The International Council on Infertility Information Dissemination, Inc

Benefits of Breast-Feeding for Baby and Mother

There are many benefits to breastfeeding. Even if you are able to do it for only a short time, your baby's immune system can benefit from breast milk. Here are many other benefits of breast milk for a mother, her baby, and others:


Health Risks of Not Breastfeeding
Breast milk has agents (called antibodies) in it to help protect infants from bacteria and viruses. Recent studies show that babies who are not exclusively breastfed for 6 months are more likely to develop a wide range of infectious diseases including ear infections, diarrhea, respiratory illnesses and have more hospitalizations. Also, infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S.

Some studies suggest that infants who are not breastfed have higher rates of sudden infant death syndrome (SIDS) in the first year of life, and higher rates of type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's disease, overweight and obesity, high cholesterol and asthma. More research in these areas is needed (American Academy of Pediatrics, 2005).

Babies who are not breastfed are sick more often and have more doctor's visits.

Also, when you breastfeed, there are no bottles and nipples to sterilize. Unlike human milk straight from the breast, infant formula has a chance of being contaminated.
Breast milk is the most complete form of nutrition for infants. A mother's milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development. Most babies find it easier to digest breast milk than they do formula.

As a result, breastfed infants grow exactly the way they should. They tend to gain less unnecessary weight and to be leaner. This may result in being less overweight later in life.

Premature babies do better when breastfed compared to premature babies who are fed formula.

Breastfed babies score slightly higher on IQ tests, especially babies who were born pre-maturely.


Nursing uses up extra calories, making it easier to lose the pounds of pregnancy. It also helps the uterus to get back to its original size and lessens any bleeding a woman may have after giving birth.

Breastfeeding, especially exclusive breastfeeding (no supplementing with formula), delays the return of normal ovulation and menstrual cycles. (However, you should still talk with your doctor or nurse about birth control choices.)

Breastfeeding lowers the risk of breast and ovarian cancers, and possibly the risk of hip fractures and osteoporosis after menopause.

Breastfeeding makes your life easier. It saves time and money. You do not have to purchase, measure, and mix formula. There are no bottles to warm in the middle of the night!

A mother can give her baby immediate satisfaction by providing her breast milk when her baby is hungry.

Breastfeeding requires a mother to take some quiet relaxed time for herself and her baby.

Breastfeeding can help a mother to bond with her baby. Physical contact is important to newborns and can help them feel more secure, warm and comforted.

Breastfeeding mothers may have increased self-confidence and feelings of closeness and bonding with their infants.


Breastfeeding saves on health care costs. Total medical care costs for the nation are lower for fully breastfed infants than never-breastfed infants since breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations.

Breastfeeding contributes to a more productive workforce. Breastfeeding mothers miss less work, as their infants are sick less often. Employer medical costs also are lower and employee productivity is higher.

Breastfeeding is better for our environment because there is less trash and plastic waste compared to that produced by formula cans and bottle supplies.


Current as of October 2005


Good Habits for Pregnant and Nursing Mothers from the Danish Government

Good Chemistry

To all pregnant and nursing mothers:

During pregnancy or when you are breast feeding, you and your child are particularly sensitive. During this period you should, therefore, pay special attention to chemicals which you and your child are exposed to. The Environmental Protection Agency has formulated 9 good habits for pregnant and nursing mothers regarding chemicals in cosmetics, in products for children and in toys. If you follow them, you will be well on your way to creating good chemistry for you and for your child.



For pregnant and nursing mothers:

Good chemistry for you and for your child

1. Use as little cosmetics and lotions as possible while you are pregnant and as long as you are breast feeding

- Certain cosmetics and lotions contain allergenic chemicals or are suspected of being hormone disruptors. By using as little cosmetics and lotions as possible you lessen the effect of chemicals on you and on your child.

2. Always choose unscented products, and stop using perfume during pregnancy and as long as you are breast feeding.

- Perfume can cause allergies, skin irritation, rashes or breathing difficulty.

3. Buy products with environmental labels whenever possible – look for the Swan label and The Flower

- The swan and the flower are environmental logos you can see on products made with special consideration for health and the environment – for instance by containing fewer problematic chemicals.

4. Don’t color your hair during pregnancy and as long as you are breast feeding

- Certain chemicals in hair dye can cause serious allergenic reactions or are suspected of being hormone disruptors. Also "natural hair dyes" like Henna can contain harmful chemicals.

5. Avoid using products that come in spray cans and do not paint while you are pregnant or as long as you are breast feeding

- If you paint or use spray cans you inhale chemicals that can be absorbed by your body and transmitted to your child. Avoid painting during this period and be sure to air out newly painted rooms properly.



Good chemistry for your baby

6. Wash everything before using it for your baby – also clothes and toys made of cloth or plastic

- New clothing, toys, nursing bottles etc. made of cloth or plastic can contain chemical residues. If you wash everything in hot water, most of the chemicals will be removed.

7. Avoid daily use of lotion, soap, etc. for your baby

- Bathe your baby in clean water and limit the use of lotions after bathing and after diaper changes. If your child has very dry or red and irritated skin or other skin problems, speak with your doctor or health visitor.

8. Always buy unscented products for your baby – also toys

- Perfume can give your baby an allergy. Therefore, always buy unscented grooming products for your baby and avoid scented toys.

9. Only use toys especially designed for babies. Toys for children older than 3 years may contain ftalates.

- Ftalates are used to soften plastics. Certain ftalates are hormone disruptors. In Denmark, the use of ftalates in toys for children under 3 years old is forbidden.


Download this fact sheet as a PDF


If you wish to read more about good chemistry for your baby see:

For information on nutrition for pregnant women see the website of the Ministry of Family and Consumer Affairs: For products containing environmental labels see the ecolabel website:


Breastfeeding is best for babies

Breast-Feeding Best Bet for Babies
by Rebecca D. Williams


New parents want to give their babies the very best. When it comes to nutrition, the best first food for babies is breast milk.

More than two decades of research have established that breast milk is perfectly suited to nourish infants and protect them from illness. Breast-fed infants have lower rates of hospital admissions, ear infections, diarrhea, rashes, allergies, and other medical problems than bottle-fed babies.

"There are 4,000 species of mammals, and they all make a different milk. Human milk is made for human infants and it meets all their specific nutrient needs," says Ruth Lawrence, M.D., professor of pediatrics and obstetrics at the University of Rochester School of Medicine in Rochester, N.Y., and spokeswoman for the American Academy of Pediatrics.

The academy recommends that babies be breast-fed for six to 12 months. The only acceptable alternative to breast milk is infant formula. Solid foods can be introduced when the baby is 4 to 6 months old, but a baby should drink breast milk or formula, not cow's milk, for a full year.

"There aren't any rules about when to stop breast-feeding," says Lawrence. "As long as the baby is eating age-appropriate solid foods, a mother may nurse a couple of years if she wishes. A baby needs breast milk for the first year of life, and then as long as desired after that."

In 1993, 55.9 percent of American mothers breast-fed their babies in the hospital. Only 19 percent were still breast-feeding when their babies were 6 months old. Government and private health experts are working to raise those numbers.

The U.S. Food and Drug Administration is conducting a study on infant feeding practices as part of its ongoing goal to improve nutrition in the United States. The study is looking at how long mothers breast-feed and how they introduce formula or other foods.

Health experts say increased breast-feeding rates would save consumers money, spent both on infant formula and in health-care dollars. It could save lives as well.

"We've known for years that the death rates in Third World countries are lower among breast-fed babies," says Lawrence. "Breast-fed babies are healthier and have fewer infections than formula-fed babies."


Human Milk for Human Infants

The primary benefit of breast milk is nutritional. Human milk contains just the right amount of fatty acids, lactose, water, and amino acids for human digestion, brain development, and growth.

Cow's milk contains a different type of protein than breast milk. This is good for calves, but human infants can have difficulty digesting it. Bottle-fed infants tend to be fatter than breast-fed infants, but not necessarily healthier.

Breast-fed babies have fewer illnesses because human milk transfers to the infant a mother's antibodies to disease. About 80 percent of the cells in breast milk are macrophages, cells that kill bacteria, fungi and viruses. Breast-fed babies are protected, in varying degrees, from a number of illnesses, including pneumonia, botulism, bronchitis, staphylococcal infections, influenza, ear infections, and German measles. Furthermore, mothers produce antibodies to whatever disease is present in their environment, making their milk custom-designed to fight the diseases their babies are exposed to as well.

A breast-fed baby's digestive tract contains large amounts of Lactobacillus bifidus, beneficial bacteria that prevent the growth of harmful organisms. Human milk straight from the breast is always sterile, never contaminated by polluted water or dirty bottles, which can also lead to diarrhea in the infant.

Human milk contains at least 100 ingredients not found in formula. No babies are allergic to their mother's milk, although they may have a reaction to something the mother eats. If she eliminates it from her diet, the problem resolves itself.

Sucking at the breast promotes good jaw development as well. It's harder work to get milk out of a breast than a bottle, and the exercise strengthens the jaws and encourages the growth of straight, healthy teeth. The baby at the breast also can control the flow of milk by sucking and stopping. With a bottle, the baby must constantly suck or react to the pressure of the nipple placed in the mouth.

Nursing may have psychological benefits for the infant as well, creating an early attachment between mother and child. At birth, infants see only 12 to 15 inches, the distance between a nursing baby and its mother's face. Studies have found that infants as young as 1 week prefer the smell of their own mother's milk. When nursing pads soaked with breast milk are placed in their cribs, they turn their faces toward the one that smells familiar.

Many psychologists believe the nursing baby enjoys a sense of security from the warmth and presence of the mother, especially when there's skin-to-skin contact during feeding. Parents of bottle-fed babies may be tempted to prop bottles in the baby's mouth, with no human contact during feeding. But a nursing mother must cuddle her infant closely many times during the day. Nursing becomes more than a way to feed a baby; it's a source of warmth and comfort.


Benefits to Mothers

Breast-feeding is good for new mothers as well as for their babies. There are no bottles to sterilize and no formula to buy, measure and mix. It may be easier for a nursing mother to lose the pounds of pregnancy as well, since nursing uses up extra calories. Lactation also stimulates the uterus to contract back to its original size.

A nursing mother is forced to get needed rest. She must sit down, put her feet up,and relax every few hours to nurse. Nursing at night is easy as well. No one has to stumble to the refrigerator for a bottle and warm it while the baby cries. If she's lying down, a mother can doze while she nurses.

Nursing is also nature's contraceptive--although not a very reliable one. Frequent nursing suppresses ovulation, making it less likely for a nursing mother to menstruate, ovulate, or get pregnant. There are no guarantees, however. Mothers who don't want more children right away should use contraception even while nursing. Hormone injections and implants are safe during nursing, as are all barrier methods of birth control. The labeling on birth control pills says if possible another form of contraception should be used until the baby is weaned.

Breast-feeding is economical also. Even though a nursing mother works up a big appetite and consumes extra calories, the extra food for her is less expensive than buying formula for the baby. Nursing saves money while providing the best nourishment possible.


When Formula's Necessary

There are very few medical reasons why a mother shouldn't breast-feed, according to Lawrence.

Most common illnesses, such as colds, flu, skin infections, or diarrhea, cannot be passed through breast milk. In fact, if a mother has an illness, her breast milk will contain antibodies to it that will help protect her baby from those same illnesses.

A few viruses can pass through breast milk, however. HIV, the virus that causes AIDS, is one of them. Women who are HIV positive should not breast-feed.

A few other illnesses--such as herpes, hepatitis, and beta streptococcus infections--can also be transmitted through breast milk. But that doesn't always mean a mother with those diseases shouldn't breast-feed, Lawrence says.

"Each case must be evaluated on an individual basis with the woman's doctor," she says.

Breast cancer is not passed through breast milk. Women who have had breast cancer can usually breast-feed from the unaffected breast. There is some concern that the hormones produced during pregnancy and lactation may trigger a recurrence of cancer, but so far this has not been proven. Studies have shown, however, that breast-feeding a child reduces a woman's chance of developing breast cancer later.

Silicone breast implants usually do not interfere with a woman's ability to nurse, but if the implants leak, there is some concern that the silicone may harm the baby. Some small studies have suggested a link between breast-feeding with implants and later development of problems with the child's esophagus. Further studies are needed in this area. But if a woman with implants wants to breast-feed, she should first discuss the potential benefits and risks with her child's doctor.


Possible Problems

For all its health benefits, breast-feeding does have some disadvantages. In the early weeks, it can be painful. A woman's nipples may become sore or cracked. She may experience engorgement more than a bottle-feeding mother, when the breasts become so full of milk they're hard and painful. Some nursing women also develop clogged milk ducts, which can lead to mastitis, a painful infection of the breast. While most nursing problems can be solved with home remedies, mastitis requires prompt medical care (see accompanying article).

Another possible disadvantage of nursing is that it affects a woman's entire lifestyle. A nursing mother with baby-in-tow must wear clothes that enable her to nurse anywhere, or she'll have to find a private place to undress. She should eat a balanced diet and she might need to avoid foods that irritate the baby. She also shouldn't smoke, which can cause vomiting, diarrhea and restlessness in the baby, as well as decreased milk production.

Women who plan to go back to work soon after birth will have to plan carefully if they want to breast-feed. If her job allows, a new mother can pump her breast milk several times during the day and refrigerate or freeze it for the baby to take in a bottle later. Or, some women alternate nursing at night and on weekends with daytime bottles of formula.

In either case, a nursing mother is physically tied to her baby more than a bottle-feeding mother. The baby needs her for nourishment, and she needs to nurse regularly to avoid getting uncomfortably full breasts. But instead of feeling it's a chore, nursing mothers often cite this close relationship as one of the greatest joys of nursing. Besides, nursing mothers can get away between feedings if they need a break.

Finally, some women just don't feel comfortable with the idea of nursing. They don't want to handle their breasts, or they want to think of them as sexual, not functional. They may be concerned about modesty and the possibility of having to nurse in public. They may want a break from child care to let someone else feed the baby, especially in the wee hours of the morning.

If a woman is unsure whether she wants to nurse, she can try it for a few weeks and switch if she doesn't like it. It's very difficult to switch to breast-feeding after bottle-feeding is begun.

If she plans to breast-feed, a new mother should learn as much as possible about it before the baby is born. Obstetricians, pediatricians, childbirth instructors, nurses, and midwives can all offer information about nursing. But perhaps the best ongoing support for a nursing mother is someone who has successfully nursed a baby.

La Leche League, a national support organization for nursing mothers, has chapters in many cities that meet regularly to discuss breast-feeding problems and offer support.

"We encourage mothers to come to La Leche League before their babies are born," says Mary Lofton, a league spokeswoman. "On-the-job training is hard to do. It's so important to learn how to breast-feed beforehand to avoid problems."


Interested women or couples are welcome to attend La Leche League meetings without charge. League leaders offer advice by phone as well. To find a convenient La Leche League chapter, call (1-800) LA-LECHE.

Rebecca D. Williams is a writer in Oak Ridge, Tenn.



Tips for Breast-Feeding Success
It's helpful for a woman who wants to breast-feed to learn as much about it as possible before delivery, while she is not exhausted from caring for an infant around-the-clock. The following tips can help foster successful nursing:


Get an early start: Nursing should begin within an hour after delivery if possible, when an infant is awake and the sucking instinct is strong. Even though the mother won't be producing milk yet, her breasts contain colostrum, a thin fluid that contains antibodies to disease. 
Proper positioning: The baby's mouth should be wide open, with the nipple as far back into his or her mouth as possible. This minimizes soreness for the mother. A nurse, midwife, or other knowledgeable person can help her find a comfortable nursing position. 
Nurse on demand: Newborns need to nurse frequently, at least every two hours, and not on any strict schedule. This will stimulate the mother's breasts to produce plenty of milk. Later, the baby can settle into a more predictable routine. But because breast milk is more easily digested than formula, breast-fed babies often eat more frequently than bottle-fed babies. 
No supplements: Nursing babies don't need sugar water or formula supplements. These may interfere with their appetite for nursing, which can lead to a diminished milk supply. The more the baby nurses, the more milk the mother will produce. 
Delay artificial nipples: It's best to wait a week or two before introducing a pacifier, so that the baby doesn't get confused. Artificial nipples require a different sucking action than real ones. Sucking at a bottle could also confuse some babies in the early days. They, too, are learning how to breast-feed. 
Air dry: In the early postpartum period or until her nipples toughen, the mother should air dry them after each nursing to prevent them from cracking, which can lead to infection. If her nipples do crack, the mother can coat them with breast milk or other natural moisturizers to help them heal. Vitamin E oil and lanolin are commonly used, although some babies may have allergic reactions to them. Proper positioning at the breast can help prevent sore nipples. If the mother's very sore, the baby may not have the nipple far enough back in his or her mouth. 
Watch for infection: Symptoms of breast infection include fever and painful lumps and redness in the breast. These require immediate medical attention. 
Expect engorgement: A new mother usually produces lots of milk, making her breasts big, hard and painful for a few days. To relieve this engorgement, she should feed the baby frequently and on demand until her body adjusts and produces only what the baby needs. In the meantime, the mother can take over-the-counter pain relievers, apply warm, wet compresses to her breasts, and take warm baths to relieve the pain. 
Eat right, get rest: To produce plenty of good milk, the nursing mother needs a balanced diet that includes 500 extra calories a day and six to eight glasses of fluid. She should also rest as much as possible to prevent breast infections, which are aggravated by fatigue. 


Medicines and Nursing Mothers
Most medications have not been tested in nursing women, so no one knows exactly how a given drug will affect a breast-fed child. Since very few problems have been reported, however, most over-the-counter and prescription drugs, taken in moderation and only when necessary, are considered safe.

Even mothers who must take daily medication for conditions such as epilepsy, diabetes, or high blood pressure can usually breast-feed. They should first check with the child's pediatrician, however. To minimize the baby's exposure, the mother can take the drug just after nursing or before the child sleeps. In the January 1994 issue of Pediatrics, the American Academy of Pediatrics included the following in a list of drugs that are usuallycompatible with breast-feeding:

  • acetaminophen
  • many antibiotics
  • antiepileptics (although one, Primidone, should be given with caution)
  • most antihistamines
  • alcohol in moderation (large amounts of alcohol can cause drowsiness, weakness, and abnormal weight gain in an infant)
  • most antihypertensives
  • aspirin (should be used with caution)
  • caffeine (moderate amounts in drinks or food)
  • codeine
  • decongestants
  • ibuprofen
  • insulin
  • quinine
  • thyroid medications



Drugs That Are NOT Safe While Nursing
Some drugs can be taken by a nursing mother if she stops breast-feeding for a few days or weeks. She can pump her milk and discard it during this time to keep up her supply, while the baby drinks previously frozen milk or formula.

Radioactive drugs used for some diagnostic tests like Gallium-69, Iodine-125, Iodine-131, or Technetium-99m can be taken if the woman stops nursing temporarily.

Drugs that should never be taken while breast-feeding include:

Bromocriptine (Parlodel): A drug for Parkinson's disease, it also decreases a woman's milk supply.

Most Chemotherapy Drugs for Cancer: Since they kill cells in the mother's body, they may harm the baby as well.

Ergotamine (for migraine headaches): Causes vomiting, diarrhea, convulsions in infants.

Lithium (for manic-depressive illness): Excreted in human milk.

Methotrexate (for arthritis): Can suppress the baby's immune system.

Drugs of Abuse: Some drugs, such as cocaine and PCP, can intoxicate the baby. Others, such as amphetamines, heroin and marijuana, can cause a variety of symptoms, including irritability, poor sleeping patterns, tremors, and vomiting. Babies become addicted to these drugs.

Tobacco Smoke: Nursing mothers should avoid smoking. Nicotine can cause vomiting, diarrhea and restlessness for the baby, as well as decreased milk production for the mother. Maternal smoking or passive smoke may increase the risk of sudden infant death syndrome (SIDS) and may increase respiratory and ear infections.


This article comes from the FDA


Child Safety Seats from US Department of Transportation Guidelines






Which child is buckled correctly?

If you guessed the one in the middle, then you’re right. The harness straps are flat, snug and in position, and the chest clip is at the proper mid-chest, armpit level. 

The other photos illustrate some common mistakes that compromise protection and result in almost 80% of children being improperly restrained.  

  • Upper left: The child is too small to be in a vehicle lap/shoulder belt. The shoulder belt is under the child’s arm, and the lap belt is resting on the child’s abdomen. 
  • Upper right: Harness straps are too high, loose and the chest clip is too low. 
  • Bottom right: Harness straps are loose and twisted and the chest clip is disconnected. 
  • Bottom left: Although the lap belt is positioned correctly, the vehicle shoulder belt is under the child’s arm.



Air Bags



  Your child should be in the back seat. This infant seat is in the air bag deployment zone.

  An infant in a rear-facing child restraint should NEVER be positioned in the path of a frontal air bag.




  Rear-facing child is positioned in front of the passenger air bag deployment zone.

  Seat is resting on the dash/air bag.

  Child is also incorrectly secured:

  Harness chest clip is too low (should be at armpit level).

  Harness straps are positioned too high (should be at, or below, infant’s shoulders).

  Air bags can cause serious injury or death to children, especially infants in rear-facing child seats.






Harness chest clip is correctly positioned at the child’s mid-chest or armpit level. 

Harness straps are snug and straight. 

Rear-facing harness straps should be positioned at, or slightly below, the child’s shoulders.

A harness chest clip should be positioned at the child’s mid-chest or armpit level. This keeps the shoulder straps in the correct position.



Blanket is correctly placed over both the internal harness straps and the child.

A blanket should never be placed between the child and the harness straps, or underneath or behind the child.



Harness straps and chest clip are correctly positioned.

Blanket covering child is correctly positioned.
Rolled towels are placed on both sides of the child for proper position



A rolled towel or foam noodle at the crack of the vehicle seat helps position the infant seat at the correct 45-degree angle (check the manufacturer’s recommendation for the correct angle).




A washcloth helps fill the space between the restraint buckle and the child’s groin area.
Harness straps are snug and straight.


General Car Seat Guidelines

General Child Seat Use Information
Buckle Everyone. Children Age 12 and Under in Back!



Age /


Seat Type /

Seat Position

Usage tips
Infants Birth to at least 1 year and at least 20 pounds

Infant-Only Seat/rear-facing or Convertible Seat/used rear-facing.

Seats should be secured to the vehicle by the seat belts or by the LATCH system.

  • Never use in a front seat where an air bag is present.
  • Tightly install child seat in rear seat, facing the rear.
  • Child seat should recline at approximately a 45 degree angle.
  • Harness straps/slots at or below shoulder level (lower set of slots for most convertible child safety seats).
  • Harness straps snug on child; harness clip at armpit level.
Less than 1 year/ 20-35 lbs.

Convertible Seat/used rear-facing (select one recommended for heavier infants).

Seats should be secured to the vehicle by the seat belts or by the LATCH system.

  • Never use in a front seat where an air bag is present.
  • Tightly install child seat in rear seat, facing the rear.
  • Child seat should recline at approximately a 45 degree angle.
  • Harness straps/slots at or below shoulder level (lower set of slots for most convertible child safety seats).
  • Harness straps snug on child; harness clip at armpit level.
1 to 4 years/ at least 20 lbs. to approximately 40 lbs

Convertible Seat/forward-facing or Forward-Facing Only or High Back Booster/Harness.

Seats should be secured to the vehicle by the seat belts or by the LATCH system.

  • Tightly install child seat in rear seat, facing forward.
  • Harness straps/slots at or above child’s shoulders (usually top set of slots for convertible child safety seats).
  • Harness straps snug on child; harness clip at armpit level.
4 to at least 8 years/unless they are 4’9" (57") tall.

Belt-Positioning Booster (no back, base only) or High Back Belt-Positioning Booster.

NEVER use with lap-only belts—belt-positioning boosters are always used with lap AND shoulder belts.

  • Booster base used with adult lap and shoulder belt in rear seat.
  • Shoulder belt should rest snugly across chest, rests on shoulder; and should NEVER be placed under the arm or behind the back.
  • Lap-belt should rest low, across the lap/upper thigh area—not across the stomach.

From INCIID the Heart: Video of the first baby born through our IVF scholarship program


The "From INCIID the Heart" program, established in the summer of 2004, provides IVF services to deserving couples who would not otherwise be able to afford them. 
(Warning: Baby video)



Shewanda and Carl Harris were one of the first couples to participate in the program.  Shewanda had one miscarriage and two ectopic pregnancies. According to Dr Mory Nouriani, “Shewanda’s case was an exceptionally difficult one. Her prior surgeries had left her with one remaining ovary which had been scarred down, and we were only able to obtain 6 eggs from that remaining ovary.  Despite the up-hill battle, we were elated that her cycle was successful.” Shewanda’s only hope to conceive was through In Vitro Fertilization (IVF).  At an average cost of over $10,000 per attempt, IVF was financially out of reach for the Harrises.


Read the People Magazine Article.


(For more on the first baby and the Harrises click here.)


Information on application to the From INCIID the Heart Program


Help us support the program by contribution or sponsorship.

If you are a clinic wishing to donate medical services or a company who would be interested in sponsoring the program, please email us at:


State Estimates of Neonatal Health-Care Costs Associated with Maternal Smoking --- United States, 1996 from the CDC

State Estimates of Neonatal Health-Care Costs Associated with Maternal Smoking --- US 1996

Smoking during pregnancy can cause poor outcomes for both the pregnant woman and her unborn child (1) and also result in added health-care expenditures. To characterize costs by state, CDC analyzed pregnancy risk surveillance and birth certificate data to estimate the association between maternal smoking and the probability of infant admission to a neonatal intensive care unit (NICU). Neonatal health-care costs, in 1996 dollars, were assigned on the basis of data from private health insurance claims. This report summarizes the results of that analysis, which estimated smoking-attributable neonatal expenditures (SAEs) of $366 million in the United States in 1996, or $704 per maternal smoker (2), and indicated wide variations in SAEs among states. These costs are preventable. States can use these data to justify or support their prevention and cessation treatment strategies.


CDC has incorporated this analysis into its Maternal and Child Health Smoking-Attributable Mortality, Morbidity, and Economic Costs (MCH SAMMEC) software, which generates estimates of the smoking-attributable fraction of neonatal expenditures and provides area-specific estimates of SAEs for all women giving birth and for selected subsets of that population. Costs for 1996 (the most recent data available when MCH SAMMEC was developed) for each area were estimated by mother's age, race, education level, health insurance status, and timing of initiation of prenatal care. Separate estimates for populations of Hispanic ethnicity were not provided; an update of MCH SAMMEC will allow for selection of Hispanic and other racial/ethnic populations.


MCH SAMMEC used national and state-specific maternal smoking prevalence estimates for 1997 by using birth certificate data collected by the National Center for Health Statistics from all areas except California, Indiana, New York state (outside of New York City), and South Dakota.


Mothers were asked whether they smoked during their pregnancy and, if they did, how many cigarettes daily. For California, MCH SAMMEC used Maternal and Infant Health Assessment data. For Indiana, New York state, and South Dakota, smoking prevalence data for women aged 18--44 years were obtained from the Behavioral Risk Factor Surveillance System. Data in MCH SAMMEC are derived by extrapolating the results of a multivariate model estimated on 1995 Pregnancy Risk Assessment Monitoring System (PRAMS) data for 13 states* to all 50 states. This model estimates the association between maternal smoking and the probability of admission to an NICU and infant length of stay, whether in an NICU or regular nursery bed.


These measures of resource utilization (i.e., NICU admission and infant nights in hospital) were assigned dollar costs based on a 1996 private-sector claims database. Details of the MCH SAMMEC methodology and estimation procedure have been published previously (3).


The MCH SAMMEC software provided a national estimate of smoking-attributable neonatal expenditures of $366 million in 1996, or $704 per maternal smoker (2). Across areas, higher total SAE estimates by MCH SAMMEC were associated with higher numbers of births and higher smoking prevalence. SAE totals ranged from $34 million in California to $537,661 in the District of Columbia (DC). After California, states with the highest SAEs were New York, Ohio, Pennsylvania, and Texas; states with the lowest SAEs were Alaska, Hawaii, Vermont, and Wyoming (Table 1). Although overall prevalence of maternal smoking was 13.2% in 1997, prevalence by area ranged from 4.8% in New York City to 25.3% in West Virginia (4). To focus on the population at risk for excess costs in and across areas, SAEs per maternal smoker were estimated. SAEs per maternal smoker ranged from $519 in Hawaii to $1,334 in DC (Table 1).


Although higher smoking prevalence usually is associated with white mothers as compared with blacks, smoking prevalence was higher among black mothers in 13 states and DC. Among black mothers in these 13 states, smoking prevalence ranged from 6.7% to 21.3%, and SAE per maternal smoker ranged from $1,008 to $1,403. Among all states, the average SAE for black mothers was almost double that for white mothers ($1,207 versus $651). However, adverse outcomes among black infants are more likely regardless of maternal smoking; at least one study suggests stronger effects of smoking on birthweight among black women compared with white women (1).


In every area except DC, Indiana, and Mississippi, smoking prevalence was higher for women aged <20 years than for women aged >20 years. In all areas, the prevalence of smoking among pregnant women with less education was more than double the prevalence of women with more education.


Persons who were uninsured or who were on Medicaid while pregnant had greater smoking prevalence than those with private or other health insurance. In all areas except DC and Texas, the prevalence of smoking among Medicaid/uninsured mothers was >10%; prevalence was highest in Indiana (37.7%) (Table 2). The highest SAE per maternal smoker among the Medicaid/uninsured group was in DC ($1,355); the lowest was in Hawaii ($523). Among women in the private/other insurance group, smoking prevalence was <10% in 28 states. The average SAEs per maternal smoker, from all areas, were $753 for those in the Medicaid/uninsured group and $626 for those in the private/other insurance group.


Mothers who are on Medicaid or uninsured are less likely to initiate prenatal care in the first trimester (5). Both the prevalence of maternal smoking and SAE per maternal smoker were higher for mothers who began prenatal care in the third trimester or who had no prenatal care, compared with mothers who received prenatal care in the first or second trimester. The average SAEs per maternal smoker ranged from $485 in Hawaii to $1,112 in DC for mothers beginning care in the first or second trimester and from $821 to $2,166 in the same two areas for women beginning prenatal care in the third trimester, or having no care at all.


Reported by: CL Melvin, PhD, Univ of North Carolina-Chapel Hill and the Smoke-Free Families National Dissemination Office. EK Adams, PhD, Rollins School of Public Health, Emory Univ, Atlanta, GA; MF Ayadi, PhD, CC Rivera, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.


Editorial Note:

In 2001, the estimated prevalence of smoking during pregnancy for all U.S. women was 11.4%, ranging from 3.9% in DC to 26.2% in West Virginia (6,7). Maternal smoking prevalences were higher among women who were younger, white, had less education and lower incomes, and were either on Medicaid or had no insurance (6,8). However, factors other than maternal smoking can result in higher neonatal costs among certain populations. For example, mothers with late or no prenatal care might be more likely to engage in other risk behaviors that affect pregnancy outcomes and increase costs (9). In addition, black infants have a greater likelihood for lower birthweight and adverse outcomes, regardless of maternal smoking (1).


The findings in this report are subject to at least three limitations. First, SAEs do not include neonatal costs incurred after the infant's initial hospital stay or any costs associated with secondhand smoke. Second, although PRAMS data include measures of resource utilization necessary to estimate costs, PRAMS data were not available for all areas. Thus, the models that used sociodemographic characteristics of pregnant women found in both PRAMS and birth certificate data were used to extrapolate SAEs to each area. Finally, SAEs in this report are in 1996 dollars (the most recent available when MCH SAMMEC was developed) and do not reflect cost-of-living variations across states or subsequent increases in costs.


State-specific estimates of SAEs per maternal smoker can help states explore potential cost savings from smoking-cessation interventions and other policies (e.g., excise taxes) that can reduce smoking prevalence among pregnant women (10). All pregnant smokers should be treated according to Public Health Service recommendations. However, sociodemographic data can help states tailor smoking interventions to populations with the highest prevalence.





  1. US Department of Health and Human Services. Women and smoking, a report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2001.
  2. CDC. Annual smoking-attributable mortality, years of potential life lost, and economic costs---United States, 1995--1999. MMWR 2002;51:300--3.
  3. Adams EK, Miller VP, Ernst C, Nishimura BK, Melvin C, Merritt R. Neonatal health care costs related to smoking during pregnancy. Health Econ 2002;11:193--206.
  4. Mathews TJ. Smoking during pregnancy during the 1990s. Natl Vital Stat Rep 2001;49(7):1--14.
  5. Kaestner R. Health insurance, the quantity and quality of prenatal care, and infant health. Inquiry 1999;36:162--75.
  6. Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: final data for 2001. Natl Vital Stat Rep 2002;51(2):1--102.
  7. National Center for Health Statistics. 2001 natality data set. Vital and Health Statistics. CD-ROM Series 21, Number 15. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2003.
  8. Lipscomb LE, Johnson CH, Morrow B, et al. PRAMS 1998 surveillance report. Atlanta, GA: US Department of Health and Human Services, CDC, Pregnancy Risk Assessment Monitoring System;2000.
  9. Wakschlag LS, Pickett KE, Middlecamp MK, Walton LJ, Tenzer P, Leventhal BL. Pregnant smokers who quit, pregnant smokers who don't: does history of problem behavior make a difference? Soc Sci Med 2003;56:2449--60.
  10. Ringel JS, Evans WN. Cigarette taxes and smoking during pregnancy. Am J Public Health 2001;91:1851--6.

* Alabama, Alaska, California, Florida, Georgia, Indiana, Maine, Michigan, New York (excluding New York City), Oklahoma, South Carolina, Washington, and West Virginia.



Table 1
Table 2


NICU: What are these wires and tubes connected to my baby?

What are these wires and
tubes connected to my baby?



Cardiorespiratory Monitor.

This is sometimes referred to as a Heart Monitor or a C-R Monitor. Three adhesive patches with wires connected to them are placed on the baby's chest, abdomen, arms or legs. The wires travel to a machine that displays the baby's heart rate, heart beat pattern, breathing rate and breathing pattern.


Pulse Oximeter.

The "pulse ox" continuously measures the baby's blood oxygen. There is a tiny light which is attached to the baby's palm, foot, finger, toe, or wrist by a piece of adhesive elastic. A cord travels from the light to a machine that displays the amount of oxygen being carried by red blood cells in the baby's body. This may be part of the cardiorespiratory monitor or a separate monitor.


Blood Pressure Monitor.

Blood pressure may be measured periodically by a small cuff placed around the baby's arm or leg, or may be measured continuously if the baby has a catheter (tiny tube) into one of the baby's arteries.


Temperature Probe.

A coated wire will be placed on the baby's skin and covered with an adhesive patch. The coated wire measures the baby's temperature. This information is used to help regulate the amount of heat from the overhead heater or isolette.


IV (intravenous infusion).

This is a needle, or small tube, that is placed into one of the veins of the infant. It is attached by tubing to a container of fluid. It is used to deliver fluids, medications and nutrients to the baby. Common sites for IVs are hands, feet, arms, legs, and scalp.


Umbilical artery catheter (UAC) or Umbilical venous catheter (UVC).

This is a small piece of tubing threaded into the baby's artery or vein in the umbilical stump. In addition to delivering fluids, medication, and nutrients, blood can be withdrawn painlessly for laboratory studies.


Transcutaneous Oxygen and/or Carbon Dioxide Monitor.

This machine measures oxygen and/or carbon dioxide at the skin. A small circular piece attaches to the skin with a thin circle of adhesive. This piece both heats up a tiny area of skin and measures the oxygen, carbon dioxide, or both. A tiny cord travels from the circular piece to a machine which displays the information. The oxygen measurement is different from that of the pulse oximeter so the numbers are different, usually lower. Because the skin must be heated, there may be a red spot where the circular piece has been. The location of the piece is changed regularly. The red spots will fade over time.


CPAP (Continuous Positive Airway Pressure).

Oxygen (or air) is delivered under a small amount of pressure usually through little tubes that fit into the nostrils of the nose. Delivering oxygen under pressure helps keep the air sacs in the lung open.


Endotracheal Tube.

This is a tube that goes from the baby's mouth or nose into the baby's windpipe (trachea). It is secured with tape and attaches by tubing to a breathing machine. It allows the machine to deliver air directly to the baby's lungs.


Respirator or Ventilator.

This is a machine to help your baby breathe. Some machines make the baby's own breaths bigger (synchronized ventilation), or give breaths like the baby should be taking. Others, called high frequency ventilators, hold the lungs open with a constant pressure and then give hundreds of tiny puffs of air or oxygen each minute.



This is a small soft circle attached to the abdomen. It is used only with certain kinds of breathing machines. It tells the machine when the baby starts to take a breath so the machine breaths can be timed to the baby's own breaths.


Information from University of Wisconsin and the The Center For Perinatal Care at Meriter Hospital Madison, Wisconsin- For Parents of Preemies



Children First: Making the Paradigm Shift from Infertility to Adoption By Patricia Irwin Johnston, MS

Moving from infertility to adoptive parenting is a complicated emotional process. In transferring from the process and the culture of infertility and its treatment to the process and culture of adoption, consumers are expected to make a huge shift. The Barrier? Medical treatment is centered on the needs and wishes of the paying-client—the adult who wanted a baby (that’s you!). Adoption’s culture is centered on the needs and best interests of the one client who has no say in the process and who bears no financial responsibility—the child (not you!) Adoption is child-centered rather than adult-centered. But you, one of three clients in the picture, will carry all of the financial risk and burden.

Not fair, you say? I understand. Been there. Felt that. But as my children by adoption have grown up, as our relationships with them and some of their birthparents have developed, I’ve changed my thinking a lot.

Here’s something you probably don’t understand if you are not yet a parent. Parenting itself changes everything. From the moment you become a parent forward, your child’s needs will always come before yours and before anyone else’s in your life. For those who conceive their children, that shift comes automatically as part of the pregnancy experience. Indeed, it’s that shift in thinking that makes it possible for birthparents to plan an adoption.

For those who adopt, however, making that shift is not automatic. Unless one makes a deliberate choice to shift thinking, to participate in an adoption expectancy period, the shift won’t likely happen until after the child arrives. And by then, many infertile couples can have made some pretty bad choices already—choices rooted in their frustration, in their reactions to many losses that infertility has brought to them, in the desperation they have begun to feel about ever being able to parent.

Over the past twenty years or so, changes in adoption have done little more than move the locus of power in adoptions. First power was moved from adoption professionals to adoptive parents, and now it has been transferred to birthparents. But changes in who holds the power have not often included the education necessary for all of these parties to understand and accept what children themselves need from adoption. And what is it that children need? They need well-prepared, unafraid, stable and loving families over their entire lifetimes!

Too many of those involved in adoption right now seem to experience it as a competition. Agencies compete with other agencies and with independent service providers to draw in limited numbers of birthparents whose healthy babies can be offered to an apparently unlimited supply of prospective adopters. Special needs agencies compete with one another for public and private grant money, and often trash one another and their differing approaches to counseling and preparation. Prospective adopters compete with other prospective adopters for the opportunity to adopt available babies. They look for too many shortcuts to “faster” placements by looking for providers who will not require education, extensive preparation, and screening, because it is too “invasive and unfair.” Adopters attempt to demonstrate to expectant parents that their adoptive family would offer a "better" life for the child about to be born than would the child’s family of origin or any other prospective adopters. When an expectant parent has a change of heart about adoption during the window of time a state or province grants for the change-of-mind process, many adopters and their professional advisors take the stance that possession-is-nine-points-of-the-law and go to court so that they might "keep" the baby, even though they are not yet the legal parents. Adopters, birthmothers and professionals often conspire to keep birthfathers and their families out of the picture entirely.

Ideally, changing adoption so that it really meets the needs of children would begin with fundamental changes in thinking and in the law. Different thinking would end the adversarial aura that surrounds adoption. If adoptions really kept the child's interests center-stage, everybody involved in any untimely pregnancy would be seeking the best possible solution for the child to be born. This solution would find him with his permanent family (birth or adoptive) as soon as possible after his birth.

Getting off to this kind of a "clean" start in an adoption, however, demands a tremendous amount of understanding and emotional work on the part of both sets of parents, as well as careful judgment on the part of well trained and well informed professionals. Those working to launch a child-centered adoption must be helped to understand how each of the decisions made and each of the procedures followed will help the child at the adoption's core.

For a baby's launch to be optimal, everyone involved must be committed to being honest with everyone else in the adoption. Birthparents must be honest with one another, with helping professionals, and with prospective adopters. Adopters must be scrupulously honest with professionals and expectant parents. Intermediaries must be scrupulously honest with expectant parents and prospective adoptive parents. There must be no assumptions that “leaving that little something out” “letting that little something go,” causes no harm. Scrupulous adherence to ethical standards that keep the child at the center while respecting the needs and interests of both adoptive parents and birthparents is absolutely crucial in making all decisions concerning an adoption.

As an adoptive parent, wife, sister-in-law, daughter-in-law, cousin-in-law, sister-in-open-adoption to my child’s birthmother, and adoption educator, I hold those who elect to join to adopt to very high standards. That’s because this is what children deserve from their parents.

Patricia Irwin Johnston. is an INCIID Advisory Board Member. She is a long-time advocate, infertility and adoption educator and author of several books, including Adopting after Infertility, Launching a Baby’s Adoption, and INCIID’s own Adoption Is a Family Affair, written with the participation of the INCIID community members on two of the forums which Pat moderates: Exploring and Expecting through Adoption.

Contact Information:

Phone: (317) 872-3055