It was an indelicate subject that bordered on indecent, according to Victorian mores. Certainly not something to be flaunted publicly.

The subject was breast-feeding.

For most of the 20th century, American society preferred to tuck away references to this act, which after all is as natural as life itself. And that's the stigma associated with just talking about it. Actually nursing a baby in public was a lot more difficult. Unless the nursing mother stayed at home with her infant, she needed to constantly find locations where she could discreetly feed her baby, and many times a day.

Breast-feeding mothers encounter less disapproval today, as medical research has accumulated about its benefits. But it's still sometimes viewed as a "lifestyle choice," said Suzanne Unger of Wildomar. Unger is a leader in La Leche League of Temecula Valley (www.lalecheleague.org). The group is a breast-feeding information and support group of mothers who have breast-fed. Formed in Chicago 50 years ago, the group gets its name from the Spanish word for milk.

La Leche League's name is a defense against this prudery, said Monique Coleman of Temecula, another group leader. The name is a euphemism for breast-feeding that, among other things, made it possible for the group's meeting notices to be published in newspapers.

The group defines its mission as helping mothers who have already decided they want to breast-feed, not to persuade mothers who don't want to breast-feed.

But pediatrians have no such limitation: They strongly endorse breast-feeding as the gold standard of infant nutrition. Breast-fed babies are healthier and less apt to become obese than those not breast-fed.

Babies should be fed only breast milk for the first six months and continue to be breast-fed until at least 1 year of age, according to a 2005 policy statement by the American Academy of Pediatrics. It's available at http://tinyurl.com/5p8fx.

The National Women's Health Information Center puts the matter more sternly. Instead of stressing the benefits of breast-feeding, it lists the "Health Risks of Not Breast-feeding." Go to: http://tinyurl.com/kfc7d for more information.

Living medicine

Breast milk is far more than food; it's medicine and a living tissue that gives the vulnerable newborn some of the strength of the mother's immune system.

It's a wizard's broth of proteins, vitamins, growth factors, fats and disease-fighting substances such as antibodies. Live white blood cells, some of which lodge in the baby's intestines, also fight disease. Breast milk also varies over time in composition in accordance with a baby's needs.

There is a 21 percent lower death rate in American infants who have been breast-fed, compared with those who have not been breast-fed at all, according to a May 2004 study in the journal Pediatrics. The study examined mortality statistics of infants between the ages of 28 days and 1 year. Go to: http://tinyurl.com/eucbw for the study.

Breast-fed babies not only survive better, they are healthier than those fed formula. The beneficial effects extend well into adolescence and perhaps beyond. Breast-fed babies have lower rates of respiratory diseases, childhood leukemia, obesity and a lower level of the so-called "bad" LDL cholesterol.

They also cope with stress better, according to a study published this month in the journal Archives of Disease in Childhood.

Moms, too, get a significant health benefit from breast-feeding. There's a lower risk of Type 2 diabetes, according to a study in the Nov. 23, 2005, issue of the Journal of the American Medical Association.

Several studies indicate that breast-feeding is associated with a reduced rate of breast cancer.

The great majority of mothers in California try to breast-feed, according to a study released Aug. 7 by the UC Davis Lactation Center. More than 83 percent of new mothers who enter the hospital start out breast-feeding,

However, the good intentions often don't last long. Only about half the mothers are feeding their babies only breast milk when they leave the hospital. The rest add supplements such as formula; the remainder never breast-feed at all.

San Diego County ranks in the middle of the state in exclusive in-hospital breast-feeding, according to the California WIC Association and the lactation center. The county ranks 29th out of 50, with a 57.5 percent rate of exclusive breast-feeding. Riverside County ranks 35th, with an exclusive rate of 44.3 percent.

Marin County is first, with a 95.5 percent rate of exclusive breast-feeding. Imperial County is last, with 5.3 percent.

Mother to mother

Coleman, the Telemecula La Leche League leader, was eager to breast-feed her first baby, now 4. Coleman prepared for her baby while pregnant by attending the group's meetings. She also talked with her mother and thought herself well-prepared.

But the happy vision of blissful mother and child didn't materialize. Coleman's new daughter had trouble getting the right "latch" onto the nipple. Result: sore breasts and a frustrated, hungry baby.

Coleman turned to La Leche League. She learned she had inverted nipples, which couldn't fit easily into the baby's mouth. So Coleman got a nipple guard, a thin perforated piece of silicone placed on the breast. By sucking on it, the baby got her milk, and the nipple was drawn outward.

After a few weeks, the nursing was much easier. She continued nursing until the child was just over 2 years old and stopped suckling of her own accord.

"I would just say to any woman who is going to have a baby and wants to breast-feed, getting information is very helpful, but it may not be enough. You can meet a network of mothers through La Leche League and get support, mother to mother."

Coleman now is breast-feeding her second daughter, who is 10 1/2 months old. This time, she said, things are going more smoothly.

Staying close

Fewer than 5 percent of mothers are physically incapable of breast-feeding, said Nancy E. Wight, M.D., a neonatologist at the Rady Children's Hospital in San Diego. Wight is a member of the California State Breast-feeding Promotion Committee and an International Board Lactation consultant.

For the remaining 95 percent plus of mothers, successful breast-feeding is a matter of getting the right information and persistence, Wight said.

Even a short period of breast-feeding is better than none at all. The first breast milk, called colostrum, is produced for the first few days of breast-feeding. Colostrum has high levels of carbohydrates, proteins and antibodies. It is low in fat, which newborns have trouble digesting.

After colostrum comes the regular milk, which has lower concentrations of these ingredients but is produced in higher volume. That change reflects the increased capacity of an infant's stomach, which at birth has the capacity of a marble. That's why newborns have to be fed so often -- at least eight to 12 times a day.

The benefits of breast-feeding accumulate as the child grows older. Wight said infants and toddlers can benefit from breast-feeding for much longer than the one-year minimum recommended by the American Academy of Pediatrics.

Protection from disease is one of the biggest benefits. "The child's immune system isn't completely formed until four, five, six years," Wight said.

During that time, the mother passes on her immunity to diseases through breast milk, Wight said. Skin-to-skin contact helps that process because it ensures the mother is exposed to any germs the baby is exposed to.

Even the most vulnerable babies of all, those born prematurely, benefit from this close contact. In what's called "kangaroo care," a diapered "preemie" is placed on the bare chest of a parent. If it's the mother, the baby is snuggled between the breasts. The practice calms the baby, helps bonding and encourages milk production.

Previously, doctors had worried that parents would bring in germs that would harm the infant, Wight said. But today's thinking is the opposite: Skin contact and transference of immunity through breast milk help preemies survive the nasty germs that are prone to spread in hospitals.

Solving problems

While attitudes today are friendlier toward breast-feeding, modern women face logistical hurdles their mothers and grandmothers usually didn't face. Many mothers work and either cannot afford to give up their jobs or find it difficult to fit in continual breast-feeding with their work.

La Leche League spokeswomen such as Coleman and Dana McCoy, a La Leche League leader in San Marcos, say these problems are solvable. That's where the mother-to-mother advice comes in. Women who have faced these problems before can directly counsel the new mother on what to do.

"I love the camaraderie and the problem-solving. … We're all mothers, doing the best we can in the time we have," said McCoy, who had her first daughter 16 years ago. After her second daughter, McCoy decided to step up her involvement with La Leche League and become a leader.

The leaders, who are volunteers, go through an accreditation process.

"We're not medical professionals and we can't solve every problem, but we can provide a lot of good information," McCoy said. If expert advice is required, La Leche League refers mothers to the appropriate professionals.

There is no cost or obligation for La Leche League support, McCoy said.

"Many of those do become members, and we appreciate that, but there is no requirement that they do. It is a free and available resource."

Contact staff writer Bradley J. Fikes at bfikes@nctimes.com or (760) 739-6641. Comment on this story at www.nctimes.com.

Call your baby's doctor if:

• Your baby sucks only briefly, very softly or irregularly.

• Your baby is very jaundiced (yellow) and getting more yellow.

• You have severe, constant nipple pain.

• Your baby fights the breast or cries after a minute or two.

• Your baby has fewer than six wet diapers a day,

• Your baby has little or no stool, or has dark green mucus stools,

• Your baby seems weak, tired, or not interested in feeding.

Source: San Diego Breastfeeding Coalition www.breastfeeding.org

On the Net:

Local breast-feeding information:

La Leche League of Temecula

http://www.lllusa.org/web/TemeculaCA.html

Palomar Pomerado Health Lactation Services

(800) 628-2880

Tri-City Medical Center (760) 940-7745

Scripps Memorial Hospital-Encinitas (760) 633-7850

La Leche League of San Diego

http://www.lllusa.org/web/SanDiegoCA.html

San Diego County Breastfeeding Coalition

(800) 371-6455 (MILK)

Information on breast-feeding a list of local breast-feeding resources and free lactation education programs for businesses:

http://www.breastfeeding.org

Southwest Healthcare System

http://www.ivrmc-rsmc.com/p1071.html

Rady Children's Hospital San Diego

http://www.chsd.org/body.cfm?id=613

Breast-feeding classes

Fallbrook Hospital

Classes are part of a six-week course on prepared childbirth. The course takes place at the hospital from 6:30 to 8:30 p.m. Thursdays in Conference Rooms A & B. For more information or to sign up, call (760) 728-1191, Ext 481.

Palomar Pomerado Women's Health Connection Boutique

(Breast pumps for rental or purchase, and other breast-feeding accessories sold.)

(858) 613-4894

15725 Pomerado Road, Suite 100, Poway

1:30 to 2:30 p.m. Tuesdays and Fridays

San Marcos Ambulatory Care Center

(Palomar Pomerado Health)

120 Craven Road, Suite 103, San Marcos

1 to 2:30 p.m. Thursdays

More classes listed online at http://www.pph.org/body.cfm_id=11b.htm

Palomar Medical Center/Birth Center

555 E Valley Pkwy, Escondido

Register online at: http://www.pph.org/body.cfm_id=11b.htm

Scripps Memorial Hospital Encinitas

"Breast-feeding Your Baby." One session -- 2.5 hour classes held at the hospital, 345 Santa Fe Drive, Encinitas. Classes will be held at 6:30 p.m. Wednesdays on these dates: Sept. 6, Oct 4, Nov. 1 and Dec. 6. Registration required. Call (800) SCRIPPS for more information and to register.

Southwest Healthcare System

10 a.m.-noonTuesdays

Inland Valley Medical Center

36485 Inland Valley Drive, Wildomar

Enter through hospital lobby to Main Conference Room, down hallway on right side.

10 a.m.-noon Fridays

Rancho Springs Medical Center

25500 Medical Center Drive, Murrieta

Go to Administrative Services Building (across from the Emergency Department entrance) Classroom 2 or Conference Center.

For more information, call (951) 696-2621.

Tri City Medical Center

Breast-feeding classes held from 6:30 to 9 p.m. Mondays on Sept. 11; Oct 16; Nov 13 and Dec. 11. Held at the hospital, 4002 Vista Way, French Rooms. Sign up at http://referrals.intellicare.com/enhanced/classSearch.asp?Facility=47044 or call (760) 940-5784.