The many nutritional and developmental benefits of breast-feeding for babies are well known, and word about lifestyle and important health advantages for moms who breast-feed is spreading fast.

	Tony Tye, Post-Gazette Dr. Todd Wolynn, of Pediatric Alliance, holds Theo Rothstein, 1, of Squirrel Hill. Dr. Wolynn and his partners have launched the Breastfeeding Center of Pittsburgh as part of their practice. Click photo for larger image. Related coverage Breast-feeding resources Support in the workplace lauded

So why don't more mothers breast-feed their children?

The question is being taken up by lactation consultants, including a group of Pittsburgh pediatricians, who say mothers are desperate for support and help with breast-feeding problems.

"It's obviously healthier to breast-feed," said Dr. Todd Wolynn. "But the more powerful message is the unspoken truth ... that breast-feeding is easier, safer and more convenient."

Dr. Wolynn, 40, is a pediatrician and a father of three who, with his partners at Pediatric Alliance, established the Breastfeeding Center of Pittsburgh this month on Beechwood Boulevard in Greenfield. They plan an expansion by January that Dr. Wolynn says will serve not only his own patients, but also other women with breast-feeding problems and questions.

The doctors -- Wolynn, Alicia Hartung, Albert Wolf and Lucas Godinez -- are lactation consultants all trained by Dr. Nancy Brent in her former position as medical director of Mercy Children's Medical Center and its infant lactation center. Dr. Brent is now working for the practice and its Breastfeeding Center of Pittsburgh.

Mercy Hospital has always emphasized breast-feeding, Dr. Wolynn said, teaching its residents to be lactation consultants.

Dr. Wolynn said Pediatric Alliance, formerly known as Southwest Pediatrics, has in turn stressed breast-feeding since its founding 11 years ago by Dr. K.G. Pai.

To help new mothers do well, Dr. Wolynn said, "Dr. Pai emphasized taking time with patients. He did expect them to breast-feed." Taking time helps the doctors to detect early any breast-feeding problems. "We find if you ask the question, you can give the answer," Dr. Wolynn said.

He recommends every pediatrician see the mother and newborn within two days after leaving the hospital to ensure that breast-feeding is going well. But not all pediatricians can help mothers with feeding problems.

Tony Tye, Post-Gazette Kate Rothstein feeds her son, Theo. "It's not always easy" for new moms, she said. Click photo for larger image.

"The Breastfeeding Center of Pittsburgh is going to be open for moms, some from as far away as Ohio, because this practice focuses on breast-feeding ... [If needed] we'll communicate with doctors, even obstetricians, through consultation letters."

One mom who takes advantage of the breast-feeding center is Kate Rothstein, of Squirrel Hill, who is expecting her third child in January, to join a 4-year-old and 12-month-old. She said she particularly needed the center with her first child, when she had a lot of feeding problems, including pain, even though she had a lactation consultant at the hospital.

"Now when I have questions, I know I can come here. It's really nice to come and make an appointment, especially for first-time moms," she said.

"Dr. Wolynn told me it wasn't normal to have a lot of pain," she said recalling her first nursing experience. "It could have been addressed sooner. You think it's going to be easy, and it's not always easy."

The pediatrician pointed out, "It shouldn't hurt. With the first latch, if the pain doesn't subside after one minute, the latch isn't good," and the mom should carefully encourage her baby to try again to latch properly around the nipple. Breast-feeding consultants can witness the latching to determine the problem.

Hospitals with lactation consultants, including Mercy and Magee-Womens, "do a terrific job," Dr. Wolynn said, "but they're not supported with enough resources. And afterward, who wants to carry their baby to the hospital?"

He said many health insurance plans will cover lactation consultants outside the hospital who treat "feeding disturbances." Otherwise consultants can charge $30 to $40 an hour.

The breast-feeding center has nonphysician lactation consultants who are paid by the practice and overseen by the doctors. Considered part of a pediatric visit, they will be available for consultation, as long as needed. The center also sells Medela products -- breast pumps, cups and other things -- with no shipping costs.

An unfriendly culture

"You have to be committed to it," said Linda Fiejdasz, mother of two, who found help with breast-feeding problems at the Pediatric Alliance.

She needed help getting started with her first child, when Dr. Wolynn personally helped her, and with her second child, when she met with a lactation consultant, with the doctor looking in. A single hourlong session, in which the two women sat and talked as the baby nursed, ironed out all issues. Both of her children were breast-fed for 10¹/₂ months.

Mrs. Fiejdasz said she could bring up any questions at her babies' checkups. She learned that pain is unnecessary with breast-feeding.

"I don't know what I would have done without Dr. Wolynn."

As far as time and effort went, she said, "It was harder than earning my master's degree. But it's the best thing I can do for my children."

Dr. Wolynn said resources available in the past for women are gone. Many mothers, aunts, sisters and grandmothers have no experience with breast-feeding to share with new moms.

"We lost the social norm," Dr. Wolynn said. "It's the culture we live in."

He said the country is far from the national goals set by Healthy People 2010: to increase to 75 percent the portion of women who will try breast-feeding soon after the birth; to 50 percent those mothers breast-feeding infants at 6 months; and to 25 percent those breast-feeding at 1 year.

Eight years ago, only 64 percent tried breast-feeding, only 29 percent were still nursing at 6 months, and only 16 percent at 1 year. More information on Healthy People 2010, a set of health objectives for the nation to reduce preventable threats to health, can be found at www.healthypeople.gov.

Feeding problems

"Getting things started on the right track" is the primary goal of the breast-feeding center, Dr. Wolynn said. If there's a significant problem with feeding, he said, it needs to be taken care of early in the baby's life. "The earlier you address it, the greater chance we have to resolve the issue."

What are the most common problems?

Dr. Wolynn estimated that 75 percent to 90 percent of problems are related to latching issues.

"If you have a good latch, it really takes care of all the problems," he said.

The other problems are related to a lack of support, he said. "The father's opinion on breast-feeding has a high bearing on a woman's choice."

Well-meaning people give babies supplemental bottles of formula, undercutting efforts to breast-feed. And Dr. Wolynn said he still has moms tell him they've been told not to breast-feed in public at malls and restaurants.

As part of his campaign to slowly dispel myths and get the unspoken truth out there, Dr. Wolynn -- who on top of everything else is also a pediatric sleep specialist (director of the Pediatric Sleep Disorder Clinic at Mercy Hospital) -- wants people to know that bottle-fed babies do not sleep better.

"The truth is, as early as 4 to 6 months, breast-fed babies sleep as well as bottle-fed."

'A lot of work to do'

The Pediatric Alliance's plans to promote breast-feeding include a room in its Pleasant Hills office dedicated to breast-feeding and lactation consulting.

"We want to make a breast-feeding environment standard in pediatrician's offices," Dr. Wolynn said. He's studying for a master's in medical management at Carnegie Mellon University, with an eye to coming up with a business model for breast-feeding resources in pediatric offices nationwide.

"We want the lactation consulting to pay for itself," he explained. Many doctors are still not taught about breast-feeding in medical school and are uncomfortable with the subject, he said.

He's been contacted by Martha Kautz at the state Department of Health. As program coordinator for breast-feeding awareness, she's first targeting areas in the state that have markedly low rates of breast-feeding.

These "gap areas" have low rates of mothers trying breast-feeding. Only five counties out of 67 in the state meet the 75 percent goal of Healthy People 2010. The state range is 40 percent to 78 percent, with the lowest rates in Philadelphia, the northeastern part of the state and southwestern Pennsylvania. In this region, Greene and Fayette counties have the lowest rates.

"We have a lot of work to do in Pennsylvania," Ms. Kautz said, adding that there is a correlation with lower socioeconomic status and low rates of breast-feeding.

She said mothers need prenatal support, obstetrician and hospital support and community support to successfully breast-feed.

Pediatricians and family practices need to give mothers help and encouragement as well.

As part of the effort to identify and overcome cultural barriers, the state sponsors a breast-feeding minigrant program. Nonprofit groups and hospitals can apply for $3,000 annual grants to pay for breast-feeding promotion. This year 27 grants were given. Applications can be found on the state Web site: www.dsf.health. state.pa.us/health.

Ms. Kautz said the work is worth it: "If we have a culture of breast-feeding, if we increase initiation and duration rates, that will help the next generation of children. Breast-fed women in turn will breast-feed their own children."