Common Obstacles to Successful Breastfeeding
Breastfeeding is natural – right? Right! Then why does is sometimes seem so difficult and why do so many moms stop breastfeeding almost before they have gotten started? Humans are mammals and by definition, mammals nourish their young with milk secreted by mammary glands. Humans are the only mammals who routinely give their young the milk from another mammal! Breastfeeding is the norm against which all other feeding methods should be measured. How then have we gotten so far removed from this most natural process? Consider that breastfeeding is much more complex than just the feeding of food. It is total nourishment. Physical sustenance yes, but also much more...love, comfort, security, reassurance, healing, stability, developmental support, and much more. Breast milk is specific for human babies and varies in nutrients with the baby's age, providing exactly what your baby needs at any given age. Consider just some of the benefits:
For Baby: Protection against respiratory, ear and gastrointestinal infections; decreased risk of obesity and of type I and II diabetes; decreased risk of SIDS as well as lymphoma and leukemia; less asthma, increased IQ and vision, and improved jaw and dental development just to name a few!
For Mom: Less bleeding after delivery with a quicker return of the uterus to it's non-pregnant size; decreased risk for uterine, ovarian and breast cancer; less chance for osteoporosis, decreased in obesity and type II diabetes, reduced risk for postpartum depression. Add to all of these the fact that it is the original “green” food, which is good for the environment, and it is free!
According to the CDC 's Breastfeeding Report Card (based on 2006 data and last updated Oct. 2009), in the United States about 74% of mothers ever do any amount of breastfeeding; however, by 3 months postpartum, only about 33% are exclusively breastfeeding and by 6 months that figure decreases to just over 13%. In Ohio, the rates are a dismal 58.5%, 22.4% and 9.1% respectively. The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life and then continued breastfeeding with the addition of complementary foods through at least the first year or longer.
So what are the obstacles or barriers that lead to lack of initiation and/or early interruption of the breastfeeding experience and what can you do to minimize them? Things that probably come to mind are the medical and technical issues such as poor latch, sore or cracked nipples, frequent feedings, and perceived low milk supply. While these problems may indeed impact some women and be difficult to overcome, in many instances they can be resolved or at least lessened with the right information and ongoing support. Of greater impact are the more obscure yet hugely significant social or societal barriers currently in place in our country. What are these societal barriers?
Lack of Support
Lack of support from the father of the baby, from other family members, from health care professionals, and from the workplace all play a major part in influencing the success of the breastfeeding experience. In countries where breastfeeding is traditional, young girls have grown up seeing breastfeeding babies and the art is passed down through the extended family. Today in the United States, many women have never seen anyone breastfeed nor have their mothers had any breastfeeding experience. This lack of role models may make a woman less likely to choose to breastfeed. While a mother or grandmother can provide encouragement and support, their unfamiliarity with breastfeeding may cause them, either intentionally or unintentionally, to sabotage its success by making disparaging remarks, doubting the adequacy or quality of the mother's milk or giving the baby unnecessary formula supplementation. To get off to the best start, a mom-to-be needs to attend a breastfeeding education class during her pregnancy and gather her support team of those she knows will give her positive and correct guidance through the breastfeeding experience. Western culture places great value on the sexual aspect of breasts rather than on their primary function of nourishing an infant. This may result in the belief that breasts are to be used for the pleasure of the woman's partner rather than for infant feeding leading to a lack of understanding and support from the father of the baby or male relatives. Taking dad to the breastfeeding class will help him to understand the benefits.... he will especially like the fact that breast milk is free! While many of today's health care professionals are avid breastfeeding supporters, they may be misinformed or not up to date about the current research and recommendations associated with successful breastfeeding outcomes. This in turn leads to the perpetuation of outdated or incorrect instructions to their breastfeeding mothers. Some are reluctant to strongly promote the benefits of breastfeeding or the risks of formula feeding because of concern about making those who choose to bottle feed feel guilty. Yet they don't express similar concerns regarding other health-related issues such as smoking or drinking or using a car seat! Most parents won't feel guilty about making an informed choice, but they often feel resentful about not being fully informed. To combat this obstacle, parents need to seek out health care providers who are both informed and in support of breastfeeding. Today, many women not only choose early discharge from the hospital (within 1-2 days), but they also need to return to work early due to financial constraints. In some countries women have an extended and paid maternity leave. In the United States, many women do not have access to a decent length maternity leave and some have no access to leave at all. Couple this early return to work with the fact that only 15 states have legislation mandating employer lactation support (CDC based on 2006 data and last updated Oct. 2009). The lack of workplace support in providing time, place, equipment, and encouragement to maintain their breast milk supply is frequently the demise of the breastfeeding experienced, working mothers. To counter last minute anxiety, moms-to-be need to be proactive with their employers about their plans to breastfeed. This gives the employer time to consider all the benefits for the workplace (less time off due to infant sickness, less money spent in health care costs, more productive worker) when a breastfeeding mom returns to work and to plan accordingly!
Hospital Practices, Early Discharge and Delayed Follow-up
The hospital experience and follow up during the early days after discharge play a major part in the success or failure of breastfeeding. Some hospital practices and policies, such as early separation of mother and baby for admission procedures, can undermine breastfeeding initiation. Early follow up after discharge (within 2-3 days) is recommended by the American Academy of Pediatrics so that early breastfeeding problems can be identified and remedied. However, for many mothers, physician visits are delayed after discharge and there are no home health visits being conducted. A family-centered atmosphere that incorporates the Baby Friendly Hospital Initiatives gives mothers a solid start in getting breastfeeding established. Many hospitals have inpatient and outpatient lactation services available as well as breastfeeding mother-to-mother support groups.
Lack of Acceptance by the Community and by Society in General
In Western society breastfeeding is devalued and breasts are viewed as sexual objects. In fact, sexuality and motherhood may be perceived as mutually exclusive! A new mom may feel embarrassed or uncomfortable with exposing her breast or be worried about how she will be perceived by others. She may be concerned about negative comments and staring. Some may feel that breastfeeding indicates the inability to afford formula. Furthermore, today's fast paced lifestyle and highly mobile society encourage newborns to fit conveniently into a structured routine or be on a specific schedule. Breastfeeding is best encouraged by keeping mothers and babies in close proximity to one another with the infant being allowed unrestricted access to nurse. Breastfeeding mothers can find encouragement and support from friends/family who have breastfed and from groups such as LaLeche League and Breastfeeding Support Groups. Talking with and seeing other nursing mothers provides both positive reinforcement and validation of their efforts.
Widespread Promotion of Formula
Bottle feeding and formula promotion are widely portrayed in the media and in advertising by formula companies. Expectant parents are bombarded by coupons, free samples, and promotions touting that while breast may be best, this or that formula is “closest” to breast milk “just in case”. This establishes that initial seed of doubt in moms minds and leads to the undermining of successful breastfeeding. Instead, we need to ban the formula bags and promote positive images of nursing women in the media. Overall, how do we provide an environment that best supports and protects breastfeeding mother-baby dyads? The following would be a good start:
- Educate the public and health care providers about not only the health benefits and practical management of breastfeeding but also of the impact on the global environment and cost savings to the public
- Initiate early education for young girls to promote positive self-image and normalcy of breastfeeding
- Improve societal marketing to spread positive images of breastfeeding mothers and provide positive breastfeeding role models
- Hold formula companies accountable to comply with the WHO International Code of Marketing Breast-Milk Substitutes to ensure that they are not acting unethically and unnecessarily sabotaging breastfeeding in pursuit of corporate profits
- Encourage and promote easy access to 1:1 lactation support/mentors as well as local support groups for breastfeeding mothers
- Increase workplace and child care facility support for continued breastfeeding
The decision to breastfeed is a complex one influenced by many things. Overcoming the barriers to successful breastfeeding will require more than just one or two interventions. There are many ways that individuals and society can demonstrate support. And research indicates that moms who are supported in their decision and who have ongoing breastfeeding support nurse for a longer period of time and have a more successful experience.