Meet Karen Moehl, the very model of a problem pregnancy.
The 33-year-old Largo woman, who already required more attention from doctors because she was expecting twins, went to bed one night and woke up 20 pounds heavier. The sudden victim of severe pre-eclampsia, a potentially fatal condition that causes a surge in blood pressure, Moehl knew something was very wrong.
"I looked pretty hideous. I think my face hurt the worst. You can imagine all your skin just stretching like that. It felt like I was going to burst out of my skin. It was horrible," Moehl says.
She went immediately to the hospital for an emergency Caesarean section, delivering a son and daughter almost a month early.
Throughout it all, she stuck to her resolve that she would breast-feed, although her pediatrician discouraged her from nursing, saying she might not be able to produce enough milk for two babies.
"I had wanted to exclusively nurse them, but you can't nurse them in recovery. It was a big problem. Once I did try, they were used to being bottle-fed already," Moehl says.
Under the best of conditions, nursing twins can be tricky. Moehl's case was particularly difficult.
"It was probably close to six weeks before everything evened out to where I could breast-feed and not use any supplements," she says.
Medical research makes a strong case for breast-feeding, citing health benefits, increased immunity and greater intellectual development among breast-fed infants.
"I don't think science will ever be able to duplicate the living cells that are in breast milk," says Denise Christian, a registered and licensed dietitian with the Pasco County Health Unit.
Some women _ such as those who have had mastectomies or chemotherapy patients _ have medical reasons for not breast-feeding, but most can. Still, there can be problems and misconceptions.
Among the myths: A woman must expose herself and suffer embarrassment to nurse outside the home; it's too much trouble; it ruins her shape; she cannot produce enough milk to satisfy her child.
Specialists address these and other concerns with simple advice, such as showing women how to use a shawl for discretion, pointing out the convenience and monetary savings of breast-feeding as opposed to washing bottles and mixing expensive formula; explaining that pregnancy _ not breast-feeding _ may affect a woman's shape; and informing women that regular nursing produces ample milk supply.
"We get hung up on silly things in this country," says Dana Raphael, director of the Human Lactation Center in Westport, Conn.
Other problems nursing women face require more scientific attention, such as that provided by lactation consultants, who often are referred by physicians.
Consultants may give advice about a baby's reluctance to properly latch onto the breast, helping "letdown" of milk occur and easing sore nipples.
A factor for working women is having a private place to pump milk during the day, a practice that is necessary to keep milk flow active and produce enough food for bottles while a mother is away from her child.
"Women have a right not to be forced to choose between breast-feeding an infant and not breast-feeding an infant because they have to work. .
. Women need to keep voicing what they need in order to nurse," Christian says.
Outside the United States, children are weaned, on average, around age 4. Among American women, breast-feeding has fallen in and out of fashion, depending on the era.
"It really goes back to the '20s, when commercial formula first began to be marketed. It started with the medical community; they perceived the formula (as being) more scientific, they knew exactly how much food the baby was getting," says Barbara Czipri, a Clearwater lactation consultant.
During World War II, women went to work and left their babies home with bottles of formula and a sitter. By the late '50s, fewer than 15 percent of women were breast-feeding, Czipri said.
The La Leche League was founded in 1956 to promote breast-feeding by addressing its benefits and helping women overcome problems.
Largely because of La Leche's efforts, the number of American women who breast-fed when leaving the hospital after childbirth peaked in the '70s and early '80s. Statistics show that 61.9 percent of mothers were breast-feeding when they left the hospital in 1982, compared with 51.9 percent in 1990.
In 1991, an estimated 53 percent of women leaving hospitals were nursing, an increase over the previous year that probably can be attributed to recently released studies outlining specific positive test results, Christian says.
Even the federal government has gotten into the act. In 1984, U.S. Surgeon General C. Everett Koop publicly announced his goal to have 75 percent of new mothers leaving hospitals breast-feeding.
The 1990 deadline was not met, and the federal government extended the deadline to 2000. Included in the effort is the hope that at least 35 percent of mothers still are nursing by the time their babies are 6 months old. A general educational program, which would address misconceptions about nursing and make the workplace more conducive to breast-feeding women, also is called for.
Women often must resolve one or more snags before settling into a breast-feeding routine, and those who stick with it sometimes find themselves at a loss for words when describing the benefits, both to their babies and themselves.
"We know that there is a closeness between mothers and babies who nurse and that's one of the hardest things for mothers to put into words," Christian says. "If I could bottle that stuff and sell it, I would do it."
_ Staff librarian Kitty Bennett contributed to this story