator of parent and lactation education at Bakersfield Memorial Hospital.

Actual knowledge of the ins and outs of breastfeeding may also be lacking. In fact, Evelyn Wade, director of Delano Regional Medical Center’s obstetric unit, said educating moms about what is going to happen and reassuring them that their baby is getting enough food is a daily challenge.

Marinda Du Toit, KMC perinatal clinical educator, said one of the biggest barriers is that parents want to breastfeed and bottle feed, not realizing that babies become accustomed to getting lots of milk at once by bottle-feeding and thus become less inclined to breastfeed, decreasing the mother’s milk supply.

“Unfortunately that’s one of the biggest things that impairs the breastfeeding success in the end,” she said.

Du Toit said KMC, which has the lowest exclusive breastfeeding rate in the county, has made big efforts to promote breastfeeding. One nurse became a full-time lactation consultant in February and the hospital is working with WIC to create resource binders of breastfeeding research and information for doctors and pediatricians. The hospital’s exclusive breastfeeding rate jumped from 16.2 percent in 2010 to 24.6 percent in 2011, according to newborn screening data.

“Even though we are the lowest in the county, I was very happy to see that we went up,” Du Toit said.

Jason believes breastfeeding is hitting a tipping point in California with the spread of the Baby-Friendly Hospital Initiative, a multi-step process to encourage breastfeeding.

More than a third of the nation’s Baby-Friendly facilities are in California but few are in the San Joaquin Valley.

“The Baby-Friendly Initiative is very strong in northern California, it’s very strong in southern California, and we need to bring it to the valley,” Jason said.

Becoming ‘Baby-Friendly’

Baby-Friendly USA Inc. recently designated the 147th Baby-Friendly hospital in the United States but 700 hospitals are working toward the title, according to Trisha MacEnroe, the group’s executive director. It’s a World Health Organization and the United Nations Children’s Fund program and the process can take one or several years to complete, depending on where hospitals are at with breastfeeding when they apply.

Locally, Bakersfield Memorial, Mercy Southwest and San Joaquin Community hospitals are in the process. Kern Medical Center is looking into applying.

San Joaquin was one of 90 hospitals picked for a grant program to help hospitals work toward the Baby-Friendly title. Grace Kwasman, director of prenatal services at San Joaquin, said the support is great but the process will still be expensive and labor intensive because of all the staff training. She estimated training not covered by the grant will cost about $200,000 and the hospital will have to pay about $22,500 for ongoing and new staff training each year to maintain the program.

“It’s worth it because breastfeeding is the most effective preventative health care measure,” Kwasman said.

Hospital staff said another challenge to becoming Baby-Friendly is educating busy doctors. The hospital’s upper management also has to be on board, they said.

But Coulthurst, from the breastfeeding coalition, said even without being part of the Baby-Friendly program, local hospitals are improving their breastfeeding rates.

“Baby-Friendly can be a pretty daunting process and it takes time so it’s really important to celebrate even the small steps,” Coulthurst said. “Even though our rates are low, our hospitals are starting to take some steps and they are starting to make some changes.”

Making it work

Breastfeeding experiences can dramatically differ from mom to mom.

Cynthia Baninge-Daanaah is a bit of a breastfeeding all-star. She had so much milk that she donated 36 gallons to a human milk bank in San Jose over the two years that she nursed her second son, Mischael. Her daughter, Mya, just turned 3 months old and Baninge-Daanaah is preparing to donate her milk again. She hopes to send the first batch of her milk in the next couple of weeks.

“Why should I go and waste money to go and buy something that is not comparable to breast milk?” Baninge-Daanaah said.

Her three kids don’t get sick often and she credits that to her breastfeeding them.

“I think breastfeeding is the best. I wish everybody could breastfeed,” she said.

But for Montano, breastfeeding was  fraught with obstacles.

Her son, Dylan, couldn’t latch properly when he was born in 2005. At the hospital, she said, staff had “just kind of shoved him on my boob” and didn’t give her much explanation of what to do.

“The pediatrician was like, ‘Oh just formula feed him and he’ll be fine,’” Montano said.

Formula made Dylan sick, causing painful constipation that required a couple trips to the doctor. Montano said it was a “nightmare.”

Montano is determined that things will be different with her daughter, Sophia Montano, though she is still apprehensive.

“Everyone’s like, ‘Oh are you nervous about labor?’ I‘m like, ‘No, I’m nervous about breastfeeding,’” she said.

When her son was born, Montano felt like there was a dearth of information available to her — but things are different now. She thinks it might be because she has better insurance with Kaiser, compared to Medi-Cal when she had her son. Her current nurse practitioner and doctor have asked Montano if she plans to breastfeed several times.

Montano also signed up for a breastfeeding class at San Joaquin Community Hospital, where she plans to deliver.

“There was no information practically when I had (Dylan) in 2005,” Montano said. “This class was like three hours long and completely explained a lot of things I thought (weren’t) normal and turned out to be completely normal.”

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