Evidence-based data informs pediatricians to recommend exclusive breastfeeding for a baby’s first six months. It’s heartening to see that 75% of mothers in the U.S. initiate breastfeeding! So how many make it the full six months?
13%. And it’s clear that many mothers stop nursing a very short time — in a matter of days and weeks — after delivery. Why is that?
Certainly moms and babies can have medical difficulties shortly after birth that delay or prevent latching on early. There may be problems related to the proper mechanics of breastfeeding which could result in an inefficient latch on (such as inverted, or cracked and painful nipples in the mother or anatomic issues with the baby, such as ankyloglossia (tongue-tie)).
Then there are the expectations that parents (and maybe other family members and friends) have regarding milk supply in the first few days of the breastfeeding process. In the first 24 hours or so, there may only be a mouthful of colostrum available for the baby at each feeding. By two days, it may only be two mouthfuls per feeding. The good news is that is all a newborn baby needs! It can take between 4-7 days before a mother will be able to tell us, with a great degree of confidence, that they can feel their milk has come in and that the supply seems to be good. (There are factors that can even affect the amount of milk produced, covered previously on The PediaBlog.)
Add to that the physical and emotional fatigue from all the excitement that sets in after the birth of a baby and you can see how 4-7 days is a long time to wonder whether breastfeeding is working or not.
Then there are moms who return to work a few weeks after delivery. Many workplaces are not friendly to mothers who want to pump and save their milk. Some moms would rather nurse at home in the mornings and evenings and have caretakers provide formula during the day. Other moms choose to wean completely once they go back to work.
All these things conspire to prevent a greater number of nursing mothers to nurse exclusively for the first six months. A new study in Pediatrics — summarized by the AAP — looks at the most frequent reasons for non-success:
The authors conducted 2,713 interviews with first-time mothers and found that breastfeeding concerns within the first 14 days postpartum are significantly linked to the duration of breastfeeding. Interviews were conducted during pregnancy, 24 hours after giving birth and again at 3, 7, 14, 30 and 60 days postpartum. Breastfeeding concerns at any of these points were significantly associated with increased risk of stopping breastfeeding and starting to use formula. The most predominant concern was difficulty with infant feeding at the breast (52 percent), followed by breastfeeding pain (44 percent) and milk quantity concerns (40 percent).
Although I don’t have any data to support this, I suspect that way more than 13% of mothers in my practice continue to breastfeed at least six months. Our local hospital nurseries are staffed by very knowledgeable and supportive nurses and lactation consultants. Our office schedules are flexible enough to bring in newborns and their mothers early — and often — after discharge. Some offices even have certified lactation consultants available to help moms and babies succeed. (Dr. Wendy Bacdayan serves that role at our Chartiers/McMurray division; Dr. Brian Donnelly at North Hills; Dr. Hilary Garbon and Dr. Mary Pagnotto at Northland.) Throughout the whole process — from initiation to weaning — our board certified pediatricians and certified pediatric nurse practitioners are all well-trained and equipped to achieve the breastfeeding goals that mothers have.
The study concludes:
Breastfeeding concerns are highly prevalent and associated with stopping breastfeeding. Priority should be given to developing strategies for lowering the overall occurrence of breastfeeding concerns and resolving, in particular, infant feeding and milk quantity concerns occurring within the first 14 days postpartum.