Postnatal breastfeeding concerns associated with discontinuation

Image: PD 

1. Most new mothers (>90%) reported breastfeeding concerns in the early postnatal period. 

2. Mothers who had any breastfeeding concerns postnatally had a significantly higher risk of formula feeding and discontinuation of breastfeeding by 60 days postpartum when compared to those with no concerns.

Evidence Rating Level: 2 (Good)

Study Rundown: Breastfeeding provides numerous nutritional and protective health benefits to infants. However, only half of US mothers achieve their breastfeeding intention; many either discontinue earlier than intended or supplement breastmilk with formula. Previous studies have cited early breastfeeding challenges as reasons for supplementation or discontinuation, although these retrospective self-reports may be biased by current feeding status. This study prospectively interviewed first-time mothers both prenatally and postnatally to determine the relative risks of using formula or stopping breastfeeding by 60 days postpartum. Results indicate that most new mothers (>90%) reported breastfeeding concerns in the first few days postpartum. Furthermore, mothers with any breastfeeding concern postnatally had a higher risk of supplementing or discontinuing. This study is limited by the possible reluctance of some mothers to share breastfeeding concerns during an in-person interview. Nonetheless, these results support the American Academy of Pediatrics’ recommendation that all breastfed newborns be evaluated by a provider knowledgeable in lactation two to three days post-discharge to help new mothers in their plan to breastfeed and address their concerns early on.

Click to read the study published today in Pediatrics (pending)

Relevant Reading: CDC Guide to Strategies to Support Breastfeeding Mothers and Babies

Study Author, Dr. Laurie A. Nommsen-Rivers, PhD, IBCLC, talks to 2 Minute Medicine: Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

“In the United States, over 75% of new mothers start out breastfeeding. Clearly evident in our results from Sacramento are the multiple and complex challenges new mothers report in trying to accomplish their breastfeeding goals. Fortunately, a lot of progress is being made in supporting mothers’ efforts to breastfeed during their maternity stay. However, we found that breastfeeding problems peak 3-7 days after giving birth, which is when most new mothers are home from the hospital but not yet hooked into breastfeeding support resources within their social circle or community. I am hopeful that this study will lay to rest the notion that because breastfeeding is “natural” it is therefore easy for today’s mothers. Every mother deserves to be supported in her efforts to breastfeed, including having her concerns acknowledged, misconceptions clarified, and problems addressed—and not just during her maternity stay, but in the critical first few days at home and beyond. I encourage anyone who interacts with new mothers to take a look at the recently released CDC Guide to Strategies to Support Breastfeeding Mothers and Babies, because we all play a role in supporting mothers’ efforts to nourish the next generation.”

In-Depth [prospective cohort study]: A total of 364 first-time mothers were interviewed prenatally and postnatally (at days 0, 3, 7, 14, 30, and 60) regarding their breastfeeding attitudes, intentions, and concerns. Most mothers (>92%) had breastfeeding concerns postnatally. The main outcomes evaluated were 1) infant was fed formula between 30 to 60 days postpartum and 2) infant stopped breastfeeding by day 60. “Uncertainty with own breastfeeding ability” was the most common concern (28%) at the prenatal interview. “Infant feeding difficulty”, “pain while breastfeeding”, and concern about “milk quantity” were of greatest concern at day 0 (44%) and day 3 (54%), day 7 (47%), and day 3 (41%), respectively. Those with any breastfeeding concerns postnatally, particularly on day 3, had a significantly higher risk of formula feeding and stopping breastfeeding (ARR = 3.3 and 9.2, respectively). The categories most significantly associated with increased risk of formula feeding and  breastfeeding discontinuation included milk quantity concern (adjusted *PAR – 23%) and infant feeding difficulty (adjusted PAR = 32%). Only 34 women did not report a breastfeeding concern at day 3; these women were more likely to be younger than age 30, Hispanic, and have prenatal breastfeeding self-efficacy, an unmedicated vaginal birth, and strong breastfeeding support.

ARR: adjusted relative risk; PAR: population attributable risk

By Cordelia Y. Ross and Leah H. Carr

Reviewed by William V. Raskza, MD

More from this author: Childhood bullying associated with increased risk of psychosomatic problems; Parents’ ADHD treatment preferences predict treatment initiation; Difficulty diagnosing autism spectrum disorders in Latino children; Children with abdominal pain at risk for anxiety, depression; Adolescent smoking heavily influenced by parents and siblings

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT.