We characterized breastfeeding concerns from open-text maternal responses and determined their association with stopping breastfeeding by 60 days (stopping breastfeeding) and feeding any formula between 30 and 60 days (formula use).
We assessed breastfeeding support, intentions, and concerns in 532 expectant primiparas and conducted follow-up interviews at 0, 3, 7, 14, 30, and 60 days postpartum. We calculated adjusted relative risk (ARR) and adjusted population attributable risk (PAR) for feeding outcomes by concern category and day, adjusted for feeding intentions and education.
In 2946 interviews, 4179 breastfeeding concerns were reported, comprising 49 subcategories and 9 main categories. Ninety-two percent of participants reported ≥1 concern at day 3, with the most predominant being difficulty with infant feeding at breast (52%), breastfeeding pain (44%), and milk quantity (40%). Concerns at any postpartum interview were significantly associated with increased risk of stopping breastfeeding and formula use, with peak ARR at day 3 (eg, stopping breastfeeding ARR [95% confidence interval] = 9.2 [3.0–infinity]). The concerns yielding the largest adjusted PAR for stopping breastfeeding were day 7 “infant feeding difficulty” (adjusted PAR = 32%) and day 14 “milk quantity” (adjusted PAR = 23%).
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.
Dear Sirs: I suggest that we apply the same protocols for the end to end treatment of breast milk as we use in the Organ/ Tissue protocols that ensure proper handling of the Milk by Le Leche League at collection points to proper handling of Milk from collection through dispersement of milk in a manner that assures proper refrigeration and speedy delivery to the end users either frozen or packed in dry ice immediately after collection under USDA supervision.
Conflict of Interest:
None declared
This study, which identifies the many breastfeeding concerns of new mothers, concludes that more lactation support is needed in the first few weeks postpartum. The researchers did not document, however, whether or not the women in the study had professional lactation help.
One of the researchers, Dr. Dewey, said the following in a UCDavis press release " ...Such support could help allay any unwarranted concerns and provide new moms with the reassurance and assistance they need to meet their breastfeeding goals." (2) Another researcher, Dr. Nommson-Rivers was quoted in a Reuters article about this study as stating "If we are able to provide mothers with adequate support, 95 percent of all breastfeeding problems are reversible." (3)
What the researchers failed to mention in the abstract or press release was that the UC Davis Medical Center, where the study was conducted, has an award winning lactation program* and "...During the study period, International Board Certified Lactation Consultants were generally available on the maternity unit 6 days per week and after discharge at the UCDMC Breastfeeding Clinic. The study research assistants referred participants to UCDMC breastfeeding support resources as needed."(1)
About half the study participants had public health insurance which would qualify them for the WIC (Women Infants Children) Program. Sacramento and Yolo County near UC Davis) WIC offers free breastfeeding support. Lactation consultants and peer counselors are on staff, there is after hours phone support, and pumps are available when necessary. Sacramento County WIC offers prenatal breastfeeding classes and support groups.
With all of this support available, why did so many women discontinue to breastfeed? And, of those that were still breastfeeding, why did 68% of them continue to have concerns at 30 days postpartum? (1)
It would be meaningful to know if these resources were used, and if so, how many of the concerns or problems were resolved, or not resolved, with professional lactation support. It would also be meaningful to know if the resources were not used, and why.
Another limitation of the study was that the researchers concentrated only on women's concerns about breastfeeding, which tended to discount the problems these women were experiencing. I would think that women with concerns of pain or feeding difficulties (which did not go below 34% by days 7 and 14), were most likely in pain or having feeding difficulties. Mothers with concerns about signs of insufficient intake (low urine output, weight loss, and jaundice), at day 7 (15%), and day 14 (17%) most likely had babies who were not getting enough milk. I would not call these merely concerns.
I feel that the authors failed to take into account of the findings of this study. By focusing only on concerns, and classifying them as such, they downplayed fact that many women do really have a hard time breastfeeding. Furthermore, by not documenting whether or not these women had lactation help, the authors could conclude that more support for lactation services is needed, as well as assert that 95% of problems are reversible.
After reading this study, I would conclude that even with good lactation support, breastfeeding can be difficult for many women, and some are unable to produce enough milk. I would think that a study such as this could serve to take some of the pressure off many new mothers to breastfeed and succeed at all costs.
Anne Risch RN
*IBCLC Lactation Care Award, .... To attain the recognition, a facility must hire individuals with IBCLC certification and have a dedicated lactation support program available five-to-seven days a week. The facility also must have demonstrated that it has provided training for its nursing, medical and other staff that care for breastfeeding families, and have implemented special projects that promote, protect and support breastfeeding and the lactation consultant profession. UC Davis Medical Center has nine IBCLC's who support new parents. (4)
(1) Pediatrics. 2013 Oct;132(4):e865-e875. Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months. Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA.
(2) Reuters . Mon Sep 23, 2013 3:34pm EDT Breastfeeding Concerns Common Among new Mothers NEW YORK | By Genevra Pittman
(3) UC Davis Health System NEWS September 23, 2013 Breastfeeding fraught with early challenges for most first-time mothers . Pat Bailey
(4) UCDavis Heatlh Syestem News May 6, 2013 UC Davis Medical Center named mother-baby friendly workplace
Conflict of Interest:
none