Breastfeeding Concerns Linked to Quitting

September 23, 2013

News Review From Harvard Medical School -- Breastfeeding Concerns Linked to Quitting

Nearly all first-time mothers who want to breastfeed have concerns about the process, a new study finds. And those with early concerns are more likely to quit. The study included more than 500 first-time mothers. Researchers did 6 interviews with each woman. The first one was during pregnancy. The others came at 3, 7, 14, 30 and 60 days after birth. About 92% of new mothers reported 1 or more concerns about breastfeeding. Common concerns included breast pain, milk supply or the baby not latching on to the breast properly. Women who had concerns 3 or 7 days after birth were those most likely to quit breastfeeding. They were up to 9 times as likely to quit as women who had no concerns. Women who had no concerns at day 3 tended to be self-confident about breastfeeding and had a good support network. Most of them had a vaginal birth, and for many this occurred without  drugs, such as pain medicine. They also were more likely to be under age 30 and Hispanic. The journal Pediatrics published the study. HealthDay News wrote about it September 23.

By Claire McCarthy, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

If we want more mothers to breastfeed, we need to get them more support in the first couple of weeks.

That's the take-home message of a study just released in the journal Pediatrics.  Researchers from Cincinnati Children's Hospital and the University of California at Davis did the study. They talked to more than 500 first-time mothers about their breastfeeding support, intentions and concerns. They talked to them before birth and then at regular intervals through 60 days after birth.

Almost all of them had some early concerns. In fact, on the third day after birth, 92% of them had at least one concern. The most common ones were about the mechanics of feeding, breastfeeding pain and milk supply. Mothers with concerns were more likely to stop breastfeeding or supplement with formula.

Having lots of concerns at day 3, which is usually when mothers leave the hospital and try things on their own, was most strongly linked with stopping breastfeeding. Mothers with worries about how their baby was feeding on day 7, and those who worried whether they had enough milk at day 14, were also more likely to stop breastfeeding.

What's sad about this is that most of these concerns could be addressed with enough education and support.  As the authors of the study point out, many new mothers don't fully understand the breastfeeding process. As a result, they misinterpret normal newborn behavior.

For example, it's very common for breastfeeding babies to want to nurse very often. Sometimes this is as much for comfort as for nutrition. Many new mothers see this as a sign that they don't have enough milk and their babies are hungry.

The authors found that three factors seemed to help protect against stopping breastfeeding:

• Self-confidence about breastfeeding
• Vaginal birth without medicine, such as pain medicine (sometimes medicines can make mothers feel sick or woozy and delay or complicate early breastfeeding)
• Breastfeeding support

What Changes Can I Make Now?

If you are pregnant, learn as much as you can about breastfeeding before you give birth. Read, talk to other mothers and visit the website of the La Leche League. The more you learn about the process, what's normal and how to handle common problems such as nipple soreness, the more prepared you will be.

It's also important to set up your support network ahead of time. Identify friends and relatives who have breastfeeding experience and can help you. Talk to your pediatrician (ahead of time!) about breastfeeding resources in your community. The La Leche League website can also help you find local support. Having these supports in place before you give birth can make all the difference.

If you have breastfeeding experience, reach out to pregnant friends and let them know you are available to help. Keep reaching out, especially during those first couple of weeks.

What Can I Expect Looking to the Future?

Currently, 75% of new mothers start breastfeeding. But just 13% feed the baby only breast milk for the first 6 months, as the American Academy of Pediatrics recommends. This is unfortunate, because breastfeeding has significant health benefits for both the baby and mother. It also can help with bonding.

Clearly, mothers need more support if they are going to breastfeed. This study tells us more about their worries and needs. I hope we will use this information to create better education and support resources for them.