Can breastfeeding concerns be overcome with support? Depends on what “support” means

Guess what? Women are having trouble meeting their breastfeeding goals.

Contain your excitement.

Apparently, this is news to the American Academy of Pediatrics, and every major news outlet in North America. The study causing such shock and awe came out this Monday in the journal Pediatrics. Researchers used self-reported data (i.e., interviews) from 532 first-time moms giving birth at a particular medical center (can’t find where, and due to geographical differences in levels of breastfeeding support and acceptance, I think this is vital information that at least one of the articles could have shared with us). The women were asked prenatally about their breastfeeding intentions and concerns, and then re-interviewed at 3, 7, 14, 30 and 60 days postpartum. According to Reuters:

During those interviews, women raised 49 unique breastfeeding concerns, a total of 4,179 times. The most common ones included general difficulty with infant feeding at the breast – such as an infant being fussy or refusing to breastfeed – nipple or breast pain and not producing enough milk.

 

Between 20 and 50 percent of mothers stopped breastfeeding altogether or added formula to the mix sooner than they had planned to do when they were pregnant.

 

Of the 354 women who were planning to exclusively breastfeed for at least two months, for example, 166 started giving their babies formula between one and two months.

 

And of 406 women who had planned to at least partially breastfeed for two months, 86 stopped before then.

Given these results, the study authors come to the conclusion:

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. (Source: Pediatrics)

 

The headlines, as usual, were both amusing and infuriating. “Nursing Troubles May Prompt New Moms to Give Up Sooner”. “Early breastfeeding challenges make women quit.” “Some moms discontinue breastfeeding within two months die to nursing difficulties”. And my personal favorite, “95% of breastfeeding problems are reversible.”

One might easily blame the media for their usual skewering of the science to make for a juicier headline, but one can hardly blame them when the experts giving interviews about this study say things like, “It’s a shame that those early problems can be the difference between a baby only getting breast milk for a few days and going on to have a positive breastfeeding relationship for a year or longer… If we are able to provide mothers with adequate support, 95 percent of all breastfeeding problems are reversible.”

So, what’s my issue? I think the study is fine. Sort of a no-brainer, considering they could’ve came to the same conclusion years ago had they just listened to moms instead of insisting we just needed more convincing of the benefits of breastfeeding, and we’d all magically lactate to the satisfaction of the World Health Organization. But the quote above (from Laurie Nommsen-Rivers, one of the study authors) makes me wonder if the results of the study are being taken in the wrong context.

The focus is on moms not getting enough support –  something that I 100% agree needs to be focused on. Like, yesterday. But where the experts quoted in these articles and I part ways is on what type of support is needed. This passage from NPR illustrates my point:

The researchers didn’t do physical exams of the moms and babies, so they don’t know what was happening for sure. But they speculate that some of the first-time mothers may have misread the babies’ cues, mistaking fussiness for hunger, for instance, or thinking the babies weren’t getting enough milk when they’re doing just fine…

 

Once again, the assumption is that women are wrong about their bodies, and about their babies. The study authors surmise that access to lactation consultants in the first week postpartum, after hospital discharge, will be the solution to many of these problems. Again, I absolutely agree that this is a great start. And yet – reading through the scores of FFF Friday stories, I have to wonder… is this really going to make a difference, given the current state of our breastfeeding culture? How many LCs have we all seen, cumulatively? How many were bullied or shamed by medical professionals? How many of us have been told our babies were fine, only to end up in the ER with a dehydrated infant? How many of us were told – by professional lactation consultants and pediatricians – that every woman can breastfeed, and that we should just keep on nursing and it will all work out?

Looking at this study, this is what I see: a ton of women are claiming to have pain, trouble latching, and concerns that their babies aren’t getting enough milk. NPR also reports that the group with the least amount of reported problems was comprised mostly of women under 30, and women of Hispanic origin. That begs for further research, doesn’t it? Could age and legitimate lactation failure be associated? What about race/ethnicity? Are there conditions more prevalent in older, non-Hispanic populations that are also associated with breastfeeding problems?

And this is what I also see: We have an opportunity – no, a responsibility- to look at the type of support these women are getting. Is it truly evidence-based? Or is it based on dogma; on the belief that “95% of breastfeeding problems are reversible”? (By the way, I am super curious about the research backing up that claim.) Are the individuals giving the support truly listening to the mothers, examining them, considering the delicate balance of hormones necessary for lactation, or the effect of emotional or physical trauma around birth on a woman’s ability to withstand latching pain or her infant’s cries? Is there nuance? Are these mothers being seen, or are they being treated as uniform breasts, needing to be “handled” so that they can fulfill their duty of providing exclusive breastmilk for 6 months?

I’m not knocking a study that advocates for more support for moms. I simply want us to open up the discussion, rather than going in circles, with the same researchers and the same experts telling us the same things – if mothers only knew better. If they could only be taught to recognize their babies’ cues. If they would only listen to us. 

I think it’s time they listened to us, instead. Which brings me to what I’d really like to see from this study: a follow-up where they ask the women who “failed” to meet breastfeeding recommendations what they think would have helped them reach their goals. Because without that piece, I really don’t think we can get very far.

 

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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12 thoughts on “Can breastfeeding concerns be overcome with support? Depends on what “support” means

  1. “It’s a shame that those early problems can be the difference between a baby only getting breast milk for a few days and going on to have a positive breastfeeding relationship for a year or longer… If we are able to provide mothers with adequate support, 95 percent of all breastfeeding problems are reversible.”

    Aaarrrrgggh! [banging my head against the wall]

    That incredibly frustrating statement and fake stat is a big part of why all these mothers (myself included) are having so much trouble!

  2. And the one that’s really bothering me lately: who CARES if it is “exclusive?” If the baby gets one bottle of formula total, or one bottle of formula/day, or several bottles of formula /day while mom works and gets nursed while mom is home, are those not worthy breastfeeding goals as well? No one seems to be listening to women who are content to achieve those goals either. It has to be all or nothing with these people. That attitude also skews the studies, since one bottle of formula/day will eliminate a baby from the EBF category even if it nurses for 2yrs, causes lactivists to wring theirs hands and worry about policies that might be just fine, but for that fact that women aren’t meeting the LACTIVIST’S goals. Maybe they need to find out if women are meeting their OWN goals and listen to the women’s reality.

    • Yes, I’m afraid I’d count as a failure according to lactivists even though I got great early support from a non-bullying LC and was able to get two premature twins exclusively nursing after their NICU stay. Only problem is, my breastfeeding goal was six months, and when we reached six months I chose not to do it anymore. No year of breastfeeding for us. No two years. Because I didn’t want to. Reaching six months was a success for me, but not for them.

    • I think some of this hand-wringing is due to the idea that if you give a feed by bottle and don’t pump, it will affect supply in the long run and maybe will even affect supply right away, that very day or the next day. Nobody wants to start a downward spiral. But I also tend to think that people who have horrible trouble with something that a lot of people don’t have issues with would probably have issues anyway even if they did/do everything “right”. If one mother gives one or two bottles of formula per day and doesn’t pump to replace, she might have zero problems nursing at other times. But another mother tries it and her supply tanks and she can’t nurse at all? If her supply is that vulnerable to changes, then there are fairly decent odds she would have had problems in either case.

      I feel like we have gone backwards on this. To listen to my parents talk, even “we’re breastfeeding” back then typically meant the occasional bottle of formula, since pumping was in its infancy and if mom had to be away that made formula pretty much the option.

  3. “I think it’s time they listened to us, instead. Which brings me to what I’d really like to see from this study: a follow-up where they ask the women who “failed” to meet breastfeeding recommendations what they think would have helped them reach their goals. Because without that piece, I really don’t think we can get very far.” <– THIS, a thousand times, THIS. I wanted to EBF for a year; I saw an LC in the hospital and had a post-partum doula at our house who encouraged me and tried to help me. I paid an LC to come to my house when I was on the verge of giving up. She examined us both, gave me some tips and told me to "keep trying." But I was mostly home, alone, with a baby who screamed bloody murder after about 5 minutes of nursing and nursing was painful. And I was exhausted. After a year, I wonder, what help did I need? Honestly, I think I needed other women who had breastfed, and I would have needed them around me all the time in those first few weeks to help me and coach me during all the nursing sessions (because the nursing sessions I had when I was with someone always went better than the ones when I was by myself or just me and my husband). I guess I'm one of those people who needed that community around me and I didn't have that. An hour or two every few days wasn't enough to help me work through the issues I had.

  4. I’d like to ask one more question of these women (and all women and men that don’t meet their goals in any area):
    “In hindsight, do you think your goals were reasonable and appropriate?”

    Non-breastfeeding example: I failed in my pre-college goal of finishing college in 3 years. I don’t consider it failing in my goal, but of revising my goal based on accurate information and new desires. I’m very glad I took four years.

    • Yes. This would go a long way towards helping women meet their OWN goals, rather than some arbitrary goal set by someone with a lactivist agenda. Why do they get to decide what is best for every mom and baby? What is reasonable and appropriate for one woman is not the same as what is reasonable and appropriate for another.

      Regardless of what a woman’s goals are, the LCs, nurses and doctors need to LISTEN to her, and take her seriously. If she says she wants to breastfeed for month, and then re-evaluate, or breastfeed all day, except for one feeding in the night which will be a bottle given by Dad, then that is what the medical professionals who are available should help her to do. It is not up to them to say “Oh no, you MUST do x, y, z.” At least in the Western world, there is no “must” aside from “feed the baby.”

      • This particular study does seem to have looked at whether women met their own stated goals, “The women were asked prenatally about their breastfeeding intentions and concerns, and then re-interviewed at 3, 7, 14, 30 and 60 days postpartum. ”

        But that doesn’t mean the prenatally stated goals were reasonable and/or were not heavily influenced by hard-core lactivists.

        I completely agree with you, however.

  5. I think Latina women may be more successful at it because it’s a non-issue in Hispanic culture. No one blinks an eye if you sit down to nurse at a family function or a restaurant or whatever. You also have female family members who can offer advice on how to keep your supply up and use a cover effectively. Part of the problem in non-latino culture may be the shaming of women who breastfeed in public and most non-hispanic American women were bottlefed so they don’t have that support from moms and grandmas.

    • I definitely thing that plays a role. I’m not Latina (well, technically I’m 1/8 Latina, but I feel like that’s not enough to count from a cultural perspective), but my mom breastfed. My MIL breastfed. Every single one of my friends who has had children so far has breastfed either exclusively or predominantly. The only people I know who formula fed were a couple of relatives who gave an honest go at breastfeeding, but truly had supply issues that made it impossible. So while I didn’t necessarily feel any external pressure to breastfeed, it was just sort of the normal thing to do in my social circle.

      I didn’t feel like I’d be judged if it didn’t work out, but I also had a ton of people I could reach out to if I had questions or concerns. I think that’s the balance that we need in order for more women to meet their goals: A society that treats breastfeeding as the most normal thing in the world (instead of acting like moms who BF in public are attention-starved exhibitionists), but that doesn’t make people feel bad when they can’t or don’t want to do it.

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